Magellan Insurance Coverage for Drug & Alcohol Treatment

Does Magellan Insurance Cover Addiction & Drug Abuse Treatments?

Magellan covers evidence-based substance use disorder treatments, including the following:

• Medication-assisted treatment
• Personalized substance abuse coaching
• Individual, group, and family counseling
• Detox treatments

Verifying Coverage

You can verify your addiction treatment coverage by first talking with a treatment provider and asking about their services, qualifications, and the costs of those services. Ideally, you will want a provider within your insurance network, although some plans will also allow you to get treated from providers outside your network. Generally, out-of-network providers are covered at a lower percentage, costing you more out of pocket.

A treatment provider will be able to tell you if they accept your insurance. You can reference the explanation of benefits associated with your plan to check the specifics of your coverage, or you can often ask the provider what your out-of-pocket costs will be for their services.

For further confirmation, contact Magellan directly and ask questions about your plan and your coverage to verify everything is covered. Clarify all out-of-pocket costs, so there aren’t surprises down the road.

Typical Cost of Treatment

Estimating addiction treatment costs is difficult since so many variables come into play. The severity of your substance use disorder, the presence of any co-occurring medical or mental health conditions, and the level of care you seek will all influence the price.

One tool that can help you estimate the potential cost of a treatment option you’ve considering is the Fair Health Calculator, which lets you input information about your coverage, location, and more. It will then generate a reasonable cost estimate based on the provided information.

However, the reality is that the best way to understand your treatment is to talk to a few treatment providers in your area about the cost of treatment. This will help you understand your options, and you can then combine this information with what you know about your insurance coverage to see exactly what you’re likely to pay.

Understanding Your Insurance Plan

Insurance plans generally have the following attributes, although some plans may not have all of them:

Premiums

This is the amount of money a plan costs you to remain active, and it’s usually given as a monthly cost. It is the most direct, consistent expense associated with having an insurance plan.

Deductibles

Deductibles are the amount of money you have to spend on medical costs before your plan becomes fully active. For example, a deductible of $3,000 (which is relatively high) would mean you had to spend a total of $3,000 on relevant medical expenses using your plan before you could begin to benefit from everything it offers. 

A higher deductible usually means a lower premium.

Coinsurance

Coinsurance is the percentage of covered medical expenses you will pay once your deductible has been met, generally ranging from 40 percent of costs for Bronze tier plans to 10 percent of costs for Platinum tier plans.

Because certain addiction treatment options can be relatively expensive for the average person, a good coinsurance rate can be a major cost saver for people seeking addiction treatment.

Copays

Copays are fixed costs associated with generally “smaller” medical expenses, such as visiting your general practitioner or specialists. For example, your plan may have a fixed cost of $25 when you see your doctor, although many plans offer a certain number of free or low-cost visits each year.

Maximum Out-of-Pocket Expense

This is the maximum amount of money you will have to spend on covered medical expenses for the year. Once you reach this number, your insurance will cover more or less all medical expenses that you can use your plan for, with no additional payments required from you regardless of your coinsurance rate.

In-Network vs. Out-of-Network Providers

When seeking addiction treatment with a Magellan plan, it is usually best to use an in-network provider. Use their provider search tool to find providers relevant to your needs within your network. This will allow you to take full advantage of the benefits your plan provides.

Some insurance plans also allow you to use out-of-network providers, but this will still cost you more. Many plans offer no coverage for out-of-network treatments, except in the case of emergency treatments (which won’t generally be relevant to addiction treatment). While certain plans offer some degree of coverage for out-of-network providers, it is usually much more expensive than going with an in-network provider.

Length of Treatment Covered

Most insurance companies, including Magellan, will cover the entire length of your treatment as long as your insurance plan remains active. 

While complications do sometimes occur, once a treatment option has been approved by your insurance, they don’t generally stop covering the costs (as long as you continue to pay for coverage), provided you continue to undergo the treatment as recommended by the medical experts treating you.

Covering Out-of-Pocket Costs

Here are some tips for covering or reducing your out-of-pocket medical costs:

• Always stay in-network for treatment.
• Shop around. Look for the treatment providers near you that can offer the best pricing while still meeting your needs.
• Read all your medical bills and call about any expenses you don’t understand, as they may be errors.
• Ask for financial help from friends and family. Loved ones may be able to offer personal loans at rates better than those offered by other financing sources.
• Talk to third-party loan companies and your chosen treatment provider about loans they can offer, as you may qualify for fairly competitive loan rates.