What is Covered California?
Covered California is a free service that connects California residents with brand-name health insurance under the Affordable Care Act and Patient Protection. This service assists people with financial help when buying health insurance from reputable health care companies. This means when people apply, they could qualify for a discount and a health plan through Covered California or receive health insurance through the state’s Medi-Cal program. Either way, those who apply will receive excellent health coverage, including addiction treatment.
CoveredCA.com is sponsored by the Department of Health Care Services and Covered California, two programs working together to help California residents receive coverage and care best for them.
Coverage Basics
With so many options available, choosing a health insurance plan can be overwhelming. Before getting started, you need to understand the critical changes in the recent health insurance changes, including:
- Coverage levels: Most health insurance providers recently sold to people and small businesses must now be classed as one of four levels of insurance coverage: bronze, silver, gold, or platinum. Additionally, to those for coverage levels, a minimum coverage plan is accessible for individuals younger than 30 or can prove they can’t afford health insurance coverage due to experiencing hardship.
- Essential health benefits: Each health insurance plan offered in the individual and small group markets must provide a complete package of services and items, known as essential health benefits. These benefits fall into 10 categories including mental health care, emergency services, and prescription drugs.
- Dental coverage: Every Covered California health insurance plan will offer fixed pediatric dental coverage. This indicates that dental insurance for children is covered in the price of health insurance plans purchased. Also, Covered California now offers supplemental dental coverage for results through family dental insurance plans.
- Vision coverage: Covered California also offers members quality vision care. Vision care coverage is available for children and health plans purchased through the exchange. Although Covered California doesn’t cover vision care for adults, it works with different vision insurance companies to offer coverage.
Members are prompted to explore all plans that include these new features by visiting the Covered California health plans page. There, members can find plans organized by coverage level, coverage tight, and region.
Health Care Plan Quality Ratings
Covered California has reported quality ratings since the beginning. Those valuations play a vital role in helping Californians receive better care at affordable prices. California’s health insurance plans perform well in most areas. Therefore, several covered California plans received top ratings with all their plans rated three stars or more.
Covered California works with other health insurance companies to improve the quality and value of its coverage. Ways to initiate are matching each member with a primary care clinician; connect the most suffering members with top healthcare organizations that can provide superior quality care; identify and eradicate holes in quality care across communities of individuals who differ by race, ethnicity, or income; and improve healthcare technology to reduce unsafe practices.
Covered California provides members with an overall quality rating in individual ratings for three-terminal health program performance aspects.
Overall Quality Rating
Each health plan will have an overall quality rating constructed with at least two of the three division scores, and at least one score must be about clinical care or Getting the Right Care point.
Receiving the Best Care
Every year, a few members from each health plan become chosen, and records are checked to compare their medical care with federal standards for care and procedures. They have demonstrated to help clients. More than 30 healthcare quality features are tracked by observing clients’ medical charts and billing records sent between doctors and hospitals. A few of these quality measures are things like how the health plan and doctors help clients reduce cholesterol, manage high blood pressure, and receive the appropriate medications.
Members Care Experience
Each member’s experiences with their physicians are based on a survey that asks about recent experiences when visiting doctors and receiving medical care. Roughly one of every five members receives a survey by mail or phone with roughly 250 members from each plan producing surveys.
Plan Services for Members
An example of Plan member’s records is monitored to see if clients received needed care for dangerous and unnecessary services that cost time and money. Another section of the member survey is used to report members’ experiences and receive help and information from the health plans service staff.
Which Types of Substance Addictions Are Covered?
Healthcare plans that participate in the insurance marketplace must administer care and ten primary health categories, including mental health and substance addiction treatment. Numerous private health insurance plans support the same rules to be bought on the marketplace later. The majority of insurance plans will not separate drugs into categories of covered and uncovered. If substance addiction treatment is considered a covered benefit, then therapy is provided for members suffering from addiction, regardless of the cause. This is the equivalent model the health insurance programs used to treat other medicinal conditions.
