Molina Healthcare Insurance Coverage
Molina Healthcare Insurance Coverage
Molina Healthcare is one of the largest healthcare insurance providers in the United States. It’s also one of the only to focus primarily on low-income patients and providing accessibility to healthcare regardless of income. As a result, Molina has some 5.2 million members, many of which are based in and around California. Molina also has a network of clinics where members can receive care. The insurance provider also has some 20,000 doctors, pharmacies, and clinics in its network.
Molina is also one of the few providers to actively work with patients to ensure ongoing treatment and care. For example, if you seek out drug or alcohol treatment programs with Molina, you’ll automatically be assigned a case worker to ensure you move through the program, get aftercare, and get adequate follow-up treatment to ensure recovery. That makes the healthcare provider stand out – no matter what your plan. However, you also want to understand your costs, what your benefits are, and what you can expect from the premium based on your plan.
Does Molina Healthcare Cover Substance Use Disorder Treatment?
Molina Healthcare offers substance use disorder treatment under every plan. That’s required under the Affordable Care Act. In addition, Molina takes extra steps to ensure its patients receive appropriate medical and behavioral health care by assigning a case worker to help you manage treatment and progress.
However, Molina only offers in-network treatment. This means it may be difficult to go to an out of state treatment center. You’ll also have to do your research to see if your preferred rehab clinic is covered, as it might not be, in which case, you simply won’t get coverage.
What Types of Treatment Does Molina Healthcare Cover?
Molina offers significant coverage for substance use disorder treatment and behavioral health treatment.
In most cases, it will cover anything that its in-network provider is offering.
Dual Diagnosis
Molina offers significant support for dual diagnosis treatment including therapy, medication, and inpatient stays.
Outpatient
Molina offers coverage of outpatient programs, sometimes with copays as low as $20 per day. However, offerings vary per plan.
Evaluation
You can have a full evaluation including health and behavioral health evaluation, covered by your Molina plan.
Government Sponsored Programs
Molina offers a significant amount of treatment options for individuals qualifying for government-sponsored programs.
Residential Treatment
Molina covers residential treatment. However, some plans can be quite pricey, with copays of up to $1,500 per day. That’s still cheaper than many competitors, however.
Aftercare
Molina offers full coverage for aftercare including ongoing therapy, some support for sober home and other stays, and ongoing counseling and treatment.
Detox
Molina offers coverage for hospital stays for detox as well as for detox medication.
If you’re not sure if your treatment option is covered by Molina, you can typically reach out to the company to discuss your needs. Call them to learn more.
What Substance Use Treatment Costs Do You Have with Molina?
Molina charges different rates depending on your plan. Like all providers, it uses a tiered system of Bronze to Platinum plans. Here, you’ll see rates of:
Bronze
You’ll pay a $6,000 deductible with a maximum out of pocket payment of $8,550. In addition, you’ll pay a $1,500 coinsurance per day for inpatient treatment. You can go to out of network providers, but coverage drops.
Silver
Expect out of pocket maximums to be around $9,100 with a deductible of around $2,500. Coinsurance is the same as for bronze. Expect roughly a $1,350 coinsurance payment per day for stays at an inpatient facility.
Gold
Out of pocket maximums are mostly set at $9,100 with a deductible of $1,900. Expect a 20% coinsurance cost after deductible.
All Molina plans are HMO (Health Maintenance Organization) plans. This means you must use in-network providers. In addition, you’ll typically need a referral to go to a treatment center.
Does Molina Healthcare Accept Out of Network Providers?
Molina Healthcare mostly does not allow out of network providers. This means that if you choose a provider that is not in the Molina network, you may have to pay everything out of pocket. However, this will vary depending on your plan.
However, Molina has a large network, especially in the state of California. You’ll have several hundred options to look through for treatment. This means you’ll relatively easily be able to find something that meets your location, treatment, or other preference needs.
Getting Treatment Started with Molina Healthcare
Finding a treatment center with Molina Healthcare should typically involve starting from researching rehab centers. Here, you can ask Molina for a list of in-network centers. Alternatively, you can contact your rehab centers and ask if they accept your insurance and if it is in network. Verifying coverage is important as Molina does not typically offer coverage for out of network providers.
You can also directly contact Molina and ask for a case worker to help you find the right treatment solution for your needs. This means Molina will do the research for you and will help you find a rehab center that meets your needs. However, in this case, you’re most likely to be asked to attend an outpatient facility, as Molina offers the most coverage for outpatient treatment.
From there, you’ll want to ask for a recommendation or referral from your doctor. Molina primarily does not offer coverage without a referral. However, you may have an exception if you’re pushed into emergency treatment. In addition, you should request preauthorization from your doctor, who can submit the request for you – although you can also call Molina to ask directly.
In each case, Molina will approve your treatment if it is with an in-network provider. Once you’re with an in-network provider, you get coverage for any treatment you get from the clinic. This includes behavioral health, medication, interventions, and complementary treatment. Molina will also assign a case worker to help you maximize treatment, to schedule follow-ups, and to ensure that you get into the right treatment program.
Molina is a great choice for an insurance company, especially if you live in one of the 15 states it covers. However, it is a relatively small insurance provider so coverage may not be as good as with some larger providers.