What is exactly covered under your HPN plan will vary based on the plan you select. Some plans have higher levels of coverage than other plans. Despite this, there are certain healthcare services, which are known as essential health benefits, that must be covered in some capacity, as mandated by the Affordable Care Act (ACA).1 Mental health and substance use disorder coverage is considered 1 of the 10 essential health benefits, meaning that your HPN health plan must provide some type of coverage for such services and treatments.
Your plan’s coverage may vary, but often, the following common treatment methods are covered in some capacity under HPN plans:
- Outpatient program rehab or therapy: Outpatient drug rehab and therapy is designed for those who don’t need round-the-clock care. Instead of staying in a facility 24/7, you’d go to the facility for treatment and then go home in the evenings. Your HPN should provide some sort of coverage for this type of mental health care service. For those who do not need around-the-clock rehab or detox, an outpatient rehab or therapy program may work best. 2, (How are behavioral therapies used to treat drug addiction?)
- Intensive outpatient programs (IOPs): IOPs are usually recommended to treat people who need a structured program but don’t necessarily need round-the-clock supervision or care.3 (under section after conclusion) Care may be provided every day for a few hours at a time, but the structure varies by facility.
- Inpatient or residential rehab: Inpatient or residential rehab treatment involves intensive care for substance use or another mental health disorder, or a co-occurring disorder. It involves receiving medical care and/or therapy within a treatment facility for a predetermined length of time.2, (How are behavioral therapies used to treat drug addiction?) Your HPN may provide some level of coverage if you need to enter an inpatient or residential rehab program.
- Partial hospitalization programs: Partial hospitalization programs are a combination of inpatient and outpatient programs. Often, a partial hospitalization program will involve a structured day program, similar to inpatient programs. However, you won’t be required to stay overnight in a facility, similar to an outpatient program.4 Your HPN drug rehab coverage will likely cover partial hospitalization programs in some capacity.
There may be other treatments that your Health Plan of Nevada medical insurance may fully or partially cover, and this list is not exhaustive. Please note, what your plan covers may vary, and it’s important to verify your Health Plan of Nevada network coverage before obtaining treatment to avoid any surprise medical costs.
Does Health Plan of Nevada Cover Mental Health Treatment Facilities?
Under the ACA, all health plans must provide some coverage for mental health and substance use disorders and their subsequent treatments.1 Specifically, the essential health benefit for mental health mandates that behavioral treatment, mental and behavioral inpatient care, and substance use disorder treatment is covered in some capacity by a health plan, including your HPN plan.1
Your Health Plan of Nevada coverage, under the ACA’s mandate, extends to the treatment of co-occurring disorders. A co-occurring disorder is a term that mental health experts use to refer to the simultaneous instance of substance use and mental health disorder. According to the National Institute of Drug Abuse (NIDA), 7.7 million Americans have a co-occurring disorder,5 20.3 million Americans have a substance abuse disorder, and 42.1 million have a mental illness.5These numbers show that, if you have a co-occurring disorder, you’re not alone. Thanks to the ACA’s mandate, your Health Plan of Nevada benefits may provide some level of coverage for treatment for both a co-occurring disorder or stand-alone drug or heroin rehab.