CareSource Health Insurance

People who have CareSource health insurance should contact their provider to determine whether their plans provide coverage for treating substance abuse, addiction, and other problems related to alcohol and drugs.

Last Edited:

04/18/2022

Clinically Reviewed:

06/17/2021

Medical Reviewer:

Dr. Pranav Balakrishnan

CareSource is headquartered in Dayton, Ohio, with more than 2 million members in six states.

It offers Medicaid managed-care plans, Medicare Advantage, and dual-eligible programs (for people who both qualify for Medicaid and Medicare). CareSource also offers coverage through the Health Insurance Marketplace in five states – Ohio, Georgia, Indiana, Kentucky, and West Virginia.

CareSource has announced plans to help members with substance use disorders (and to help prevent them). Tactics include utilizing and coordinating more community resources to offer crisis intervention teams, mental health first aid, and medication-assisted treatment programs. CareFirst is also working to make sure fewer opioids are made available.

When someone begins looking into rehab treatment for drug or alcohol addiction, many questions will arise. A lot of them revolve around cost, whether insurance will cover care, and how much. While rehab is rarely inexpensive, most insurance plans do have some level of coverage to treat substance use and mental health disorders. (Treating both is important because often both conditions co-occur, aka dual diagnosis.)

Affordable Care Act

The Affordable Care Act (ACA) named 10 essential health benefits, like emergency services and preventive care. It also designated mental and behavioral health services as essential benefits. That includes services like counseling, psychotherapy, inpatient services, and substance abuse treatment. The exact benefits will vary depending on what state you live in and the plan you have.

It’s always wise to conduct some research beforehand. Insurance companies can answer questions about what’s covered, the copays, and other costs. They’ll also be able to tell you what needs prior authorization, what centers are in your network, and more.

Rehab centers can answer many questions, too.

CareSource Levels of Care

CareSource offers many levels of care. On the Health Insurance Marketplace, they’re categorized by metals:

  • Gold: These have higher monthly premiums, but out-of-pocket costs are lower. These tend to be a better choice if you have a lot of doctor’s appointments, several prescriptions, or procedures planned. With Gold plans, the amount you’ll pay out of pocket for every doctor’s visit or filling a prescription will be lower than with Silver or Bronze plans.
  • Silver: These tend to be most popular due to occupying a happy middle ground. There are varying levels of silver, but generally, premiums run lower than Gold and higher than Bronze, and costs for services and prescriptions tend to be a bit higher than Gold’s options. Cost-sharing reductions are available, too, where a tax credit (when you qualify) lowers your premiums. With CareSource only the Silver plans offer cost-sharing reductions, but if you qualify that means reduced costs in deductibles, copayments, and coinsurance.
  • Bronze: These plans have the smallest monthly premiums but the highest out-of-pocket costs. There are several Bronze options available through CareSource, including one that’s Health Savings Account-eligible.

Exactly what’s available will depend on factors like household size, income, and where you live.

Drug and Alcohol Rehab

Does CareSource insurance cover drug and alcohol rehab? Mental health and substance use disorder services are among the essential health benefits that CareSource provides subscribers.

Treatment can include detoxification, counseling, medication, support groups, inpatient, outpatient, and other forms of care.

Costs can vary, however, and what your deductible, coinsurance, and copays will run will be determined by the plan you have. Prior authorization is also required for treatment, especially for inpatient or residential care.

Length of Treatment

The recommended and allowed lengths of treatment will vary.

Insurance companies aim to help their subscribers be healthy or to help them get healthy and stay there. Costs can be a factor, too, so some insurers may prefer to start small and only approve a short length of treatment.

Rehab doctors will sometimes request more treatment days to help their patients strengthen their recovery, especially if they or the patient feel they need more time.

The National Institute on Drug Abuse (NIDA) suggests that a patient’s health history, how long they’ve used, how often, and other factors like gender and age be considered as a treatment plan is devised. Generally longer stays in rehab – three months, or longer – tend to result in better outcomes for patients.

Mental Health

Does CareSource also cover mental health? It is one of the essential benefits spelled out by the ACA, so patients can get counseling, inpatient services, and medication to help with any mental health conditions they may be struggling with. Those can include depression, anxiety, schizophrenia, post-traumatic stress disorder, and more.

Getting treated for mental health issues can be helpful, too, since mental illness and substance use disorders commonly co-occur. (That’s also called a dual diagnosis.) One condition can lead to the other. As a result, treating both tends to result in better outcomes.

