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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 drug or alcohol addiction treatment with Magellan Health, it’s important to look into what they cover, how, and why.
For example, Magellan’s treatment and coverage options will vary depending on where you go. In addition, with a network of 77,000+ network providers plus over 300 rehab centers that accept Magellan, you’ll have plenty of options. Still, it’s important to ensure you fully understand your options and what you can get coverage for with Magellan.
The simple answer is, yes, Magellan Health covers addiction treatment. In fact, every insurance provider is required by the Affordable Care Act to offer coverage for addiction treatment, this includes detox and therapy. However, the amount covered and the amount covered per treatment method can vary significantly from provider to provider. 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 treatment for drug and alcohol use disorders including co-occurring disorders. This means that if you have a diagnosis for anxiety or depression with a co-occurring substance use disorder, Magellan will cover both.
Magellan is also a premium provider supporting medication assisted treatment. It is also Magellan’s preferred treatment option, which means that many of Magellan’s approved providers will use medication assisted treatment.
Magellan specifically lists that it covers a range of treatment options. However, what’s available will sometimes depend on what your rehab center offers. For example, if you choose from the available rehab centers 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.
Magellan covers inpatient as well as 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.
Still, Magellan has a lot of different plans. 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 program.
Magellan allows you to use any provider that you want for treatment. However, you should expect that 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 maximum 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 for your 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, 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 your 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 play, that could be much different.
Most Magellan plans require that you get pre-authorization for treatment. Some plans allow you to request preauthorization within 48 hours of starting treatment. The penalty for not obtaining preauthorization is typically either 20% of the total charge or refusal to pay for services.
Preauthorization or preapproval 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.
It’s important to contact Magellan Life Resources to ask about your insurance policy and what it covers before you start getting care. You can contact them at 866-266-2376 to learn more. In addition, you can typically check 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 centers. 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 provider.