It seems as though lawmakers, educators, physicians, and health administrators are constantly batting about statistics related to drug abuse in Kansas. A study published by The Trust for America’s Health showed that the teen drug overdose death rate in the state of Kansas has quadrupled since 2003. The same report shows that more than 11 percent of all deaths in Kansas are related to drug use and addiction. In fact, according to the Kansas Substance Abuse Epidemiological Indicators Profile, more than 8 percent of the population of the state, ages 12 years and older meet the criteria for alcohol abuse or dependence. The 18-25 year old substance abuse rate is more than double that of the general population with more than 20 percent meeting the criteria for abuse. As shocking as these statistics may be, they only begin to tell the tale of the shame, despair and isolation addiction brings to the sufferer as well as their family members.
Kansas Insurance for Alcohol and Drug Rehab
The federal Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) prevents health insurers from imposing lifetime benefit limitations to mental health and substance abuse treatment that are more restrictive than the medical or surgical benefits they offer. Kansas takes this limitation one step further with the Kansas Mental Health Parity Act which states that any group health insurance polity, including hospital contracts, fraternal benefits societies, medical service plans, or organizations that provide insurance must include coverage for treating alcoholism or other substance abuse problems. This law also extends to state-funded resources including Medicaid and federally funded Medicare. As long as an insurance company covers mental health and substance abuse care with the same limitations as medical or surgical coverage, how they choose to cover drug and alcohol abuse treatment is up to them.
The second largest health insurer in the country, Aetna is also one of the largest insurers in Kansas. Many plans within the Aetna umbrella cover mental health services including drug and alcohol treatment. Most plans cover the costs of both inpatient and outpatient treatment programs after the deductible for the plan is met. However, mental health treatment is limited only to severe, biologically-based mental or nervous disorders on the Preventative and Hospital care plan. By definition, this may exclude alcohol and drug rehab programs from coverage. PPO and Managed Choice plan premiums range from $600 to $750 a month for a family of four (two adults and two children) while high deductible plans typically save $150 per month in premium costs. Federal employee insurance coverage is often as low as $150 per month for an individual and also covers drug and alcohol treatment programs.
With five insurance plans to choose from, Blue Cross/Blue Shield of Kansas is one of the largest employer-sponsored insurance companies in the state. There are noticeable differences in out-of-pocket costs for using in-network providers and drug and alcohol rehab programs are no exception. For in-network service providers, plan deductibles range from $500 to $2,750 for an individual and from $1,000 to $5,500 for a family.
Additionally, coinsurance ranges from 20 percent to 50 percent depending on the plan with a maximum out of pocket expenses ranging from $5,500 for an individual to $14,700 for a family depending on the plan. Deductible and coinsurance requirements for drug and alcohol treatment programs are the same as they are for inpatient or outpatient medical services, with coinsurance ranging from 20 to 50 percent of the cost for in-network providers and at 50 percent of the cost for out-of-network providers plus the plan’s deductible costs.
In addition to insuring thousands of people throughout the state of Kansas, Humana is one of the largest providers of Medicare supplemental insurance in the country. With similar offerings to other major insurers, ranging from high deductible plans to PPO plans that provide maximum flexibility of care, Humana tends to have stricter coverage when it comes to inpatient stays for both medical patients and those seeking Kansas drug rehab and alcohol rehabilitation. For instance, while they will cover detox as well as inpatient and outpatient rehab services, a physician’s referral must be made prior to checking into a facility. The referral must then be processed through the insurance company in order for any benefits to kick in. Once that takes place, Humana will cover the cost of drug and alcohol rehab at the same levels as their medical coverage with appropriate coinsurance and deductibles due at the time of service.
The state of Kansas’ Medicaid offerings fall under the state’s KanCare program. Administered by one of three insurance companies, AmeriGroup of Kansas, Sunflower Health Plan and United Healthcare, KanCare is designed to cover low-income families, persons with disabilities and otherwise uninsured children throughout the state. While other benefits vary across KanCare insurance providers, drug and alcohol abuse recovery programs are the same for all three insurers. Any inpatient, outpatient, detox or partial inpatient facility that accepts Medicaid is covered under KanCare without an out-of-pocket expense. Additionally, the Sunflower Health Plan also provides a smartphone to those with a diagnosed substance use disorder so they can have instant access to support information.
Medica is one of the largest health insurance providers in the Midwest. Offering access to the Mayo Clinic Centers for Excellence Program, Medica has more than 32,000 providers in the region including several of Kansas’ drug rehab and alcohol rehabilitation centers. There are three tiers of insurance coverage, gold, silver and bronze with catastrophic coverage available to beneficiaries under age 30 who are otherwise healthy.
Drug and alcohol treatment is covered only after the high deductible cap is met in catastrophic coverage, deductibles range from $750 for an individual and $2,250 for a family to $6,000 for an individual and $12,500 for a family. Once this deductible is met, whether, through medical and surgical treatment or drug and alcohol recovery treatment, coinsurance is due for 20 percent of the total cost for in-network providers and 50 percent of the total cost for out-of-network providers. Fortunately, out of pocket maximums are generally capped at $6,600 for an individual and $13,300 for an entire family.
Federally funded Medicare insurance is designed for Americans age 65 or older, or those who receive Social Security Disability Insurance. In addition to covering a portion of the cost of general medical care, Medicare will cover some of the cost for drug or alcohol abuse treatment facilities including inpatient and outpatient treatment options. Although Medicare is a federally funded insurance, it is not subject to federal laws governing coverage levels the same way private insurers are. For instance, Medicare will only cover a total of 190 days of inpatient psychiatric care (including drug treatment) over a person’s entire lifetime. Part A plans cover inpatient substance abuse treatment the same way it covers inpatient hospital care, with the same out-of-pocket expenses. Part B covers 80 percent of outpatient treatment while either you or your supplemental insurance is responsible for the remaining 20 percent.
Sunflower Health Plan
In addition to administering Kansas’ Medicaid program, Sunflower Health Plan also offers Ambetter, a comprehensive medical insurance program akin to an HMO. Available in Gold, Silver, and Bronze, each plan covers in-network substance abuse treatment, including inpatient and outpatient services, after the plan’s deductible has been met and coinsurance has been paid. While affordable, coverage is only available in Johnson and Wyandotte counties and tends to be limited to in-network providers.
One of the largest insurers in the country, United Healthcare administers benefits for the KanCare program as well as employer-sponsored programs and short-term individual health insurance. Short-Term United Healthcare plans, those designed to extend coverage during coverage gaps, will cover up to 30 days of inpatient treatment for substance abuse and outpatient treatment up to $15,000. Other plans cover inpatient, outpatient, detox, and partial inpatient services after deductible and copays are met.
While an overwhelming prospect, it is possible that your existing insurance will cover some or all of your or your loved one’s Kansas drug rehab program.