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

Many Tennessee treatment centers accept both Medicare and Medicaid. If you do not have private insurance through Oscar but you are enrolled in either of these, you will likely find a treatment center that meets your needs. Medicare is the US federal healthcare plan for people who are ages 65 and older. Medicaid, however, is the US federal healthcare plan for those who are economically disadvantaged. Although Medicare and Medicaid aren’t for everyone, these options can help those who aren’t covered through private insurance.

Information on Medicare

First, Medicare generally serves elderly people who are 65 or older. However, the federal program also serves people with other circumstances. For example, certain people with disabilities and people who have End-Stage Renal Disease (ESRD) may qualify for Medicare. ESRD is a permanent kidney failure that requires dialysis or a transplant. Further, Medicare’s services come in four distinct parts. These are the four parts:

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

We want to help you understand more about these services. This way, you can determine if Medicare is right for you.

Medicare Part A

Part A is hospital insurance. Therefore, Part A covers care in a skilled nurse facility (such as an assisted living center), hospice care, inpatient hospital visits, and home healthcare in some situations.

Medicare Part B 

Part B is medical insurance. Consequently, Part B covers outpatient care, some doctors’ visits, medical supplies, preventative services, and some doctors’ services.

Medicare Part C

Part C is a combination of Part A, Part B, and (most of the time) Part D. This means that those covered by Part C have access to hospital care, medical care, and prescription services.

Medicare Part D

Part D covers prescription drug coverage. This means that those covered by Part D can receive their medications at a lower cost than they normally are.

Information on Medicaid

Another option for federally funded insurance is Medicaid. Millions of people in the US receive healthcare through Medicaid. Primarily, Medicaid serves those who are economically disadvantaged. Further, Medicaid does not only serve able-bodied adults. People with disabilities, pregnant women, children, and adults can all receive coverage from Medicaid. Through Medicaid, people can receive care who would not otherwise have the means to do so. States administer Medicaid, and the program is funded by states and the federal government.

Coverage of Inpatient, Outpatient, and Residential Treatment

Although there are no specific benefit categories for addiction treatment, Medicare covers those types of services when providers deem the services reasonable and necessary. Therefore, Medicare could potentially cover inpatient, outpatient, and residential treatment. Further, Tennessee’s Medicaid also covers addiction treatment for adults with alcohol or drug dependency.  Medicaid’s coverage includes outpatient and residential services, among other treatments. 

Here is some information about the difference between outpatient, inpatient, and residential treatment. Outpatient treatment is part-time, usually between 10 to 12 hours a week, meaning that the recovering user comes to the facility, but they do not stay in the facility. These programs usually run between three months to one year. Ultimately, outpatient treatment is right for those who have more mild addictions.

Inpatient treatment means the person stays at a facility for a period of time—usually between three weeks and six months. While staying at the facility, they undergo intensive treatment. Inpatient treatment has a higher success rate than outpatient treatment, but it is also more expensive. Further, inpatient treatment interrupts daily life. Ultimately, inpatient treatment is especially effective for those who have undergone serious addictions.

Residential treatment means that patients live in a residence with other patients. Treatment staff transports the patients to the treatment center each day. In this way, they experience the benefits of both inpatient and outpatient treatment. Residential treatment is best for those who want to keep their treatment and living areas separate, but they still want to separate themselves from their toxic environments.

How to Find Information

Behavioral and mental health sections of insurance company websites often contain information about substance abuse treatment. If you are looking for a specific facility, check your insurance company’s website to make sure the provider is covered by your plan. Many facilities in Tennessee offer payment assistance and/or offer their services on a sliding fee scale. 

How Insurance Can Help You Receive Treatment

No matter how you’re covered through insurance, you can find the treatment you need. To review, 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.

Further, those who do not have insurance through Oscar can find help through either Medicare or Medicaid. In summary, Medicare is federal healthcare that covers those over the age of 65. Also, Medicare covers certain people who have disabilities and those who have ESRD. Therefore, Medicare can be a good option for people who fall into those categories. Additionally, Medicaid is a federal program designed to serve people who are economically challenged. Therefore, people who have severe financial constraints may qualify for Medicaid.

HMO Plans and PPO Plans

Another element of insurance to be aware of is the types of plans offered. Most insurance companies offer a Health Maintenance Organization (HMO) plan or a Preferred Provider Organization (PPO) plan. The difference between these types of plans has to do with network size, ability to see specialists, costs, and out-of-network coverage. Specifically, HMOs provide access to certain doctors within a certain network. However, PPOs offer more flexibility in choosing doctors and medical facilities.

While HMO plans usually require lower monthly premiums, they also require more out of pocket. Further, PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of the network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan. Clearly, you have a lot of options when it comes to deciding which method of payment is right for you. If you would like more information about HMOs, PPOs, or Oscar insurance, please call us today. Contact us at 901-403-7925.