Guide to Humana Health Insurance Coverage for Addiction Treatment

Last Edited: December 29, 2023

Patricia Howard, LMFT, CADC

Clinically Reviewed

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

Using Your Humana Health Insurance To Cover Addiction Treatment.

Click Here for a confidential benefits check or call (866) 578-7471 to speak to a addiction specialist.

Humana is one of the largest health insurance providers in the country and they have recently merged with Aetna to further increase their reach. They offer a wealth of insurance plans for people to choose from. There are many different levels of coverage, including Humana military health care for service members and their families. Humana insurance offer prescription programs, online resources, and health care apps to help their clients as well.

According to the 2013 National Survey on Drug Use and Health, 23 million people in this country over the age of 12 require drug or alcohol treatment, but only 10 percent of them received it. Finances and health insurance coverage were two significant barriers. The 2010 Affordable Care Act aimed to change this by improving on the 2008 Mental Health Parity and Addiction Equity Act, defining mental health and substance abuse as illnesses that must be covered by insurance plans. In response to this, Humana has developed several plans that cover at least some substance abuse treatment.

Humana Insurance and Substance Abuse Treatment

If you require substance abuse treatment, you should first check your policy to make sure you are covered. A treatment center of your choosing will be able to help you with this. You can also purchase an add-on for behavioral health and substance abuse treatment. You can go to the “Provider Look-Up” tool on the website or telephone Humana directly if you want to ask questions directly. If you need hands on assistance there are Humana guidance center locations throughout the U.S.

You will first have to visit your PCP, who will authorize a referral to a rehab facility. The PCP, in turn, will contact Humana to determine what is covered. Some 5 million people currently have Humana Behavioral Health program coverage. A copay is usually required but the other expenses will be billed directly to Humana, who will determine what their maximum coverage is. You may also have to pay a deductible first, but there should be a maximum to that as well. Some expenses will not be covered, particularly complimentary therapies or facilities. For prescription drug coverage, there is an available humana drug list that will help you determine the best health insurance coverage for you.

Types of Humana Coverage

There are different types of insurance plans available, with the two most popular being the Health Maintenance Organization and the Preferred Provider Organization. The HMO is less flexible than the PPO. Under the HMO, people do not need a referral for treatment and they can choose in network and out of network providers. A Primary Care Physician must be designated, and only in network providers are covered. However, an HMO is usually cheaper and if you use an out of network provider under a PPO, you will have higher deductibles and co-pays. Exact details vary depending on your plan and geographical location.

Humana only covers the states of Wisconsin, Florida, Indiana, Illinois, Kentucky, Louisiana, Tennessee, Ohio, Virginia, North Carolina, Arizona, Nevada, Colorado, Missouri, Georgia, Mississippi, Kansas, Michigan, Utah, and Texas.

Individual and Group Medical Plans

Group plans are purchased by employers and employees can enroll in them at specific dates. Sometimes, employers pay part of the premium; at other times, the premium is automatically deducted from the employee’s paycheck. Humana offers many group medical plans for employers, including:

  1. PPO’s with lower deductibles but higher monthly costs
  2. HMO’s, specifically the Traditional and the Open Access plans. The latter allows for treatment from any network provider but is somewhat more expensive. With a Traditional HMO, the cost is lower but clients must have a PCP.
    Humana Classic, where individuals pay higher premiums but can see any provider at no extra cost. There are deductibles and co-pays, and you may also have to pay for coinsurance. This is a percentage of the costs you are allowed. There are usually out of pocket maximums.
  3. Point of Service, which is very flexible and comes with lower in network provider but higher out of network work provider costs. No referral is needed for either and co-pays are generally in place.
  4. High deductible health plan, whereby the monthly premiums are much lower. Pharmacy costs are included in the deductible, which means that it is quite easy to afford, after which coinsurance starts, sometimes up to 100 percent. You can also start a Health Savings Account that allows for tax free contributions.
  5. Coverage First, whereby most preventive care and medical services are 100 percent covered up to an allowance of $500.
  6. Once you reach that $500, you will pay a deductible to a certain level, after which coinsurance begins.
  7. Personal Care Account Plan, which you can combine with a POS, HMO, or PPO plan. There are no co-pays but coverage is offered through the spending account until you reach the deductible. Coinsurance rates start at the point, which may also mean out of pocket expenses.
  8. Humana Simplicity, which is the no deductible plan, with a copay only and a maximum out of pocket expense, but only for in network providers.

What Coverage Will I Get?

Substance abuse treatment is now classed as a mental health service, which means that, with Humana, you will be covered for in network healthcare practitioners, hospitals, or treatment facilities. They will not provide health insurance coverage for residential treatment or halfway homes. You will be covered for health care practitioner visits and outpatient office exams and therapy. If your mental health service is deemed medically necessary, then you will be covered, including urgent and emergency care. If emergency care is delivered in an out of network clinic, you must contact Humana within 48 hours to make them aware of it.

If you’re wondering – does humana cover counseling? The answer is yes. You can also be covered for preventive services, such as drug screening and counseling, aimed to reduce abuse in those over 18. Between the ages of 10 and 17, dependents may also be covered for tobacco counseling.

Under the Humana PPO, you may be covered for residential treatment, as well as for psychological testing. According to the National Alliance on Mental Illness, around 50 percent of people who use drugs and around one third of those who abuse alcohol, also have a mental illness. This is known as a co-occurring disorder and more treatment options are generally covered in this case.

Humana’s behavioral health services are managed by LifeSynch. Additionally, Humana military health insurance is available to servive members, veterans and family member. Humana military provides health coverage through Tricare insurance. Some of the services they cover include psychological and neuropsychological testing, routine outpatient services, intensive outpatient treatment, partial hospitalization, inpatient acute psychiatric care, and acute detox services. However, you do have to demonstrate that there is a medical need for these tests. If you or a loved one are struggling with a drug or alcohol addiction- give us a call. We are here to help in any way we can: (866) 578-7471.