Rehab that Accepts CareFirst
CareFirst is one of the largest health insurance providers in the United States, and many drug and alcohol rehab centers accept CareFirst insurance.
About CareFirst
CareFirst is a health insurance company and part of Blue Cross Blue Shield, and serves the Mid-Atlantic region—Maryland, Washington, D.C. and Northern Virginia. CareFirst dates back to 1938. They began in Maryland, under the name Group Hospitalization, Inc. They’ve since expanded to 3.6 million members in the Mid-Atlantic area.
CareFirst now offers care for individuals, families, employers, and small businesses, and offers the largest network for medical, dental and vision insurance.
CareFirst Insurance Plan Options
CareFirst, like most health insurance companies, offers coverage for substance abuse treatment . This can include inpatient and outpatient treatment, counseling, and medication-assisted treatment. The specific details of CareFirst's substance abuse coverage will depend on the specific plan you have. You can contact CareFirst directly or look at your plan's coverage details online to learn more about what substance abuse services are covered under your plan.
CareFirst offers open-access plans, copay only plans, and high-deductible plans.
- Open-access plans allow you to choose your doctors; they don’t require a referral, and they don’t require a primary care physician.
- Copay-only plans will guarantee that your costs after paying your deductible are only copays, with primary care physician visits and generic drugs covered before you hit your deductible.
- High-deductible plans offer preventative care services before the deductible is met, and some coverage through a primary care physician before the deductible is met (with copay), and the option of a health savings account. To view your plan’s details, you can log into the member website.
- Bronze plans—These plans have lower premiums but have the highest deductibles, which will result in higher out-of-pocket expenses. CareFirst covers about 70% of the cost of care services after the deductible is met.
- Silver plans—These plans cost more in premiums but have lower deductibles and have lower out-of-pocket expenses than bronze plans. CareFirst pays about 80% of the cost of care services after the deductible is met.
- Gold plans—These plans have the highest premiums but have the lowest deductibles and will have the lowest out-of-pocket expenses. CareFirst pays about 90% of the cost of care after the deductible is met.
CareFirst, Medicare and Medicaid
CareFirst Medicare plans are alternatives to Original Medicare, which is the federal health insurance program for people who are 65 or older, as well as people with certain disabilities. CareFirst Medicare Advantage plans provide the same benefits as Original Medicare, but often with additional benefits, such as vision, hearing, and dental coverage. CareFirst also offers Medicare Supplement plans, which can be used to help cover the costs not covered by Original Medicare.
CareFirst Medicaid plans are offered in some states to individuals who are eligible for Medicaid, which is a joint federal and state program that provides health coverage to people with low incomes. CareFirst Medicaid plans typically cover a range of health services, including preventive care, doctor visits, hospital stays, and prescription drugs.
The specifics of what is covered by CareFirst Medicare and Medicaid plans will vary depending on the plan you have and the state you live in. To find out more about what is covered by CareFirst's Medicare and Medicaid plans, you can look at your plan's coverage details or contact CareFirst directly .
Addiction Treatment Options
CareFirst for Medical Detox
CareFirst typically covers medically-supervised detox programs, which involve the use of medication and other treatments to help individuals manage the physical and emotional symptoms of withdrawal from drugs or alcohol. In some cases, Aetna may also cover the cost of inpatient or residential detox programs, which provide a more intensive level of care and support.
CareFirst and Medically-Assisted Treatment:
MAT is a form of rehab that combines medication with therapy to help those recovering from addiction. Aetna insurance covers many forms of MAT, including methadone and buprenorphine.
CareFirst Coverage for Residential Treatment
Inpatient treatment is the most intensive form of rehab , and it typically involves staying at the center for several weeks or months. Inpatient treatment is ideal for those with severe addiction or mental health issues.
Intensive Outpatient Programs (IOP)
Intensive outpatient treatment is less intensive than inpatient treatment, and it typically involves visiting the center for a few hours a day. Outpatient treatment is ideal for those who need to continue working or taking care of their family while in rehab.
Partial Hospitalization Programs (PHP)
Partial hospitalization typically involves staying at the center for several hours a day. Partial hospitalization is ideal for those who need a higher level of care than outpatient treatment but do not require 24-hour supervision.
CareFirst Rehab Coverage FAQs
Does CareFirst insurance cover drug and alcohol rehab?
CareFirst insurance may cover drug and alcohol rehab, but the coverage depends on the individual's insurance plan and policy. CareFirst plans typically have benefits for addiction treatment, including inpatient and outpatient rehab, counseling, and therapy.
How can I verify my CareFirst insurance benefits?
There are several ways to verify your CareFirst insurance benefits:
Check your insurance card: Your CareFirst insurance card will typically have information about your plan, including your copayment amounts, deductibles, and the services that are covered by your plan.
Log into your online account: If you have an online account with CareFirst, you can log in to view your insurance information, including your coverage details, claims history, and copayment amounts.
Contact customer service: You can call CareFirst's customer service department to speak with a representative who can provide information about your coverage, including what services are covered and what your out-of-pocket expenses may be.
Check your plan's summary of benefits: CareFirst provides a summary of benefits for each of its insurance plans, which you can view online or request a printed copy of. The summary of benefits provides an overview of your plan's coverage, including what services are covered, what your out-of-pocket expenses may be, and any limitations or exclusions that apply.
