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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.

female client during admission

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:

Inpatient and Outpatient Treatment

Oscar Health offers the same coverage for inpatient and outpatient treatment services with most of its plans.

Prescription Coverage

Your prescription for medication or medication assisted treatment is covered with Oscar.

Complimentary Treatment

Oscar Health offers assistance with paying for physiotherapy, classes, gym memberships, and other complimentary mood-boosting activities.

Counseling and Psychotherapy

You can seek out psychotherapy, counseling, and group therapy independent of your primary treatment program and have it covered. This makes it easier to sign up for aftercare and ongoing treatment.

Case Management

Oscar Health will pay for your case manager to ensure you get the treatment and the programs you need.

Crisis Support

If you’re in crisis, Oscar Health will offer staff and insurance support for getting care to help you into a treatment program.

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.
male client with mental health expert during treatment program

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.

a female client with an admission counselor during insurance verification

How to Start Addiction Treatment with Oscar Health?

In most cases, you can simply check with your addiction treatment provider to ensure they are in network for Oscar and then attend the program. However, in some cases, you may need preauthorization for the program. That’s especially true if you are not going on an emergency basis.

Some plans also require that you get preauthorization for programs over X number of days. However, if you’re going to an outpatient program, you rarely need preauthorization. In either case, your doctor can help you by submitting an electronic preauthorization request, after which you should be able to attend the program.

Oscar is a relatively small health insurance provider. However, it offers significant coverage for its in-service area. If you’re in an Oscar area, Oscar offers more coverage than most of its competitors, especially if you have a platinum plan, which means you’ll pay very little out of pocket. However, you will want to verify that your provider is in-network before going ahead with treatment as Oscar offers very little to no coverage for out of network rehab centers.

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Medical Disclaimer: Nothing on this Website is intended to be taken in place of medical advice. Before making any decisions regarding your health, please consult your doctor. The staff at Stairway Resource Center develops a custom treatment plan for each of our patients. Specific medical advice will be provided to our patients by our professional providers while in our care.