First Health Rehab Coverage
First Health insurance offers rehab coverage for residents of states with participating First Health providers and subsidiaries. First Health insurance is available on both coasts:
- First Health of California: Serves residents of California
- First Health of Oregon: Serves residents of Oregon and Washington state
- First Health Northeast: Serves residents of Connecticut, New York, and New Jersey* (see note)
First Health health insurance plans offer healthcare access and treatments to residents of the above states either in the form of a Marketplace purchase, such as self-bought individual or family plans (now Ambetter by First Health for California individual & family plans), or as the official Medicaid/Medicare for that state:
- California Medicaid
- Oregon Medicaid
- Connecticut Medicaid
- New York Medicaid
- New Jersey Medicaid
All First Health health insurance plans cover some mental health and drug addiction treatment services. Nevertheless, the amount covered varies between healthcare providers and can depend on your location, chosen plan, the treatment methods you’re considering, and other variables.
*Note: Individuals with First Health insurance plans in the First Health Northeast region (including Connecticut, New York, and New Jersey) remain First Health subscribers. However, First Health Northeast coverage is now under the larger UnitedHealth Group umbrella of health insurance and healthcare providers.
Do you need to find an insurance plan for yourself or a loved one that covers the cost of drug abuse treatment? If you need help understanding your insurance benefits as they apply to addiction treatment, Zinnia Health has facilities that are in-network with First Health insurance and can help you navigate your coverage benefits. Learn more about our treatment facilities by calling our toll-free helpline, day or night, at (855) 430-9439.
Does First Health Insurance Cover Alcohol Rehab?
Yes, First Health covers alcohol treatment services.
The Affordable Care Act established certain essential benefits for insured individuals, and alcohol rehab and substance abuse treatment are considered essential care services.
All insurance carriers in the Marketplace, including First Health, must cover at least a portion of the costs associated with mental and behavioral health services, alcohol rehab, and substance abuse and substance use disorder (SUD) treatment. Some companies may only cover evidence-based — and not experiential — therapies.
First Health covers alcohol rehab through Managed First Health Network (MHN); the behavioral and mental health services subsidiary of First Health.
Often, entering alcohol rehab requires detox before entering a residential treatment facility or beginning an outpatient program. With outpatient rehab, you may need to consider expenses like per-visit copays. There may also be a limit on the number of visits per policy period. If you exceed your visits, you may have to pay out of pocket.
Does First Health Insurance Cover Substance Abuse Treatment?
Yes, First Health covers substance abuse treatment.
First Health plans offer insurance benefits to cover both inpatient and outpatient substance abuse treatment programs. If you don’t yet have coverage or you want to find a provider in your area, you can use First Health’s free Find a Provider tool.
Substance abuse treatment often involves an inpatient program, but it’s important to consider exclusions and restrictions. For instance, the rehab center may need to request prior authorization before providing services. It’s a good idea to verify what your policy covers — not all plans cover rehab facilities offering experiential treatments.
Does First Health Cover Mental Health Treatment?
Yes, First Health covers mental health treatment services and other behavioral health care.
First Health plans offer coverage for mental health disorders and related treatments through MHN, as noted above. However, coverage for substance abuse and mental health services is in the same category and share coverage on your plan, so this might mean that drug rehab could reduce your coverage for mental health services. Health benefits generally reset at the start of a new policy period.
First Health Inpatient Coverage
The level of coverage provided by First Health for inpatient treatment options depends on your plan. However, your insurance will pay some portion of your inpatient treatment costs. There is no out-of-network care for some plans.
Many health insurance providers, including First Health, cover drug abuse treatment but may limit coverage of certain services. For instance, experimental treatment methods, such as hypnotherapy, or experiential treatment methods, like those at outdoor or wilderness camps — even if the program is for helping people with mental health or substance use disorder — may not be covered.
First Health Outpatient Coverage
Outpatient treatment is covered for those with an First Health health insurance plan, but the coverage level depends on your plan type. If you don’t have a plan yet, there are several First Health plan types.
When assessing plan benefits, it’s important to consider coverage caps. For instance, some plans may not cover any out-of-network doctor visits at all, while others may have a cap on the number of visits or “stays” per policy period.
Intensive outpatient treatment programs, or partial hospitalization programs (PHPs) may:
- Require prior authorization for coverage.
- Demand several appointments each day or week.
