Magellan Insurance Addiction Treatment Coverage

Magellan Health is one of the fastest-growing insurance providers in the United States. It’s also one of the few health insurance companies to focus on offering digitally distributed and managed insurance, making it an extremely accessible healthcare option. However, if you’re looking into getting mental health or addiction treatment with Magellan Health, it’s important to look into what they cover, how, and why. Magellan Health covers various mental health services so clients can best manage their mental health disorders.

For example, Magellan’s treatment and insurance coverage options will vary depending on what addiction or mental health treatment center you choose. In addition, with a network of 77,000+ network providers plus over 300 rehab facilities that accept Magellan insurance plans, you’ll have plenty of options. Still, it’s important to ensure you fully understand your treatment options and your insurance benefits with Magellan. 

Magellan Insurance Addiction Treatment Coverage

Magellan Health covers both outpatient and inpatient rehab. In fact, every insurance provider is required by the Affordable Care Act to offer coverage for addiction treatment, which includes medical detox and evidence-based therapy sessions. However, the amount covered per treatment method can vary significantly between in-network providers and out-of-network providers. In addition, that coverage can even change based on your plan with Magellan, which means it will be important to do your research.

Magellan covers addiction treatment and co-occurring disorders, including comorbid mental health conditions. This means that if you have a diagnosis for anxiety or depression combined with substance use disorder, Magellan will cover an array of substance abuse and behavioral health treatment programs to support your path to recovery.

Magellan Health Insurance is also a premium insurance company that covers medication-assisted treatment. It is also Magellan’s preferred treatment option, which means you can let your healthcare provider know that they indeed cover medication-assisted treatment.

Magellan Insurance Rehab Coverage

Substance abuse and mental health treatment coverage are important to reduce the risk of relapse. Magellan specifically lists that their insurance company covers a range of substance abuse treatment services. However, what’s available will sometimes depend on what your rehab center offers. For example, if you choose from the available rehab facilities accepting Magellan, you might find that some are outpatient only, or some don’t provide therapeutic services, etc. Therefore, you’ll also have to choose a provider that offers the treatment you want if you are looking for full Magellan insurance rehab coverage.

However, Magellan covers various levels of care, including inpatient and outpatient rehab. This means you can get coverage whether you’re staying in a clinic or simply making visits to the clinic. That makes Magellan one of the better insurance policies to have if you need residential treatment, as many insurance programs will not cover inpatient care.

Magellan lists coverage for the following types of treatment:

Magellan has a lot of different plans covering different types of addiction. The exact coverage you get will vary depending on the plan itself. This means you may want to consult with your exact plan before moving forward or determining if you’re going with an inpatient or an outpatient treatment program.

What About Out-of-Network Providers?

Magellan rehabilitation coverage allows you to use any provider that you want for treatment. However, you should expect that the payment will be higher. For example, while it is possible to get up to 100% coverage for an in-network approved provider, you can expect to have 50% coverage at most for an out-of-network provider. That’s because you typically pay a 40% coinsurance on out-of-network providers plus a deductible. However, for some plans, Magellan doesn’t offer any out-of-network coverage at all. Therefore, you’ll always want to double-check your plan.

What Do You Pay When You Use the Magellan Insurance Plan?

Magellan Health operates similarly to most other healthcare providers in the United States. You’ll have to meet copays and deductibles before Magellan will contribute. In general, the copay and deductible will depend on your plan itself.

For example, for the Premium Plan, you pay 20% coinsurance if you use an in-network provider and 40% coinsurance if you use an out-of-network provider. That’s the same for either inpatient or outpatient services, which is something that many providers don’t offer. You also need pre-certification and pre-authorization to get coverage. In addition, you’ll typically pay 15% or a $15 copay for generic medication and a $35 copay for preferred brand medication.

Magellan also has a $1,500 deductible for a single contract, a $3,000 deductible for a family contract, and that doubles for out-of-network providers. In addition, if you’re getting in-network treatment, you have a maximum out-of-pocket expense of $4,000 per person or $8,000 per family, or up to $16,000 for an out-of-network provider plus the coinsurance.

So, fees could look like:

• Deductible: $1,500-$16,000
• Coinsurance: 20%-40%
• Copay: $15-$35 each time you need medication

So, if you’re paying $24,000 for an inpatient treatment program with an in-network provider, you’ll likely pay $4,800 in coinsurance, $1,500 in deductible, and Magellan insurance will pay the remaining $17,700.

On the other hand, if you were to go for the same treatment with an out-of-network provider and have a family plan, that could be much different.

How Do You Use Magellan Insurance for Drug & Alcohol Rehab?

Most Magellan insurance plans require that you get pre-authorization for treatment. Some plans allow you to request pre-authorization within 48 hours of starting treatment. The penalty for not obtaining pre-authorization is typically either 20% of the total charge or refusal to pay for services.

Pre-authorization or pre-approval means that your insurance company wants to ensure that the treatment is medically necessary before paying for the service. They will also often contact the company in question to ensure that it is a legitimate treatment provider before giving the go-ahead for treatment. If everything is approved, you get coverage as you would for any hospital visit.

Checking Your Magellan Rehabilitation Covera

It’s important to contact Magellan Life Resources to ask about your insurance policy and understand your Magellan insurance addiction treatment coverage. For example, it’s best to inquire with your treatment facility about addiction and behavioral healthcare coverage, as well as aftercare options for ongoing support. Doing so will ensure your treatment plan is covered and support long-term recovery. Feel free to contact Magellan Insurance using the information provided on the back of your insurance card, or simply call the helpline at 866-266-2376 to understand which health plans Magellan covers. You or your loved one can typically check your health insurance coverage and what you’ll pay out of pocket with your rehab center.

In addition, it’s always better to work with an in-network provider for Magellan. Magellan Health works with 77,000 health services and providers, including over 300 licensed rehab facilities. Working with one of them will, at minimum, reduce out-of-pocket costs, because you’ll pay a 20% coinsurance instead of a 40% coinsurance for an out-of-network health care provider.

Are you ready to get started on your journey to long-term recovery? Call (888) 450-2701 to learn more about our admissions process or call now to speak with a treatment expert.