Inpatient Rehab

CareSource insurance inpatient rehab is often recommended for people with addictions to drugs or alcohol (or both). Inpatient treatment can last 30, 60, or 90 days, or sometimes even longer. It will depend on the patient’s needs, including how severe their addiction may be.

Inpatient rehab typically takes place in several stages:

  • Assessment: This occurs right away, so the rehab can get a clear overall health picture of the patient, including whether they have any co-occurring disorders or if they have any complications resulting from drug or alcohol abuse. That information helps the addiction treatment center devise a treatment plan.
  • Detoxification: Many patients will detox right after checking into rehab. In this stage, they’ll get clean of drugs or alcohol. Depending on their mental health diagnosis or the substances they’re addicted to, the patient might get medication-assisted treatment. That helps stabilize the patient and keeps the withdrawal symptoms (which can include vomiting, insomnia, and anxiety) easier to endure.
  • Treatment: This involves behavioral (talk) therapies to help the patient discover and understand what led to the addiction. In addition to learning why they use, patients will learn new, healthier ways to cope and handle triggers. Cognitive-behavioral therapy is commonly used to help patients with addiction. In addition to one-on-one treatment, support group sessions give clients a chance to meet and communicate with others who are in similar situations.
  • Aftercare: As the patient approaches the end of their rehab stay, they’ll be prepared for life outside of the facility. They may plan to check in regularly to discuss progress and pitfalls. They may be linked up with support groups and counselors closer to home, so they continue to focus on recovery and avoid relapse.

Usually, a more long-term and more intensive course of treatment can help people stay drug- and alcohol-free for longer periods. Plus inpatient treatment tends to offer fewer distractions and allows the patient to focus harder on recovery.

Prior authorization is required for residential or inpatient care. CareSource suggests members contact its member Services Department to help find a provider for addiction or mental health treatment. They also have a dedicated addiction treatment phone number: 833-674-6437.

Outpatient Services

CareSource insurance outpatient services lets patients rehab without requiring that they stay at an inpatient or residential facility. That can be helpful for patients who are unable to do so because they need to work or tend to obligations at home. Rehabs will devise a care plan that involves therapy and other treatments that the patient will attend sometimes daily for a few hours at a time, sometimes as much as five days a week. Then they may go home or to a sober living facility once their daily treatment is completed.

Suboxone Treatment

Suboxone is one of the medications used to treat opioid use disorders. It can help during detoxification to help minimize withdrawal symptoms, but it can also be used to help maintain abstinence.

The generic version includes buprenorphine and naloxone. Buprenorphine produces some of the effects of opioids, but without the extremes like euphoria. The addition of naloxone means if someone injects the two drugs, the naloxone brings on opioid withdrawal syndrome. That can help a person avoid abusing the substance and prevent relapse.

More often, the generic version of Suboxone is prescribed. That includes CareSource. Usually, prior authorization is required.

Methadone Treatment

Methadone is also approved to treat opioid use disorders, often part of medication-assisted treatment.

Methadone has a long half-life so it won’t produce intense highs. That can help with cravings and withdrawal, either during detoxification or in the weeks and months following. That can reduce the chances of relapse.

Does CareSource cover methadone treatment? It does cover some formulations, but prior authorization is often needed.

Paying for Rehab

Addiction rehab can quickly turn pricey. Especially if a patient requires hospitalization for detoxing or they need to stay at an inpatient rehab to get clean and learn how to live substance-free.

It can be a worthwhile investment, however. Addiction can turn not just the user’s life upside down but also the lives of their loved ones. Job loss, jail time, and health risks (anything from increased risk of heart disease and many cancers to contracting diseases from shared needles) are all possible.

Getting treatment may be able to steer a person away from those risks, resulting in a happier, healthier life.

Insurance can help pay for rehab, especially when going in-network for care. That can keep costs down. Finding out what your plan’s deductibles, copays, and coinsurance portions will be can help avoid sticker shock, too.

Addiction centers can answer a lot of questions as well, and for services not covered by CareSource, some rehabs may be willing to set up an installment plan to better manage costs. Financing may be a possibility, too.

Sources

Medical disclaimer:

Sunshine Behavioral Health strives to help people who are facing substance abuse, addiction, mental health disorders, or a combination of these conditions. It does this by providing compassionate care and evidence-based content that addresses health, treatment, and recovery.

Licensed medical professionals review material we publish on our site. The material is not a substitute for qualified medical diagnoses, treatment, or advice. It should not be used to replace the suggestions of your personal physician or other health care professionals.

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