Beacon Insurance Coverage for Drug & Alcohol Treatment

Does Beacon Cover Addiction & Drug Misuse Treatments?

Beacon Health Options has a heavy focus on offering significant mental health and substance use disorder treatment coverage. You can expect coverage for most evidence-based drug treatment options as well as behavioral treatments that may contribute to your struggles with drugs, such as counseling for depression and anxiety. 

Covered services include the following:

• Medication-assisted treatment, when appropriate
• Individual, group, and family counseling 
• Outpatient and inpatient treatment programs
• Detox treatments

Verifying Coverage for Addiction Treatment

To verify your coverage, first contact the provider you intend to receive treatment from. Make sure they can accept your insurance and find out the typical cost associated with their services. Then, read through your plan’s explanation of benefits to see exactly how it covers your medical costs for addiction care. 

If you want to confirm your coverage, which is reasonable for some of the more expensive addiction treatment options, you can also contact Beacon directly and ask questions about your coverage.

The Typical Cost of Treatment

The typical cost of drug or alcohol addiction treatments is going to vary significantly by where you live and the type of treatment you’ll be receiving. Without insurance, the yearly cost of addiction treatment can range for a few thousand dollars to over $10,000 if you receive inpatient treatment. Luckily, insurance plans can cover a significant percentage of these costs to make them much more affordable.

One option that can help you calculate your estimated treatment cost is the Fair Health Calculator, which can be a useful tool for seeing what a provider might cost you. By answering a few simple questions with as much accuracy as you can, this tool can generate what is often a fairly close estimate of the medical costs you can expect.

Understanding Your Insurance Plan

Insurance plans can have the following attributes that are important to understand, although not every plan will have all of the attributes discussed below:

Premiums

A plan’s premium is the amount of money it costs to keep your plan active. This is often calculated and paid on a monthly basis, although some plans may have different pay periods. This is the most obvious direct cost of an insurance plan, although it is not the only important factor when judging how much a plan will cost you each year.

Deductible

Your deductible is the amount of money you need to spend on medical expenses before your plan’s full coverage begins. Higher deductible plans usually have lower monthly premiums. 

Coinsurance

Your coinsurance rate is the amount of money you will have to pay out-of-pocket for covered medical expenses once you meet your deductible. These rates usually range from 40 percent to 10 percent. 

If you had a coinsurance rate of 20 percent and had a medical bill of $1,000, this would mean you were responsible for $200 of that bill, and your insurance was responsible for the remainder, assuming the cost was covered by your plan.

Copays

Copays are fixed costs for certain kinds of medical expenses, such as getting checkups from your doctor or seeing certain specialists. Copay costs are usually separate from coinsurance. 

For example, if you met your deductible and had a coinsurance rate of 20 percent, a $75 doctor’s office visit may not necessarily be 80 percent covered. Instead, you may have to pay a copay (which, in that instance, would likely be between $15 and $25).  

Maximum Out-of-Pocket Expense

Your maximum out-of-pocket expense is the maximum amount of money you will have to pay on covered medical costs. As long as your plan remains active, further medical expenses will usually be completely covered by your plan for the remainder of the year.

In-Network vs. Out-of-Network Coverage

In-network vs. out-of-network medical costs can vary significantly. Beacon points out on their website that their HMO and EPO plans don’t typically cover out-of-network costs unless those medical costs were for emergency treatments.

This changes if you have a PPO or POS plan, although how much coverage you can receive still depends on the specifics of your plan. Your plan will have an associated allowance, meaning the maximum they will pay for a service, and you will have to cover any cost over that allowance for out-of-network treatment. 

Length of Treatment Covered

As long as your Beacon plan remains active, your addiction treatment should be covered. This may change if your doctor recommends a change in your treatment course, but you disregard that advice and go with a different treatment option, but this is not typical for most patients.

Covering Out-of-Pocket Costs

The internet is full of valuable advice about ways to cover out-of-pocket medical costs. The truth is that even with insurance, some medical expenses can be overwhelming if you’re unprepared. Some of the best ways to get help include asking for personal loans from friends and families, and making sure that, whenever possible, you get your medical treatments in-network, which usually offers the highest level of coverage.

It’s also recommended that you avoid going to the ER for anything besides medical emergencies, as ER costs are often significantly higher than if you got the same services elsewhere. Admittedly, sometimes drug abuse health issues are emergencies, such as in the case of overdose, and it’s important to visit the ER for these scenarios. 

But other cases aren’t best suited to the ER anyway. These issues can be better dealt with (and for likely much lower cost) at an addiction treatment facility.