Oscar Health Insurance for Drug & Alcohol Rehab

Oscar Healthcare is a modern insurance company focusing on telehealth, technological interfacing with health, and transparent pricing systems. That’s made it increasingly popular as individuals look for clear and affordable health insurance. However, if you or a family member is struggling with drug or alcohol use, you likely want to know if the insurance provider covers drug and alcohol rehab and if so, how much coverage it provides.

The short answer is, yes, Oscar Health covers drug and alcohol rehab. However, there’s a lot you should know including about how plans affect coverage and treatment, what you can qualify for, and how going to an out of network provider may affect care.

Does Oscar Health Insurance Cover Drug and Alcohol Treatment?

Yes! All insurance providers in the United States cover substance use services. This is required by law under the Affordable Care Act (ACA) also known as Obamacare. This means that you can go to rehab and get coverage from any provider in the United States.

However, the amount of coverage you get significantly depends on which plan you have. In addition, Oscar Health rarely covers out of network providers. This means you’ll have a more limited number of rehab centers to choose from, as Oscar simply will not offer coverage for most out of network providers on most plans.

What Types of Drug and Alcohol Rehab Does Oscar Health Cover?

Oscar Health is an insurance provider focused on providing quality mental healthcare including prevention and aftercare services.

This means you can get:

Essentially, Oscar offers a lot of coverage when you’re in its network coverage area.

What Do You Pay with Oscar Health Insurance?

Oscar Health uses a very simple and transparent pricing scheme for its plans. These include:

• Bronze – You pay 40% of costs. You’ll have an out-of-pocket limit of $7,500, with a deductible of $3,000. You’ll also have a $50 copay for outpatient services and 50% coinsurance for inpatient services. Out of network providers are not covered. In addition, you’ll need preauthorization for more than 180 days of inpatient care.
• Silver– You pay 30% of costs. You’ll have an out-of-pocket limit of $7,500 and a $2,500 deductible. Everything else is the same as the Bronze plan.
• Gold – You pay 20% of costs. You’ll have an out-of-pocket limit of $4,750 and a deductible of $1,250. You’ll have a 20% coinsurance for inpatient or outpatient services. However, you will need preauthorization.
• Platinum – You pay 10% of costs. You’ll have no deductible. You’ll also have a $2,250 out of pocket maximum. In addition, you’ll pay a $250 copayment per day for the first 5 days for inpatient or outpatient treatment. However, you will need preauthorization for non-emergency treatment.

In addition, Oscar Health uses negotiated rates. On average, it negotiates rates 10-60% lower for its in-network providers. This means that even if you’re barely getting coverage for the treatment, you’ll still pay less than you would with an out of network provider.

Oscar is also unique in that it offers roughly the same coverage for inpatient and outpatient treatment services. However, you may have to get preauthorization for inpatient services, and you don’t with outpatient services. On the other hand, with up to 90% of inpatient services covered depending on your plan and deductibles, Oscar is one of the best health insurance premiums to have in case you want to go to a residential rehab facility.

What About with Out of Network Providers?

Oscar Health is a relatively small insurance provider. With just 1 million members, it’s one of the smallest providers in the country. It also has a limited coverage area of Texas, New York, Florida, and Georgia. This means that your chances of going to an out of network provider are especially high with Oscar.

In addition, if you have an EPO or HMO plan, you have to live within a coverage area to receive coverage. If you move out of that area, you’ll have 60 days to enroll in a new plan, but you’ll need to do so before getting coverage.

Most Oscar Health plans do not allow you to get treatment with an out of network provider. This means that it’s crucial to verify that your clinic is in network before starting treatment. You’ll also want to check your plan and its specifications as some plans do allow for out of network treatment.