Magellan Insurance Coverage for Drug Rehab and Detox

Does Magellan Cover Rehab for Drugs and Alcohol?

Magellan insurance does offer coverage for alcohol or drug treatment programs, such as detox and rehab. Your Magellan coverage for addiction treatment depends on the specific plan that you have, so it is important to check with your provider to confirm that your treatment will be covered.³

If you have a family member or dependent in need of addiction treatment, they will also be covered under your Magellan insurance coverage for drug and alcohol rehab.

Types of Substance Use Treatment Covered by Magellan Insurance

Magellan substance abuse coverage must be seen as medically necessary to be approved. Some services may have limits or require prior authorization. ¹⁰

Magellan insurance offers benefits to many types of addiction treatment programs, including:

• Detox. Detox, also known as medical detoxification services or medically managed withdrawal, is the process by which the body rids itself of substances before treatment. Oftentimes, detox can be accompanied by potentially fatal withdrawal symptoms. Many may seek to undergo detox while under 247 medical supervision to reduce the risk of complications.
• Inpatient treatment, where you stay at a facility for the duration of treatment.^{3, 9, 10, 11}  Treatment usually involves an intense combination of group and individual therapy.
• Outpatient therapy allows people to receive less intensive treatment while having the freedom to live at home and attend work and/or school.³

Types of Magellan Insurance Plans

Magellan insurance provides plans through employers, labor unions, and companies that administer insurance for other organizations (third-party administrators), and also works in conjunction with different government and military agencies.^{1 , 2}  Recognized as a Fortune 500 company, Magellan provides health insurance coverage to approximately 55 million people.² 

Magellan Insurance is available in many states in the United States; plans it offers may vary by state.² Healthcare plans available through Magellan Insurance fall into 3 categories:³ 

• Health maintenance organization (HMO) plans, where you can receive care only from rehab providers who are in-network. This plan generally costs less than any other type of plan.⁴  You may not be able to see an out-of-network rehab provider unless it is an emergency.⁴  Magellan out-of-state addiction treatment coverage may be limited with this type of plan.⁴ 
• Point-of-service (POS) plans offer more freedom to see a rehab provider of your choosing.⁴  In-network addiction treatment providers are available at a lower cost but you are also allowed to see out-of-network rehab providers as long as you’re willing to pay higher copays.^{4 )} Before seeing a specialist, you’ll need to obtain a referral from your primary care physician.⁴ 
• Preferred provider organization (PPO) plans generally cost more than any other type of plan, but offer the most freedom of choice.⁴ Like a POS plan, you can either see rehab providers in the network and pay lower copays, or go to out-of-network providers who will cost more to see.⁴  However, with a PPO plan, you will not need a referral to see a specialist.⁴

Visit Magellan Member Websites and Secure Portals for more information about the plans that are available in your state.

Magellan, Medicare, & Medicaid

Medicare is a government program that provides health insurance to people who are over age 65 or people with certain disabilities.⁵  Magellan Insurance works in conjunction with Medicare to provide Medicare Advantage plans.^{6 (p1)} These provide hospital (Part A), medical (Part B), and, typically, prescription (Part D) coverage all in one plan.⁷ You may be required to get referrals for specialist visits and see a provider who is in-network, since not all plans offer coverage for out-of-network providers.⁷ 

Magellan Complete Care plans are available for residents of certain states who are eligible for both Medicaid and Medicare.⁸ This plan strives to provide integrated care to meet all the needs of its members by using all of the resources available.⁸ 

How to Check My Magellan Benefits for Drug Rehab

To check your Magellan health benefits, a first step would be to check your Magellan insurance card. Many insurance cards have phone numbers that can put you in contact with a Magellan representative who can help you check your coverage. You can also visit Magellan’s website. Magellan members may have access to an insurance portal that can help them check their coverage. You may also reach out to a rehab facility. If a rehab is in-network with Magellan, they may be able to help you check your coverage for substance use disorder treatment.

How to Use Magellan to Pay for Rehab

In order to use your Magellan insurance plan to cover addiction treatment, you may first need to clear everything with the insurance company. Preauthorization may be needed for the insurance company to begin paying. Most preauthorization occurs between the insurance provider and your healthcare provider. As such, it will be important to be open in communications with any potential rehab centers to attain the maximum amount of coverage. It’s also a good idea to confirm which rehabs are in-network with Magellan, and which are not. Receiving treatment at an in-network facility can greatly reduce out-of-pocket costs.

How Much Does Magellan Cover?

While the Affordable Care Act requires that all insurance plans provide coverage for the medically necessary treatment of substance use disorders, this may not mean everything will be covered. While Magellan health plans generally provide some type of coverage for the treatment of substance use disorder, there are several factors that may caused your coverage to vary. Some of these factors may include:

• The type of Magellan health plan you have.
• Where you receive addiction treatment.
• Whether a rehab is in-network with Magellan.
• Intensity of treatment.
• Length of treatment.
• Accommodations and amenities offered by a rehab.

It’s important to reach out to a Magellan health representative to check your treatment before committing to treatment.

Do Rehab Facilities Need to Be In-Network with Magellan?

In-network rehab facilities work with Magellan to provide Magellan members with quality care. Oftentimes receiving treatment at in-network facilities will result in better coverage and benefits from your Magellan insurance plan. While you can attend treatment at an out-of-network treatment facility, you may receive less benefits from your Magellan health plan. In some cases, Magellan may not cover any of the cost of treatment if you attend treatment at an out-of-network rehab. It’s important to determine if prospective rehabs are in-network with Magellan before committing to treatment.

Finding Rehabs that Accept Magellan Insurance

American Addiction Centers (AAC) is one of the nation’s foremost providers of quality and evidence-based detox and rehab services for people with alcohol or substance use disorders.  It accepts many health insurance plans, including Magellan Insurance, and maintains an in-network status with a wide range of other insurance plans.

With American Addiction Centers facilities all around the country, it’s easy to access local detox and rehab services no matter where you are with the assurance that you’ll receive tailored, effective, and cutting-edge treatments.  All treatment begins with an effective medical detox for which you’ll have support from a full medical staff to ensure your safety.

Your treatment plan at ACC focuses on more than just alcohol or drug addiction; it also addresses any other concerns you may face, including physical and mental health and social, legal, occupational, and family issues, to help you recover successfully.  For more information about detox and rehab at American Addiction Centers, our confidential rehab hotline is available 24/7 at or through text.