Ask your healthcare provider: If you have any questions about your coverage, you can also ask your healthcare provider. They may be able to provide information about what services are covered by your CareFirst insurance plan and what your out-of-pocket expenses may be.
Does CareFirst cover outpatient addiction treatment?
CareFirst typically covers a range of outpatient treatments for substance abuse, including individual and group therapy, medication-assisted treatment, and support groups. Coverage may also include access to a network of licensed mental health and addiction specialists.
Does CareFirst cover inpatient drug and alcohol rehab?
Yes, CareFirst insurance plans typically cover costs of inpatient drug and alcohol rehab. The extent of coverage for inpatient rehab will depend on the specific CareFirst insurance plan you have and any exclusions or limitations.
Does CareFirst cover inpatient mental health?
Yes, CareFirst insurance plans may cover inpatient mental health treatment for conditions such as depression, anxiety, and other mental health conditions. The extent of coverage for inpatient mental health treatment will depend on the specific CareFirst insurance plan you have and any exclusions or limitations.
Do treatment centers need to be In-Network?
CareFirst insurance plans may cover out-of-network rehab, but the specific coverage will depend on the individual's insurance plan and policy. Some CareFirst plans have out-of-network benefits that allow members to receive coverage for services from providers not in the plan's network. However, this coverage is usually at a lower level than in-network coverage, and members may have to pay more out-of-pocket costs.
How much does CareFirst insurance cover?
The amount that CareFirst insurance covers will depend on several factors, including:
The type of insurance plan you have: CareFirst offers a range of insurance plans, including individual and family plans, employer-sponsored plans, Medicare plans, and Medicaid plans. The coverage details will vary depending on the plan you have.
The type of health service you need: CareFirst insurance plans typically cover a range of health services, including preventive care, doctor visits, hospital stays, and prescription drugs. However, the specifics of what is covered and to what extent will vary depending on your plan.
Your annual deductible: A deductible is the amount you pay out-of-pocket each year before your insurance begins to cover the costs of your care. Deductibles can vary depending on your insurance plan and the type of care you need.
Your copayments and coinsurance: In addition to a deductible, you may also be responsible for copayments (a set amount you pay for a service) and coinsurance (a percentage of the cost of a service that you pay).
CareFirst insurance plans may also have limits on the amount of coverage available for certain types of services or treatments. To find out how much your CareFirst insurance plan covers, you can look at your plan's coverage details or contact CareFirst directly.
How do I pay for costs not covered by CareFirst insurance?
If you receive health services not covered by your CareFirst insurance plan, you may be responsible for paying for those costs out of pocket. There are several options for paying for these costs, including:
Paying directly: You can pay the healthcare provider directly for the costs not covered by your insurance plan.
Using a health savings account (HSA) or flexible spending account (FSA): If you have an HSA or FSA, you can use these tax-advantaged accounts to pay for out-of-pocket healthcare expenses.
Applying for financial assistance: Depending on your financial situation, you may be eligible for financial assistance from the healthcare provider or a government program.
Negotiating with the healthcare provider: In some cases, you may be able to negotiate a payment plan with the healthcare provider to help make the costs more manageable.
The exact options available to you will depend on the type of healthcare services you received, the cost of those services, and your financial situation. If you have questions about paying for costs not covered by your CareFirst insurance plan, contact CareFirst or the healthcare provider directly.
How is a CareFirst HMO different from a PPO?
CareFirst HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) are both types of health insurance plans offered by CareFirst, but they differ in how they handle healthcare providers and costs.
In a CareFirst HMO, you typically choose a primary care physician (PCP) who acts as a gatekeeper to the healthcare system. To see specialists or receive treatments, you usually need a referral from your PCP. Additionally, HMOs usually have a smaller network of healthcare providers, and you may need to pay more if you receive care outside of the network.
In a CareFirst PPO, you have more flexibility in choosing healthcare providers without the need for referrals. PPOs often have a larger network of healthcare providers, but you may need to pay more if you receive care outside of the network.
When it comes to costs, HMOs often have lower monthly premiums and out-of-pocket costs than PPOs. However, with a PPO, you may have more flexibility to choose your healthcare providers, which can be an advantage if you value having more control over your healthcare decisions.
Consider your individual needs and preferences when choosing between a CareFirst HMO and PPO. You can also compare the features and costs of different plans to determine which plan is the best fit for you.
Can you get a single case agreement with CareFirst?
Yes, it is possible to request a single case agreement (SCA) with CareFirst for coverage of a specific medical treatment or procedure (such as inpatient drug and alcohol rehab) not otherwise covered by your insurance plan. An SCA is a request for a one-time exception to CareFirst's usual coverage policies.
To request an SCA with CareFirst, you will typically need to provide medical documentation to support your case and demonstrate that the treatment or procedure is medically necessary. CareFirst will then review your request and make a determination about whether to grant the SCA.
SCAs are not guaranteed and are subject to approval by CareFirst. Additionally, the decision to grant an SCA is based on a number of factors, including medical necessity, cost, and alignment with CareFirst's coverage policies.
If you are interested in requesting an SCA with CareFirst, you can contact CareFirst's customer service department to learn more about the process and what information you will need to provide.