Addiction Treatment in New Jersey Covered by Humana Insurance

Humana is one of the largest health insurers in the United States, with over 16 million members. ¹

Humana plans are available in New Jersey and nearby areas. That means that if you have a plan and are struggling with addiction, you’ll likely be able to find an addiction treatment facility near you where you can use your Humana coverage.

Does Humana Cover Drug & Alcohol Rehab?

It is very likely that your Humana plan provides some level of coverage for substance use disorder (SUD) treatment. The Affordable Care Act (ACA) and Mental Health Parity and Addiction Equity Act (MHPAEA) require most health insurance policies to provide coverage for mental health and behavioral health care. ^2-4

Exactly what your Humana health insurance will cover will depend on your exact plan and where you seek treatment.

Sunrise House works with many major insurance companies, including Humana. This means that you may be able to have your rehab at Sunrise House fully or partially covered by your Humana plan.

Use the secure, HIPAA-compliant to check your Humana coverage and receive results in just minutes.  You can also learn more detailed information about your coverage and the care provided at Sunrise House by speaking to an admissions navigator at .

Addiction Treatments & Therapies Covered by Humana

Every person’s path to recovery is different, and the right treatment varies between individuals and their specific needs. Many different treatment facilities will offer various levels of care that range from detox (inpatient or outpatient) to residential rehab all the way to standard outpatient therapy visits. At Sunrise House, an in-network provider with Humana, we offer inpatient programming that includes:

• Inpatient medical detox.
• Residential, or live-in, treatment.

For those who prefer outpatient treatment or whose plans only cover this form of care, Sunrise House has sister facilities across the U.S. that offer these programs. Upon arriving at Sunrise House, or another American Addiction Centers facility, staff will evaluate you and ask you questions about your substance use, prior treatment attempts, and your medical and mental health history. From there, staff will determine the appropriate treatment course.

How to Use Humana to Cover Addiction Treatment at Sunrise House

Some Humana plans may require you to get a referral from a primary care provider (PCP) to an addiction treatment facility. Others may allow you to refer yourself to specialty treatment. If you’re unsure, you can call the number on your insurance card and ask a Humana representative.

Many addiction treatment services require preauthorization from the insurance company. In-network providers, such as Sunrise House, can obtain this preauthorization on your behalf before you start treatment. Generally, a service will be approved as long as it is “medically necessary” (required to treat your substance use disorder and in line with accepted medical standards).  If a service is rendered without prior approval from Humana, they may have the right to deny payment.

How Much Will Rehab Cost with Humana?

While there are many different factors that determine cost, reviewing the Summary of Benefits and Coverage (SBC) pamphlet for your specific plan may help you estimate what you’ll owe in out-of-pocket expenses. Here are some terms you should know:⁵

• Co-payment. This is your portion of payment for receiving a service, due at the point of service. For example, a fixed dollar amount is often charged for filling a prescription or visiting a therapist.
• Deductible. This is the amount you’re responsible for paying out-of-pocket before health insurance will kick in. After you meet this limit, your insurer begins covering costs.
• Co-insurance percentage. Once you’ve reached your deductible, you’ll usually still have to pay a percentage of the cost of some health services. For example, with a co-insurance percentage of 25% for inpatient detox, your insurer would cover the remaining 75%.
• Out-of-pocket maximum. This is the maximum cost you’ll be responsible for paying out of your pocket each year (except for monthly premiums). Once you hit this amount, you’ll no longer owe anything for covered services during the plan year.

An admissions navigator at Sunrise House Treatment Center—reachable 24/7 at —can help you better understand your insurance coverage and give more detailed information regarding costs.

Why Use Humana Insurance to Pay for Rehab?

While not getting treatment is usually more expensive in the long run than the cost of that treatment, cost is often a significant barrier to treatment.^6,7 It’s incredibly important to get the care you need today so that your condition doesn’t worsen.

As with almost any health care service, using insurance to pay for rehab will likely be the most cost-effective option available. It may be helpful to review some suggestions on ways to pay for rehab if you don’t have insurance or you are interested in options to cover your out-of-pocket costs.

If you’re struggling with addiction, you’re not alone. Sadly, substance abuse in the Northeast runs rampant:^8-10

• In 2018, there were 2,900 reported drug overdose deaths in New Jersey, and almost 90% of those deaths involved opioids.
• In 2017, an estimated 16.7% of adults in New Jersey reported binge drinking within the past 30 days.
• 82,254 people in New Jersey were admitted into substance use treatment centers.

Call an admissions navigator at today to learn more about the treatment options and coverage that may be available to you at Sunrise House. If you’d prefer to check yourself, please fill out the verification of benefits form below.