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Anthem Insurance Coverage for Drug & Alcohol Rehab

On this page, you will learn about Anthem health insurance coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
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Provider Overview

Anthem provides health insurance coverage to individuals and families in various states across the U.S.1 Anthem is part of Blue Cross Blue Shield, a federation of independent health insurance companies that provide health insurance plans.1 As such, Anthem plans may be able to help one cover some or all of the costs of treatment for substance use disorders (SUDs), also known as addiction.

Anthem Health Insurance Plans

Types of Anthem Insurance Plans

There are many different markets in which Anthem provides health insurance plans, including the Health Insurance Marketplace, Medicare, Medicaid, small business market, and mid-to large employer group markets.2 Anthem also offers dental, vision, and life insurance plans, as well as supplemental health insurance plans. 2

Within these various markets, there may be several plan designs and types. Anthem offers a variety of health plans that cater to the needs of different individuals and families. Here are some of the types of health plans that Anthem offers:3

  1. Health Maintenance Organization (HMO) — HMO plans require you to choose a primary care physician (PCP) who will manage your healthcare and refer you to specialists when necessary. These plans usually have lower out-of-pocket costs and may require you to get pre-authorization for some services.
  2. Preferred Provider Organization (PPO) — PPO plans give you more flexibility in choosing healthcare providers. You can usually see any provider in the PPO network without a referral, and you may be able to see out-of-network providers for a higher cost.
  3. High Deductible Health Plans (HDHPs) — HDHPs usually have lower monthly premiums but higher deductibles. These plans are often paired with a health savings account (HSA), which allows you to save pre-tax dollars to pay for healthcare expenses.

Medicare and Medicaid

Anthem offers several health insurance plans in conjunction with Medicare and Medicaid. Here is an overview of their relationship with these 2 programs:

  • Medicare:4 Anthem has a variety of Medicare Advantage plans available, which are also known as Medicare Part C. These plans are offered through private insurance companies like Anthem and provide all the same benefits as Original Medicare (Parts A and B) with additional benefits such as prescription drug coverage, dental, vision, and hearing benefits. In addition to Medicare Advantage, Anthem also offers Medicare Supplement plans, which are also known as Medigap. These plans help cover out-of-pocket costs that Original Medicare doesn’t cover, such as deductibles, copays, and coinsurance. Anthem offers several Medigap plans, including Plan A, Plan F, and Plan G, each with different levels of coverage.
  • Medicaid:5 Anthem provides managed care services for Medicaid beneficiaries in several states, including California, Indiana, Kentucky, Nevada, Ohio, Virginia, and Wisconsin.5 Anthem’s Medicaid plans offer comprehensive coverage for medical services, prescription drugs, and behavioral health services, including substance abuse treatment and counseling.5 Their Medicaid plans also provide extra benefits such as transportation services, vision, dental, and hearing services.5

Overall, Anthem’s relationship with Medicare and Medicaid allows them to provide a range of health plans and services to meet the unique needs of Medicare and Medicaid beneficiaries.

Using Anthem To Cover the Cost of Rehab

If someone is seeking treatment for a substance use disorder and has Anthem health insurance coverage, it is important to understand how it can be used to cover some or all of the cost of treatment. As an example, here is how this might work at Laguna Treatment Center in California:

  1. Verify insurance coverage. The first step in using Anthem insurance to cover the cost of treatment at Laguna Treatment Center is to verify that the facility accepts it. This can be done by contacting the hospital directly or by calling the Anthem customer service line to confirm that Laguna Treatment Center is an in-network provider.
  2. Check coverage details. Once it is confirmed that Laguna Treatment Center is an in-network provider, it is important to check the details of the insurance coverage. This includes understanding the deductible, copays, and coinsurance amounts that the person must pay. The coverage may vary depending on the specific plan and location.
  3. Determine out-of-pocket costs. Even with insurance coverage, the person may still be responsible for some out-of-pocket costs, such as copays, deductibles, or coinsurance. It is important to understand these costs up front so that there are no surprises later.

Overall, using Anthem insurance to cover the cost of treatment at Laguna Treatment Center or any other treatment facility can help make treatment more affordable and accessible for people struggling with substance use disorders.

Anthem Insurance Benefits

What Types of Rehab Does Anthem Insurance Cover?

The addiction treatment coverage you receive under Anthem Blue Cross Blue Shield depends on the specific plan you have. It is crucial to confirm your insurance coverage before seeking treatment, as each health plan is unique.

Here are 4 types of rehab or treatment services that may be covered under your Anthem insurance benefits:

  • Medical detox. Typically, the initial step in treating addiction involves detoxification or detox. Detox entails the removal of substances from the body and is frequently performed under medical supervision to assist in managing the symptoms of withdrawal.6
  • Inpatient care. Inpatient care refers to treatment provided in a facility where the patient resides for the duration of their care. Inpatient rehab programs entail patients receiving 24-hour medical supervision throughout their stay.7
  • Outpatient care. Outpatient care refers to treatment where the patient visits a facility once or twice a week to receive services without staying overnight. Common services provided in outpatient care include group meetings and therapy sessions.7
  • Aftercare or sober living. Aftercare is the term used for care provided after completion of rehab. An instance of aftercare is sober living, where patients reside in a home free from substances with other individuals in recovery.8

Substance use disorder treatment can vary in length, with common options including 30, 60, or 90 days of treatment. It is important to note that insurance coverage for treatment may depend on the length of the treatment, as well as the intensity and location of the treatment.

Does Anthem Blue Cross Cover Mental Health Treatment?

In addition to covering substance use disorder treatment, the Affordable Care Act (ACA) requires all health insurance plans to provide some degree of coverage for the treatment of mental health disorders.9 Here are some common mental health disorders that may have treatment covered under Anthem health insurance:10

It is important to note that the specific details of insurance coverage for mental health treatment may vary depending on the insurance plan and provider. It is important to carefully review the policy details to understand what is covered and what is not, and to work closely with the mental health provider to ensure that the treatment is covered appropriately.

Additional Resources

Other Options to Pay for Addiction Treatment

While the ACA requires health insurance plans like Anthem to provide some degree of coverage for the treatment of mental health and substance use disorders, there may still be out-of-pocket costs associated with treatment that are not covered by insurance.

It is important for patients to communicate with both the treatment facility and their insurance company to determine what costs they may be responsible for. Patients can also ask the treatment facility if they offer payment plans or sliding scale fees based on income to help cover the cost of treatment.

Additionally, there are other ways to cover out-of-pocket costs for mental health and substance use disorder treatment. Some patients may choose to pay for treatment out-of-pocket or through private insurance. Others may be eligible for scholarships or grants to help cover the cost of treatment. Some treatment facilities may also offer financing options, such as loans or payment plans, to help patients cover the cost of treatment.

It is important for patients to understand that the cost of treatment should not deter them from seeking help. There are resources available to help cover the cost of treatment, and patients should explore all options to ensure that they receive the care they need to achieve recovery.

Other Insurances That Cover Rehab

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