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  • Gateway Health is a managed care provider that helps people sign up for and access benefits with Medicaid and Medicare systems. Plans in the Gateway Health system may cover addiction treatment and/or other behavioral health and mental health services

    How To Determine Gateway Health Benefits For Substance Abuse Treatment

    When you decide that it’s time to get help for substance abuse, you’ll want to reach out to Gateway Health directly to learn more about your substance use coverage. 

    You’ll be able to talk with a health insurance rep who can help you understand your plan. You can also read your plan policy, or reach out directly to a rehab center or other healthcare providers to learn more about the type of insurance they accept. 

    Does Gateway Health Cover Detoxification Programs?

    The first step to a successful recovery is often the completion of a detox program that includes medical assistance that monitors your mental and physical health. 

    Depending on your health or other special needs, your Gateway Health plan may cover some or all of your detox or withdrawal management program. 

    Does Gateway Health Cover Inpatient Drug Or Alcohol Rehab?

    During inpatient treatment, people with substance use disorder live at the facility and have access to 24-hour health care services from their treatment team. Your enrollment at a residential rehab center may be covered under your Gateway Health plan. 

    Does Gateway Health Cover Outpatient Drug Or Alcohol Rehab?

    For many people, inpatient treatment is not a possibility due to the need to keep up with other responsibilities. Luckily, outpatient treatment can be an effective option. 

    During outpatient treatment, you’ll commute to and from the treatment facility each day. Depending on your health, medical needs, and your individual plan’s provider network, outpatient drug and/or alcohol rehab may be covered within your Gateway Health plan. 

    Does Gateway Health Cover Intensive Outpatient Treatment?

    During intensive outpatient treatment, you receive therapy and other treatments for several hours each day. Intensive outpatient treatment (IOP) is more intense than regular counseling appointments but still allows you to meet the demands of your day-to-day life. 

    IOP treatment may be fully or partially covered by your Gateway Health plan. 

    Does Gateway Health Cover Partial Hospitalization Programs?

    More intense than IOP treatment, partial hospitalization programs (PHPs) offer much of the same services as an inpatient treatment program. Patients who go through partial hospitalization programs still go home at night and return for treatment the next day. 

    Your Gateway Health plan may partially or fully cover a partial hospitalization program.

    Does Gateway Health Cover Methadone Or Suboxone Treatment?

    Medication-assisted treatment (also known as MAT) combines medication(s) like methadone or Suboxone with behavioral therapy to help you work against the psychological and physical issues that can result from opioid use. 

    Your Gateway Health plan may cover some or all of your medication-assisted treatment with these medications. Your Gateway Health plan may also cover a certain amount of doses of naloxone, which is an opioid overdose reversal medication.

    Does Gateway Health Cover Medication-Assisted Treatment For Alcohol Addiction?

    Medication-assisted treatment for alcohol addiction combines prescription drugs like naltrexone or disulfiram with behavioral therapy. Depending on your plan and coverage, some or all of your MAT services may meet eligibility for coverage. 

    Where Are Gateway Health Plans Available? 

    Gateway Health offers insurance coverage in different service areas and counties across Pennsylvania.

    Types Of Gateway Health Plans

    Gateway Health offers different types of plans, including:

    Ruby Plan

    The Ruby Plan offers a $0 coinsurance or copay for primary care provider visits and a $25 copay for a referral to a  specialist or telehealth visit. 

    Diamond Plan

    The Diamond Plan offers a $0 copayment for primary care provider, telehealth, and specialist visits. 

    Other Things To Consider

    As you begin the addiction treatment process, it’s important to keep an eye out for various factors that can affect your insurance coverage. This can include out-of-pocket costs, reimbursement requirements, in-network providers, prior authorization, and more.

    At Ark Behavioral Health, we’re here to provide you with the help that you need to begin your recovery — reach out today to verify your insurance coverage

    Written by Ark Behavioral Health Editorial Team
    ©2024 Ark National Holdings, LLC. | All Rights Reserved.
    This page does not provide medical advice.

    National Institute on Drug Abuse - Drug Addiction Treatment in the United States

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