Oscar provides health insurance in the United States, and many drug and alcohol rehab centers accept Oscar insurance . However, it can be difficult to know which centers are the best fit for your specific needs.
About Oscar
Oscar Health, Inc. delivers high-quality healthcare plans in 18 U.S. states across select counties(1). Founded in 2012, Oscar serves 1.6 million members, providing healthcare services for individuals and families, Medicare, and small businesses(2). Oscar Health Inc. strives to simplify seeking healthcare while improving the health outcomes of its members(2). With Oscar Health, Inc. coverage for rehab, you can access various levels of care, from inpatient treatment to standard outpatient rehab(1,3). Keep reading to learn more about Oscar coverage for addiction treatment and how to start your recovery journey.
This page is intended to be a general overview of how Oscar Health Inc. covers addiction and mental health services, not a comprehensive guide on the subject. For specific questions about your plan and Oscar Health Inc. coverage contact a Oscar Health Inc. representative directly and learn about how to pay for rehab.
Does Oscar Health Cover Drug and Alcohol Addiction Treatment?
Oscar Health, Inc. covers drug and alcohol addiction treatment through its partner, Optum Behavioral Health(3). You can visit the Optum website to search for an in-network provider and find the care you need(3). Depending on your specific plan, you may receive a portion or complete Oscar Health, Inc. coverage for addiction treatment.
The Affordable Care Act (ACA) protects your access to essential health benefits (EHBs), including addiction and mental health care(4). This law requires that all marketplace plans cover EHBs to some degree(4). With increased SUD treatment accessibility in the United States, the ACA ensures you have options to find the help you need. Still, your specific amount of coverage depends on your insurance plan. Understanding your health insurance policy can simplify finding the best care for you.
Which Types of Treatment Does Oscar Health Cover?
Recovery is different for everyone(5). What works for someone else may not work for you(5). That’s why multiple levels of care are available to meet you where you are in recovery. Here are some common types of addiction treatment you may receive coverage for with Oscar Health, Inc.(5):
- Medical detox. People complete detox to eliminate substances from their bodies safely. It involves 24/7 medical supervision and monitoring throughout the withdrawal process. Depending on your situation, you may receive medications to ease cravings and withdrawal symptoms.
- Inpatient or residential rehab. Inpatient rehab provides a structured, supportive living environment with 24/7 attentive care. Patients participate in therapeutic interventions, such as individual and group therapy, addiction education, and peer support, to develop coping skills for long-term recovery.
- Outpatient programs. With outpatient programs, you live at home while attending rehab. These levels of care offer similar treatment approaches to inpatient rehab. Outpatient programs vary in intensity, from daily treatment to less intensive programs.
- Addiction aftercare. Mental health professionals recommend remaining in aftercare once completing an initial program. Some common aftercare services include ongoing therapy, 12-Step programs, and sober living homes.
Generally, many begin treatment in detox before transitioning to another level of care(5). Depending on your situation, the next step in your journey could be inpatient rehab, a partial hospitalization program (PHP), a high-intensity outpatient (HIOP)/intensive outpatient program (IOP), or standard outpatient treatment(5). Once completing treatment, you’ll start addiction aftercare to stay on track in recovery(5). Your doctor or addiction specialist can help you understand the best level of care for you. Mental health professionals use the American Society of Addiction Medicine (ASAM) criteria as a guideline for the placement, transfer, and discharge of those seeking addiction and co-occurring disorder treatment(6). This criterion is a continuum of care ranked 0.5 to 4, from early intervention to inpatient rehab(6). Before starting treatment, you’ll complete an assessment and evaluation to diagnose your SUD and determine appropriate care(5).
Oscar Health Coverage for Co-Occurring Disorder Treatment
Many struggle with mental health disorders, like anxiety, depression, post-traumatic stress disorder (PTSD), and schizophrenia, along with addiction(7). This is known as co-occurring disorders or dual diagnosis. Addiction may occur from attempting to cope with the symptoms of mental health disorders using drugs or alcohol(7). Prolonged substance use can also encourage the development of mental health disorders(7). A rehab covered by Oscar will often treat co-occurring disorders. Regardless of the situation, mental health experts recommend treating both conditions in tandem to promote long-term recovery(7). Without a blended approach, these underlying disorders can negatively affect your recovery journey.
Oscar and Medicare
Oscar Medicare Advantage plans are alternatives to Original Medicare, the federal health insurance program for people 65 or older and people with certain disabilities. Oscar Medicare Advantage plans provide the same benefits as Original Medicare but often with additional benefits, such as vision, hearing, prescription, and dental coverage.
The specifics of what is covered by Oscar Medicare Advantage plans will vary depending on your plan and your state. To learn more about what is covered, you can look at your plan's coverage details or contact Oscar directly.
How to Use Oscar Health for Addiction Treatment and Rehab
Using Oscar Health, Inc. coverage for rehab is straightforward. Oscar’s digital tools, such as their mobile app and website, make it easy to find in-network providers and facilities specializing in addiction treatment(1). You can contact Oscar Health, Inc. to learn more about the specific details of your policy and verify your addiction treatment coverage levels(1). Oscar Health, Inc. also provides an online patient portal where you can search for information on your plan(1).
Sources
- Oscar. (n.d.). Individuals.
- Oscar. (n.d.). About us.
- Oscar. (n.d.). FAQs.
- Healthcare.gov. (n.d.). Affordable Care Act (ACA).
- National Institute on Drug Abuse. (2018). Principles of drug addiction treatment: A research-based guide (third edition).
- American Society of Addiction Medicine. (2024). About the ASAM criteria.
- National Alliance on Mental Illness. (n.d.). Substance use disorders.