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When Does Humana Cover Drug Rehab?

Humana is a large health insurance company that provides coverage to people across the United States. In 2015, it announced plans to merge with health care company Aetna, to provide client-centered care to more than 33 million people. Together, the companies aimed to offer a wider range of affordable health care options based on consumer needs, reduce the growth of health care expenses, improve health outcomes for their members, and promote overall wellness.

The Humana/Aetna merger was ultimately blocked in 2017, however, by a federal judge who ruled in favor of antitrust laws. U.S. District Judge John Bates determined that the merger of these two large health insurance companies would reduce competition among insurance providers. Such a scenario could drive up health care expenses for individuals.

Since Humana’s plans to merge with Aetna were blocked, Humana announced that it would focus its services on Medicare Advantage plans. Humana planned to stop providing individual health insurance plans and stop participating in Affordable Care Act health insurance exchanges by 2018. It planned, however, to continue to operate its employer group insurance plans. Dental and vision coverage would also continue to be offered in 2018.

By focusing on Medicare Advantage plans, Humana can provide more resources to people who have chronic conditions. Medicare primarily covers people over age 65. Humana explained that nearly 85 percent of people over age 65 struggle with at least one chronic condition. Humana has also partnered with the Centers for Medicare & Medicaid Services to improve the quality and effectiveness of its Medicare plans.

Humana ultimately decided to pull out of the individual health plan business because it experienced a decrease in enrollees over many years. Following the passage of the Affordable Care Act in 2010, Humana attempted to make changes to its coverage networks and plans to keep this sector of the company viable, but it was not able to do so. Humana’s ultimate goal is to offer affordable and accessible health care to consumers, but it couldn’t do so in a sustainable way for the company through individual health care coverage.

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Humana Medical Plans

For customers currently enrolled in Humana individual health coverage plans and those who receive Humana coverage through an employer-sponsored program, costs associated with attending a drug rehab program are likely to be covered. Individual plans, even when provided through your employer can vary, so it is important to consult customer service to verify your specific benefits. The contact numbers to customer service can be found on the back of your insurance card.

Due to Humana’s plan to withdraw from the individual health insurance sector, you will likely not get much coverage for health care costs by the end of 2018 if you purchased the insurance plan yourself. If your Humana coverage comes through your employer, however, you are still set.

Humana offers a wide range of employer-sponsored medical plans. The benefits its offers and costs it covers vary depending on plan type, location, and necessity of services. Insurance plans also vary state by state.

You can view the details of plans offered in your state through Humana’s website. For group medical plans, typical plans that employers offer include:

PREFERRED PROVIDER ORGANIZATION (PPO) PLANS.

These plans offer access to health care providers that have an agreement to provide services to customers at reduced costs. At Humana, PPOs typically have higher monthly costs but lower deductibles.

HEALTH MAINTENANCE ORGANIZATION (HMO) PLANS.

These plans are available for customers to select care from a network of contracted providers. At Humana, these plans are usually cheaper, and care is coordinated through one’s primary care provider.

HUMANA CLASSIC PLANS.

This plan allows customers to see any provider, though monthly expenses will be higher. Copays and deductibles still apply, but additional expenses will be fully covered once personal cost maximums are reached.

HIGH-DEDUCTIBLE HEALTH PLANS.

These plans have lower monthly costs but much higher deductibles. Once out-of-pocket expense maximums are met, individuals usually have to pay a percentage of any additional expenses.

HUMANA€S COVERAGE FIRST PLANS.

This plan covers 100 percent of the costs of most medical services as well as preventative care. Copays likely still apply, but customers can receive care from in-network providers for no fee. Services will be covered up to $500, and then a deductible must be met followed by coinsurance coverage.

Humana and Medicare


In addition to the range of group employer-sponsored plans it offers, Humana provides Medicare plans to millions of customers. Medicare is a federal health insurance program that provides coverage for people who are 65 and older, younger people with certain disabilities, and people with end-stage renal disease. There are four main parts to Medicare.

MEDICARE PART A

is known as the hospital insurance. It covers inpatient hospital stays, treatment in skilled nursing facilities, hospice care, and some home health care services.

MEDICARE PART B

is known as the medical insurance. It covers many physicians’ services, outpatient treatment, medical supplies, and preventative services.

MEDICARE PART D

provides prescription drug coverage. It is a supplemental insurance plan that adds coverage for prescription medications to many other specific Medicare plans.

MEDICARE ADVANTAGE (PART C)

is the most comprehensive plan. It provides coverage of Part A, Part B, and usually Part D all in one plan.

Medicare plans are offered by health insurance companies that have been approved by Medicare. Medicare Advantage plans are what Humana has focused its efforts on providing.

Humana Coverage for Drug Rehab


Drug rehab services are covered through several of Humana’s health insurance plans. Whether you have a PPO or an HMO, behavioral health services are included in your coverage. The degree to which these services are covered will vary based on your plan, however. You must speak with Humana directly to confirm what types of treatment are available to you and at what costs.

Typically, Humana covers mental health and behavioral services that are received at in-network providers. Health care treatment facilities, such a drug rehab programs, fall under this category. Preventative services, such as counseling on drug prevention and reduction, are also typically covered. People who require residential treatment programs are also likely to have costs covered by their PPO plan.

Behavioral health services that Humana has traditionally covered include:

  • Medical detox
  • Psychiatric care
  • Partial hospitalization
  • Intensive outpatient treatment
  • Routine outpatient services
  • Psychological testing

The catch to receiving coverage for most of these services is that preauthorization is often required. Individuals must demonstrate a need for services, and the services being provided must be considered to be medically necessary.

If your insurance plan does not cover the treatment services you need, Humana does offer additional substance abuse and behavioral health treatment coverage as a supplemental coverage plan. A good place to start is with your primary care doctor who can make a referral for appropriate treatment services within the Humana network.

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While this additional coverage will come at a fee, it will be far less than attempting to pay the full cost of treatment on your own.

Finding the Right Drug Rehab Facility


Finding the right drug rehab facility for you can be a lengthy and sometimes confusing process. There are many factors to consider, such as cost, location, availability, and the services offered. If you have already made the difficult step of admitting to yourself that you need treatment, do not let the rest of these factors be a barrier to receiving the care you deserve.

Figuring out how to pay for addiction treatment can feel like an overwhelming task, but it is not impossible. Health insurance providers, like Humana, have customer service representatives available 24 hours a day, seven days a week, to answer all of your policy-related questions. While they cannot make clinical judgments or referrals for you, they can provide you with valuable information about treatment services that are available to you and treatment facilities that are covered by your insurance plan.

In addition to the staff at Humana, staff members are available at drug rehab facilities to walk you through the admissions and insurance verification process. Depending on the services available, some treatment facilities can contact your insurance provider for you to alleviate some stress.

Addiction recovery is a lifelong process. Companies like Humana are there to help get you started on your journey to healthier and happier living.

How can you end addiction? Get a call from our experts and find out!

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