Concerning covering substance addiction, health insurance plan administrators refuse to cover interviews and in-depth testing regarding which substances were used, how the addiction was developed, how they got the drugs, and what they mix them with. Plans keep it simple by covering all substances when an addiction treatment benefit is provided.
Covering substance addiction treatment like residential treatment can also help states to keep costs down. Private plans can see the benefits of saving money when addicts don’t check into expensive emergency rooms due to organ failure or overdose. By implementing care for substance addiction, they can also reduce the number of organ transplants they need to cover for the long-term. When it comes to profits, treatment for all substance addictions is the best way to go, and most health insurance plans participate.
Which Types of Rehab Treatment Facilities Are Covered?
Reports stated that there are more than 14,000 specialized addiction treatment facilities alone. Although your health plan might provide substance addiction coverage, not every facility is covered by that plan.
Some health insurance programs have an exclusive agreement with providers of these essential services. With these arrangements in place, the providers consent to offer a particular type of care at a specific price. And return, the health insurance plan agrees to produce referrals to that facility. This suggests that people in these healthcare plans can ask the doctors for a professional or facility name that their insurance company uses as a network provider.
Many substance addiction personalities are still happy to answer any questions about health insurance coverage. A fast call to your health insurance provider could be all needed to get answers to these questions. In addition to concerns regarding network coverage, there are also issues concerning substance addiction care types.
New Directions for Women can provide multiple different types of care, which include:
- Detox services
- Outpatient treatment
- Partial hospitalization program
- Residential treatment
Some health insurance plans provide coverage for all of the treatment approaches listed. For example, some health insurance plans in California, like Medi-Cal, provide detox services, residential treatment, and outpatient therapy. That is the full spectrum of substance addiction treatment, all under the same plan.
However, some programs offer payments for only one type of care, and the amount may limit the time a client can access treatment. This is a great question to ask the health plan or the treatment facility’s assessment coordinator to research that on your behalf.
Substance Abuse and Mental Health Coverage
For over the last ten years, federal legislation has extended mental health and substance abuse coverage for clients. The actual primary laws are:
- The Patient Protection and Affordable Care Act: For a client’s security, mental health care is classified as one of the ten health insurance benefits that each exchange plan must cover. The Affordable Care Act stipulates that insurers may not place spending limits on lifetime or annual amounts in the plan. A health insurance plan purchased with the state should provide coverage and substance addiction or mental health services.
- The Mental Health Parity and Addiction Equity Act: This law, passed in 2008, guarantees the health insurance companies covering substance abuse or mental health services cannot maintain those benefits differently than other medical or surgical benefits. Specifically, this indicates that health insurance companies may not impose any annual or lifetime payment limits on mental health care that would not be placed on other care forms.
Contact New Directions For Women About Your Covered California Plan
When it comes to substance addiction treatment, one circumstance people worry about most is paying for it—the high cost of rehab warrants these concerns. But, many people don’t realize how affordable addiction treatment becomes with health insurance coverage. Some of those concerns can be alleviated by learning more about what precisely your insurance plan covers.
You can review your policy to determine your health insurance benefits. However, if you notice wording or terms that you don’t fully understand, you aren’t alone.
Here at New Directions For Women, our admissions team has the means to verify your insurance coverage to make sure that you or your loved one receives the treatment care needed. To that end, New Directions For Women offers many treatment services, from medical detox and therapy to aftercare services. Some of the treatments used include:
- Detox services
- Residential treatment for women’s addiction
- Partial day treatment
- Intensive outpatient program
- Intensive sober living for women
- Aftercare
- Alumnae
Don’t let concerns about paying for medical detox and substance addiction treatment keep you from recapturing your life. Allow New Directions For Women to verify your insurance coverage.
Contact us today at New Directions For Women with any questions about your health insurance or our treatment services.
