Guide to GEHA Health Plans Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Matt Esaena

Clinically Reviewed
Andrew Lancaster, LPC, MAC

All of the information on this page has been reviewed and certified by an addiction professional.

Fighting Back Against An Addiction is Hard, Don’t do It Alone. GEHA Health Plans Is Here To Help.

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A substance abuse problem in a person can destroy lives, families, and communities. Thanks to the Mental Heath Parity and Addition Equity Act of 2010, addictions are now considered to be illnesses, which means that insurance companies must offer some form of coverage for them. However, exactly what they cover, how much they cover, how long they cover and where they cover, can vary greatly from one company to the next, and even from one plan to the next. If you are covered under a GEHA Health plan, then you may wonder what type of coverage you can expect for your detox and rehab facility. Unfortunately, this is a hard question to answer, because some GEHA Health plans only cover alcohol detox, whereas others cover all types of substance addictions and both detox and rehab.

GEHA Health Plans Insurance Coverage for Alcohol and Drug Rehab

While it is likely that your GEHA Health Plans policy will cover the cost of detox, it may not cover rehab costs. Sometimes, health plans cover only certain elements of rehab, but they will not cover all of it. There are several factors that will determine if you are covered and how much for. If you are covered under the GEHA High Options Benefits plan, then you will likely also receive rehab coverage. Another factor of influence in terms of whether or not you will be covered is the type of facility you decide to go to.

How Long Will GEHA Health Plans Insurance Cover Treatment?

Again, how long you can receive coverage for treatment depends on the plan that you have. Some plans only cover members for a specific period of time. Others cover a fraction of the cost, regardless of how long you need treatment. Some plans will cover all of the costs of your treatment program. This may seem confusing, but a GEHA representative will be more than happy to discuss your options with you. You could also ask a treatment facility that you are interested in to perform an insurance check for you. Either way, your information will be 100 percent confidential and discreet, and you will be under no obligation to commit to any kind of treatment afterwards.

GEHA Health Plans Insurance Coverage for Specialty Drug and Alcohol Treatment

No two treatment facilities are the same. However, they can be divided into standard facilities and specialty facilities. Specialty treatment centers can be private, luxury and/or executive programs. All of them offer more upmarket services to their residents, including luxurious amenities, such as private rooms in serene surroundings, equine therapy and more. It is also possible that your GEHA Health Plan will cover you for these services, but if they do, you will probably have to copay as well.

One thing that sets GEHA Health Plans apart from other insurance companies is that they cap deductibles and coinsurance payments on a yearly basis. If you do have coverage for specialty treatment, you will never have to pay more than what your cap is. The caps vary depending on the plan that you have, and were as follows at the time of this writing:

  • $5,000 for the Standard Plan for in network providers
  • $7,000 for the Standard Plan for out of network providers
  • $4,000 for the High Option Plan for in network providers
  • $6,000 for the High Option Plan for out of network providers
  • $5,000 for the HDHP Option Plan for in network providers
  • $10,000 for the HDHP Option Plan for out of network providers

GEHA Health Plans and Inpatient and Outpatient Treatment Services

If you decide that you need help with your addiction problem, you will first have to go through a period of detox, ridding your body of the last of the harmful toxins from the substance. Once completed, you will have to choose between inpatient and outpatient rehab. Outpatient care means that you can remain in your own home and continue to meet your domestic, and perhaps even professional responsibilities. If you go to an inpatient facility, you will remove yourself fully from the outside world, allowing you to focus solely on your recovery. GEHA Health Plans may cover you for either inpatient or outpatient treatment, although this will depend on your need, plan and personal situation.

Paying for Some of the Costs Out of Pocket

It is possible that your GEHA Health Plans membership does not cover 100 percent of the treatment you feel you need. Don’t worry because there are options out there for you. What you have to remember is that any money you will end up paying out of pocket should be seen as an investment into your own future. According to a report by the National Institute on Drug Abuse, only a very small percentage of people who need treatment actually end up getting it. It is believed that one of the reasons for this is the fact that people may have out of pocket expenses, without the financial capabilities of meeting these. Understand that treatment facilities are aware of this, and their goal is to make sure that you can get better.

Yes, you may have to pay for some of your treatment. However, not paying will cost you a whole lot more in the long run, and not just financially. To help you bridge the financial gap if nothing else, there are options out there. Most treatment facilities allow for payment arrangements, often on a sliding scale relevant to your income; some may even sponsor you! If you meet certain criteria, there are also grants available. You could go to your bank, or even look up specialized medical and treatment loans. Perhaps you have some assets you can sell, or maybe your family and friends would be happy to borrow you some money. Either way, make sure that you get the help that you require. By calling (866) 578-7471 you can determine what your insurance plan covers to make a decision on how you will proceed with your rehabilitation.