Oscar Insurance

If you are in Tennessee and seeking addiction treatment, you may wonder where to start. There are so many addiction treatment centers and recovery options out there. Where do you begin? Also, you may wonder how you will finance your stay at an addiction treatment center. We want to help you learn all you need to know about addiction treatment before you commit to rehab. Therefore, we want to help you learn about the type of treatment you could find through Oscar Health Insurance. If you have any other questions that this article does not answer, please call 901-403-7925.

Oscar Health Insurance Plans

Oscar Health Insurance is a relatively recently established insurance company. Two friends founded the company in 2012 after they both had frustrating healthcare experiences. The center of both of their bad experiences had been getting lost in an insurance jargon when they needed help. Therefore, Oscar’s focus, ultimately, is on serving clients one by one. Their client-first approach means that they prioritize convenience and simplicity for their clients. Another selling point includes being able to talk to an on-call doctor whenever clients need to. Additionally, Oscar enables clients to refill prescription orders without needing to visit a doctor. There are three plans Oscar offer to people in Tennessee.

To begin, there are three plans to be aware of: Oscar Simple Bronze, Oscar Classic Silver, and Oscar Saver Silver. Although these three plans all provide effective treatment, they do not all cover addiction treatment. For example, Oscar Simple Bronze provides care for mainly basic use with infrequent medical needs. Therefore, this plan may not cover substance abuse treatment. Coverage often depends on which county you reside in. Further, Oscar Classic Silver provides care for more general needs. Consequently, this plan may cover substance abuse treatment with a copay or coinsurance.  Along with that, those seeking treatment may have to meet a deductible. Whether or not someone needs to pay a deductible depends on the individual plan.

Finally, another plan is the Oscar Saver Silver. This plan provides limited, yearly use care. Therefore, the Oscar Saver Silver may cover substance abuse treatment a limited number of times per year with a copay or coinsurance. Depending on the individual plan, patients may have to meet a deductible.

Medicare and Medicaid in Tennessee

Several Tennessee treatment centers will accept Medicare and Medicaid. If you do not have private insurance through Oscar but if you are enrolled in either of these, you will likely find a treatment center that meets your needs. Individuals who are 65 years old and older qualify for Medicare. It is a US federal healthcare plan along with Medicaid. But Medicaid is designed for individuals who are disadvantaged economically. Medicare and Medicaid are not designed for everyone, however, they are great options for those who do not have private insurance and can’t receive coverage.

Information on Medicare

First, Medicare generally serves elderly people from the ages of 65 and older. However, the federal program also serves people with other circumstances. For example, people with End-Stage Renal Disease or other kinds of disabilities may qualify for Medicare. This healthcare is broken down into four parts. They are:

  • Medicare Part A, Hospital Insurance
  • Medicare Part B, Medical Insurance 
  • Medicare Part C, all-in-one coverage called Medicare Advantage
  • Medicare Part D, Prescription drug coverage

Each of these services we will go into greater detail down below. We want to help you determine if Medicare is right for you.

Medicare Part A

Medicare Part A hospital insurance will cover your care provided from a skilled nurse facility. This means your assisted living center, inpatient hospital visits, hospice care would all be covered under this plan. Sometimes home healthcare will be covered depending on the circumstances.

Medicare Part B 

Medical insurance is Medicare Part B. This plan will cover preventative services, outpatient care, and medical supplies. It will only cover some doctor’s visits and their services however. Therefore, it is recommended to ask how many visits and what services will be covered.

Medicare Part C

Medicare Part C is called Medicare Advantage. The Medicare privileges of parts A and B are included in this plan along with part D which is explained in greater detail in the next section. This all in one kind of coverage allows you to retrieve medical care, hospital care, and prescription services.

Medicare Part D

Medicare Part D is insurance for prescription drugs. If you choose this coverage then you can acquire your prescription medications at a lower price.

Information on Medicaid

Medicaid is another option for federally funded insurance. Medicaid is designed for those who are challenged economically, however, it does not only serve able-bodied adults. Rather, Medicaid can also serve people who have a disability, children, adults, or pregnant women. It’s purpose is to cover millions of individuals who do not have the means for health insurance. By being administered by the states and funded by the federal government, Medicaid is a suitable option for many people who need health insurance.

Coverage of Inpatient, Outpatient, and Residential Treatment

Medicare doesn’t have specific addiction treatment categories. Therefore, addiction treatment is only covered by Medicare if the provider approves it. But Tennessee’s Medicaid insurance does cover addiction treatment. This includes drug and alcohol treatment services such as outpatient or inpatient care. 

Outpatient care is where you go to treatment during the week for a couple of hours a day. You do not live at the facility, rather you voluntarily come and attend each day. Depending on your addiction, you could be in outpatient care for a couple of months or longer if you need it. There is not a time limit on how much care you need  

Inpatient care is considered a residential service where you get to stay on-site for your treatment. How long you stay depends on your recovery process, therefore it can be anywhere from a couple weeks to half a year. Patients get hands-on care at inpatient facilities and it has been shown to be quite effective. It is more expensive than outpatient treatment though. It is important to keep that in mind. 

Residential care means that the patients are all living together on a residential property. The treatment might be given here or depending on the center, the patients could be taken to another location where they would receive care. This concept allows for individuals to have a combination of inpatient and outpatient care. Some people chose to do this to escape unhealthy living environments and they want to focus on their recovery full time.

How to Find Information

Insurance companies have areas on their websites for you to inquire about what services they cover. There are usually sections for mental health and behavioral coverage when it comes to addiction and substance abuse care. However, if you previously have a place in mind make sure to see if it is covered by your Medicaid or Medicare insurance first before applying.

How Insurance Can Help You Receive Treatment

No matter how you’re covered through insurance, it is possible to find the treatment you want and have it covered. Oscar insurance provides quality care that focuses on convenience and customer experience. Three of their many plans in Tennessee include the Oscar Simple Bronze, Oscar Classic Silver, and Oscar Saver Silver. Although they offer limited options for addiction treatment, you may find a treatment center that fits with your plan. Remember if Oscar insurance doesn’t suit your needs, you can also look into Medicare and Medicaid options.

PPO and HMO Plans Offered Plans

Within every insurance plan there are additional layers that are always offered. The most common plans that are add ons are called HMO and PPO plans. What makes each plan different has to do with the network size, ability to see specialists, costs, adn out-of-network coverage. Specifically, the HMO or the Health Maintenance Organization plan provides access to certain doctors within a certain network. PPOs or the Preferred Provider Organization plan lets patients choose their doctors and medical facilities more flexibly and less strictly. 

The flexibility that the PPO plan provides is beneficial for some individuals however it is more expensive. This is because clients are able to choose their providers rather than under the HMO plan, clients have to pick a provider under the HMO list. Therefore, there is less flexibility through the HMO plan but you get lower monthly premiums. With the PPO plan, there is more flexibility to choose your provider but you have higher monthly premiums. It all depends on your needs and the way you view the costs and benefits of each plan. Choosing what kind of insurance you want can be overwhelming. That is why we are here to help. If you have any concerns or questions regarding Oscar Insurance please call us today at 901-403-7925.