When you begin looking for the treatment center that is right for you or your loved one, you will need to answer a very important question. How will I pay for this? While everyone’s financial situation is different, Oscar Insurance can cover some addiction treatment and three other common ways of paying for an addiction treatment program are:
- Through private insurance
- Through Medicare or Medicaid
- Out-of-pocket payment
Although some treatment centers offer payment assistance, the cost of many treatment centers depends on the type of insurance you have. If you are enrolled in Oscar Insurance and you live in Arizona, you may receive help with payment for addiction treatment.
While Oscar offers several plans, three common plans are Oscar Simple, Oscar Classic, and Oscar Saver. The level of coverage and cost for Oscar insurance depends on which plan you choose to enroll in. If you have questions about Oscar Insurance and how it covers addiction treatment, please call us at 623-335-0909.
First, the Oscar Simple often has the most out-of-pocket expenses of all the plans. This means that you will spend the most of your own money on healthcare as compared to the other plans. However, you may also have the lowest monthly premiums with this plan. There are three tiers of coverage in plans: Bronze, Silver, and Gold. Bronze is normally cheapest with the least amount of coverage. Gold is usually the most expensive with the most coverage, and Silver is in between the two. The Oscar Simple may cover substance abuse treatment. But copays, deductibles, and/or coinsurance may still apply.
Second, the Oscar Classic provides a middle ground option between out-of-pocket expenses and monthly premiums. Like the other plans, the Oscar Classic offers three tiers of coverage. The three tiers are Bronze, Silver, and Gold. Further, the Oscar Classic may cover substance abuse treatment. However, copays, deductibles, and/or coinsurances will likely still apply.
Third and finally, the Oscar Save offers better coverage. However, those enrolled in this plan may have higher deductibles. Once the deductible is met, they may find that their higher copays were worth it. Like the other plans, the Oscar Saver has Bronze, Silver, and Gold plans. Further, they may provide coverage for addiction treatment. However, deductibles, copays, and/or coinsurance may still apply.
Although each of these plans offers different coverage and different options, all of them have the possibility of partially covering addiction treatment.
HMO vs. PPO
Like most other operating insurance companies, Oscar’s plans provide both HMO and PPO options. An HMO plan stands for Health Maintenance Organization. PPO stands for Preferred Provider Organization. Both of these plans have some benefits and some disadvantages. For example, HMOs have a network of hospitals, medical centers, and primary care physicians. To be covered by an HMO, you will need to choose your physician within network.
Typically, HMO plans have lower monthly premiums, and you can expect to pay less out of pocket. If you have an HMO, you usually schedule an appointment through your primary care physician, and then they give you a referral to a specialist. One benefit of an HMO plan is that you don’t need to file claims usually since the insurance company pays the provider directly.
PPOs work a little differently. In a PPO plan, you don’t have to stay within your network. You have the flexibility to see a physician in or out of your network. However, you have to pay a separate deductible and usually also pay more out of pocket if you do decide to see a physician out of network. Further, you won’t need to rely on referrals to see specialists. Further, PPOs typically have higher monthly premiums since they offer so much flexibility. You also may have to pay a doctor directly and then file a claim if you have a PPO plan. Although each of them have different strengths and weaknesses, both PPOs and HMOs are great ways to get coverage.
Medicare and Medicaid in Arizona
In several cities in Arizona, many treatment centers accept both Medicare and Medicaid. Of the 401 treatment centers in Arizona, 285 accept Medicaid and 202 accept Medicare. Both Medicaid and Medicare are important pieces of public insurance. However, they serve different demographics. First, Medicare is the US federal healthcare plan for people who are ages 65 and older. Second, Medicaid is the US federal healthcare plan for those of a lower socioeconomic status. Both of these types of insurance can help those who can’t access private insurance to still have access to healthcare, including addiction treatment.
Information on Medicare
Medicare, the federal health insurance program, serves the following people:
- Those who are 65 or older
- Some younger people who have disabilities
- People who have End-Stage Renal Disease (ESRD)
To explain, ESRD is a kidney disease that causes permanent kidney failure. Further, Medicare’s services come in four distinct parts. Here are the four parts:
- Hospital Insurance, Medicare Part A
- Medical Insurance, Medicare Part B
- Medicare Advantage, or all-in-one coverage, Medicare Part C
- Prescription drug coverage, Medicare Part D
Medicare helps elderly people access hospital care, physician visits, and prescription drugs. Through Medicare, their copays, deductibles, and out-of-pocket expenses are often lower than they would be through private insurance.
Information on Medicaid
Further, millions of people in the US receive healthcare through Medicaid. Primarily, Medicaid serves those who are economically disadvantaged. Additionally, people with disabilities, pregnant women, children, and adults with a low socioeconomic background can all receive coverage from Medicaid. Through Medicaid, people can receive care who would not otherwise have the means to do so. States administer Medicaid, and the program is funded by states and the federal government.
Coverage of Inpatient, Outpatient, and Residential Treatment
Although there are no specific benefit categories for addiction treatment, Medicare covers those types of services when providers deem the services reasonable and necessary. Therefore, Medicare could potentially cover inpatient, outpatient, and residential treatment. Further, Arizona’s Medicaid (called Access) also covers addiction treatment for adults with alcohol or drug dependency. Medicaid’s coverage includes outpatient and residential services, among other treatments.
More Information on Oscar Health Insurance
Now that you understand more about the plans, we can discuss what sets Oscar Health Insurance apart from other insurance companies. Mainly, Oscar is different because the company operates from the perspective of the insurance client. In fact, the entire motivating factor of creating the company for the two founders was their own dissatisfaction with the insurance industry as a whole.
In 2012, two friends founded Oscar Insurance after they both had frustrating healthcare experiences. Although their experiences were different, their central point of frustration was the same. They felt that most insurance companies weren’t built to deal with the human concerns and understandings of their clients. They felt that insurance companies were more concerned with their financials than they were with helping people.
As a result, Oscar’s focus is serving their clients one by one. Their client-first approach means that they prioritize convenience and simplicity for their clients. Oscar also prides itself on having an on-call physician always available to talk with. Additionally, Oscar’s clients can refill prescription orders without needing to visit a doctor. If excellent customer service, ease, and convenience are important to you, Oscar may be the right fit for insurance. Further, all of Oscar’s insurance plans have the potential to help cover your addiction treatment. If you are in Arizona and you have questions about Oscar insurance or addiction treatment in general, please give us a call today. You can reach us at 623-335-0909.