How to Pay for Drug Rehab: Molina Insurance 

Molina is a multiple-state health insurance provider with more than 30 years of industry experience. The company has Medicaid Molina contracts with individual state governments, providing health plans through the Medicaid system. At the same time, Molina also offers Medicare Advantage plans to specific individuals. The particular policy options and programs available vary depending on the state. Molina also provides Healthcare Marketplace and Integrated Medicare/Medicaid plans in certain states.

In the majority of cases, Molina provides coverage for substance use disorder treatment. The exact coverage varies. It may include outpatient services, partial hospitalization programs, and residential treatment in an inpatient rehab facility. Because every state has slightly different regulations regarding healthcare coverage, the options available will vary depending on your location. Different areas have diverse requirements and benefits offerings.

Rehab Coverage Through Molina

Molina’s healthcare policies are purchased through the marketplace healthcare exchange that was established by the Affordable Care Act. The ACA requires that insurance companies offer the same coverage for physical and mental health conditions. Mental health treatment must be subject to the same policy limitations and benefits as a physical health treatment. 

Regardless of whether or not you purchased your Molina plan through the state exchange marketplace, rehab options are available. Rehab coverage plans are all built around federal and state requirements since the company functions as a coverage coordinator for Medicare.

molina healthcare

Mental health services are a covered benefit in all Molina plans. They’re subject to the same requirements as physical health services. If you have a Molina health insurance plan, you can contact a Molina company representative to discuss the specifications of your insurance policy. You can also ask your primary care doctor to give you a list of in-network mental health providers that might match your needs.

Outpatient Mental Health Services

Molina covers mental health services on an outpatient basis. The company’s policy guidelines define outpatient psychological services as any services that are designed to treat diagnosed mental health issues that range from mild to moderate.

 Many different services fall under this umbrella. They include:

  • Individual mental health evaluations and psychiatric assessments
  • Any psychological testing clinically required for the diagnosis and evaluation of a mental health issue
  • Outpatient laboratory tests
  • Outpatient supplements, supplies, and laboratory drugs
  • Outpatient services monitoring drug therapy
  • Psychiatric consultations

Unfortunately, Molina does not cover mental services that relate to relationship issues. This includes family counseling, marriage counseling, and couples counseling. With that said, family therapy is often an integral part of the recovery and healing process. If you’re able to pay for it out-of-pocket, it’s a worthwhile endeavor to integrate into your treatment plan.

Behavioral Health Coverage Through Molina

As a general rule, behavioral health benefits and coverage are available through Molina. Members of the network can receive a referral by their primary care physician or by Molina itself to receive treatment from the correct provider. Most Molina plans will cover behavioral health services like medication management and mental health assessments.

Most of the coverage and benefits offered through Molina’s plans are built around state and federal guidelines. The Affordable Care Act created exchange guidelines regarding what health policies must cover before they could be sold on the Marketplace. 

Also, Molina adheres to state and federal requirements regarding Medicare and Medicaid. Under these guidelines, covered behavioral health services include therapist and doctor appointments, treatment programs, medication management, and care coordination between multiple mental health providers.

Molina is staffed by teams of care coordinators; These individuals can work with members to help them understand their policies, options, and treatment plans. Their job is to connect members with the ideal provider for whatever behavioral health needs they have. Besides, Molina can help to coordinate long-term and medical treatments with behavioral treatments, allowing better communication between all of your healthcare providers.

On top of all of this, Molina is responsible for operating a behavioral health crisis line that’s available to call 24 hours a day. If a member has a problem related to their behavioral or mental health, they can contact a qualified nurse at any time to get a recommendation for how to proceed.

To get specific information regarding your benefits, you can contact the Member Services division of Molina. There’s also a Summary of Benefits that you can read to get the highlights of your medical coverage, including coverage for behavioral health treatment.

Rehab Coverage Through Molina

Molina’s rehab coverage gets a little complicated, mainly depending on the state. Though there are services provided for essential substance use treatment, many areas and plans impose limitations on the mental health coverage. One example is with Medi-Cal plans, which are used in California. A Medi-Cal policyholder can receive preventative services regarding substance use disorders, but they won’t have coverage, allowing treatment for major alcohol issues. If you have a severe addiction, Molina may work to connect you with county options instead of offering rehab coverage.

But this isn’t true across all states. Illinois, for example, provides full coverage of substance abuse treatment. That includes day treatment, psychiatric evaluations, medically supervised detoxification, and outpatient treatment.

Different states have significantly different rehab coverage options based on state regulations.

Molina Healthcare Plans

There are three main types of Molina plan: bronze, silver, and gold. The lowest monthly premiums tend to come with the bronze plans, but the gold plans have the lowest number of out-of-pocket expenses. Gold plans are a good investment for those who can afford the higher monthly premiums and need frequent health services.

Bronze Plan

The bronze plan has the highest out-of-pocket costs with the lowest monthly premiums. Before you can start receiving coverage, you have to meet a yearly deductible of $6,400. There’s a maximum out-of-pocket expense cap of $7,350. For in-network services, your copay is 40 percent of the visit after you’ve met your deductible. If you get out-of-network services like an ER visit, you have to pay $400 as a copay.

The bronze plan covers outpatient services with a $35 copay. After the inpatient services have been pre-authorized, Molina covers up to 60 percent of the costs. The bronze plan also covers inpatient rehabilitation as long as the treatment center is in-network, and the treatment is authorized before beginning.

Silver Plan

The silver plan has a yearly deductible of $2,500 and a maximum out-of-pocket cap of $5,850. Copays in the network vary depending on the service, and they could be anywhere from $20 to 50 percent of the total visit. Emergency services come with a $400 copay, and no other out-of-network services are covered.

Outpatient services have a copay of $20, while inpatient services receive up to 60 percent coverage. If you meet the pre-authorization requirements for an in-network treatment center, Molina will cover up to 60 percent of residential rehab treatment.

Gold Plan

The gold plan has a yearly deductible of $3,800 and a maximum out-of-pocket cap of $7,350. You can expect in-network copays to range from $10 to 35 percent of the total service cost. Emergency visits come with a $300 copay, and no other out-of-network plans are covered.

The gold plan has the lowest out-of-pocket cost for drug treatment. Outpatient treatment comes with a 10 dollar copay, and inpatient treatment has 80 percent insurance coverage. With the pre-authorization of an in-network treatment center, Molina covers 80 percent of the costs of residential rehab.