If you forget to obtain your primary care provider’s authorization or the demands of your chosen program don’t align with your policy benefits, you could be looking at potentially high out-of-pocket costs.
If you need assistance finding your insurance coverage information, reach out to a compassionate admissions specialist at Zinnia Health by calling (855) 430-9439. With your permission, we can contact your insurance company on your behalf and find out your exact levels of coverage.
Rehabs That Accept First Health Insurance Near You
Regardless of its state of origin, First Health coverage applies across the nation. If you’re looking for an in-network rehab facility that accepts First Health insurance, look for an inpatient or outpatient rehab facility operated by Zinnia Health.
Zinnia Health offers convenient locations around the country. We’re an approved, in-network provider for First Health health insurance. Our substance abuse treatment specialists are especially experienced with clients in need of dual diagnosis treatment.
Contact our admissions department to see if your preferred location accepts First Health.
Our locations that may accept First Health insurance include:
If you would like to speak with a treatment specialist who can help you find in-network drug and alcohol rehab programs in your area, reach out to Zinnia Health at (855) 430-9439 to learn more.
How to Check Your First Health Coverage
With more than 30 independent providers in the national insurance network, speak directly with your First Health insurance provider. First Health also offers a quick video to help you learn more about the First Health network of providers.
If you’re having trouble locating your benefits, you can contact First Health directly or reach out to Zinnia Health. We can help answer your questions.
First Health can also help if you haven’t received or can’t find your card.
Types of First Health Plans That Cover Addiction Treatment
All health insurance plans cover addiction treatment, but the coverage amount varies depending on the type of plan.
- Bronze plans typically cover 60% of the costs of most services, including mental health and substance use disorder treatment. This means you’re responsible for 40% of the costs.
- Silver plans typically cover 70% of the costs of most services, including mental health and substance use disorder treatment. Your responsibility will be 30% of the costs.
- Gold plans typically cover 80% of the costs of most services, including mental health and substance use disorder treatment. You’ll be responsible for 20% of the costs.
- Platinum members enjoy 90% coverage for most healthcare services and only 10% out-of-pocket costs.
These plan tiers align with the standards set by the Affordable Care Act. However, your plan may cover substantially more (or less), depending on variables like your deductible, your coinsurance costs (if any), and whether you have personal accident, vision, dental, or other care included in your plan.
In addition to checking your coverage, you also need to assess your annual deductible, out-of-pocket maximum, and access to out-of-network services. For instance, if your plan has a low annual deductible of $500, you only have to pay that amount for your care and then your plan’s coverage takes over.
But low deductibles mean higher monthly premiums. The highest deductible means you’ll have the lowest premiums, but you’ll have to pay more before your coverage takes over. Once you’ve reached your policy’s out-of-pocket maximum, your insurance policy begins covering all your costs.
Learn more about mental health and substance abuse treatment policies at Healthcare.gov.
Get a quote for an individual or family First Health Insurance plan today.
Frequently Asked Questions
What Length of Stay Will First Health Cover?
There are caps on how long you can stay in an inpatient facility and how many outpatient visits you can make each calendar year. These limits vary from one health plan type to the next, which is why it’s important to contact your insurance carrier or a treatment center for more information about your benefits.
How To Pay for Costs First Health Doesn’t Cover?
Insurance rarely covers 100% of treatment costs for drug and alcohol abuse, opioid treatment programs, or any other type of treatment. If you’re worried about covering the out-of-pocket expenses, like copays, deductibles, treatments that First Health may not cover, or other terms of your policy, call and speak directly to the treatment facility you’re considering.
Many facilities offer payment plans, grants, and/or be able to put you in touch with other programs that may cover your out-of-pocket expenses.
What To Do If First Health Doesn’t Cover Rehab?
First Health covers some costs of rehab, behavioral health, or mental health types of co-occurring disorders, and healthcare for other health conditions in most cases. However, it might not cover certain facilities, especially those that employ nontraditional techniques.
If you have chosen a treatment provider but are worried about the cost of drug or alcohol recovery, speak to the treatment center. A rehabilitation center can give you information on grants, payment options, and other alternatives to ensure you get the care you need.
Do Rehab Facilities Need to Be In-Network?
The type of health insurance plan you have determines whether an inpatient rehab center needs to be in-network. With HMO plans, you’ll only receive coverage if with someone in your network. With PPO plans, you have some coverage for all providers, but you’ll have less coverage for those out of network.