Insurance Plans That Cover Addiction Treatment

New York Medicaid is the foundation of addiction treatment access on Long Island, covering virtually every level of care at OASAS-certified facilities with $0 copay and $0 deductible for qualifying members. Medicaid managed care plans — including Fidelis Care, Healthfirst, UnitedHealthcare Community Plan, WellCare, and Aetna Better Health — each contract with a network of Nassau and Suffolk County providers offering detox, inpatient rehab, IOP, PHP, and all FDA-approved MAT medications. Under New York's OASAS system and Timothy's Law mental health parity protections, Medicaid members cannot be denied medically necessary addiction treatment. Most outpatient and MAT services require no prior authorization. Eligibility is based on income — individuals earning up to 138% of the federal poverty level qualify. Same-day benefit verification is available by calling our team at 631-762-3763.

Aetna Better Health of New York is a Medicaid managed care plan serving eligible New York residents including those enrolled in Medicaid, the Health and Recovery Plan (HARP), and dual Medicare-Medicaid coverage. Coverage includes the full OASAS continuum — medical detox, inpatient rehab, residential, PHP, IOP, and outpatient counseling — with $0 copay for qualifying members. All FDA-approved MAT medications are covered including Suboxone, Sublocade injectable, Vivitrol, and Brixadi. HARP-enrolled members have access to enhanced behavioral health services including peer support specialists and community-based care coordination. Most outpatient addiction treatment services do not require prior authorization under the Aetna Better Health Medicaid plan. Call 631-762-3763 to verify Aetna Better Health benefits and find OASAS-certified Long Island providers in the network.

UnitedHealthcare Community Plan is UHC's Medicaid managed care product serving New York State Medicaid-eligible members on Long Island and throughout the state. UHC Community Plan covers the full OASAS addiction treatment continuum with $0 copay for qualifying Medicaid members — including medical detox, inpatient rehabilitation, residential, PHP, IOP, outpatient counseling, peer support, and all FDA-approved MAT medications. Behavioral health benefits are administered through Optum, UHC's behavioral health division. HARP (Health and Recovery Plan) enrolled members have access to enhanced community-based services including peer specialists and community psychiatric support. Most outpatient and MAT services do not require prior authorization under the Community Plan. Call 631-762-3763 to verify UHC Community Plan coverage and identify in-network OASAS-certified Long Island facilities.

Fidelis Care is one of New York's largest Medicaid managed care plans, serving over 1.7 million members statewide. Their Medicaid Managed Care and HealthierLife (HARP) plans provide comprehensive addiction treatment coverage at OASAS-certified facilities across Long Island with $0 copay and $0 deductible for qualifying members. Coverage includes medical detox, inpatient residential rehabilitation, intensive outpatient programs (IOP), partial hospitalization (PHP), and all FDA-approved MAT medications including Suboxone, Sublocade, Vivitrol, and Brixadi. Most outpatient services do not require prior authorization. Fidelis also offers the Essential Plan for low-income adults above the Medicaid threshold, and Ambetter from Fidelis Care through the NY State of Health Marketplace.

Healthfirst is New York's largest non-profit health insurer, serving over 1.8 million members. Their Medicaid managed care plan provides comprehensive addiction treatment coverage at OASAS-certified facilities across Long Island with $0 copay. Coverage includes medical detox, inpatient rehabilitation, intensive outpatient programs, medication-assisted treatment (Suboxone, Sublocade, Vivitrol, Brixadi), and ongoing recovery support. Healthfirst also offers Essential Plan and Medicare Advantage options with addiction treatment benefits.

MetroPlusHealth is New York City's largest municipally sponsored health plan, serving Medicaid, Essential Plan, and Qualified Health Plan members across New York. MetroPlus members on Long Island — including those who have moved from NYC to Nassau or Suffolk County — retain full addiction treatment benefits at OASAS-certified Long Island facilities. Coverage includes $0 copay for Medicaid members accessing medical detox, inpatient rehab, PHP, IOP, outpatient counseling, peer support, and all FDA-approved MAT medications including Suboxone, Sublocade, Vivitrol, and Brixadi. HARP-enrolled members have access to enhanced behavioral health and recovery services. Most outpatient addiction treatment services do not require prior authorization. Call 631-762-3763 to verify MetroPlus coverage and find in-network Long Island providers.

WellCare of New York is a Medicaid managed care plan serving New York State Medicaid-eligible members across Long Island and throughout the state. WellCare covers the full OASAS addiction treatment continuum — medical detox, inpatient residential rehabilitation, PHP, IOP, outpatient counseling, peer support, and all FDA-approved MAT medications including Suboxone, Sublocade, Vivitrol, and Brixadi — with $0 copay for qualifying Medicaid members. WellCare is a subsidiary of Centene Corporation, one of the nation's largest Medicaid managed care organizations. HARP-enrolled members have access to enhanced behavioral health services including peer support specialists and community-based recovery coordination. Most outpatient and MAT services do not require prior authorization. Call 631-762-3763 to verify WellCare Medicaid benefits and identify in-network OASAS-certified Long Island providers.

Medicare covers medically necessary substance use disorder treatment for beneficiaries 65 and older or those with qualifying disabilities. Part A covers inpatient hospital-based detox and short-term residential rehabilitation, with costs shared after deductible. Part B covers outpatient services including therapy, psychiatric evaluations, IOP, PHP, and MAT prescriber visits — typically at 80% after the annual deductible, leaving a 20% coinsurance responsibility. Since 2020, Medicare Part B includes a bundled Opioid Treatment Program (OTP) benefit covering methadone maintenance and all associated counseling. Part D plans cover FDA-approved MAT medications including buprenorphine films, Sublocade injectable, and Vivitrol. Medicare Advantage (Part C) plans available on Long Island often include enhanced behavioral health benefits, lower cost-sharing, and broader provider networks than Original Medicare. Call us at 631-762-3763 to confirm which Long Island facilities accept your specific Medicare plan.

Self-pay is a viable path to addiction treatment on Long Island, especially for individuals who are uninsured, between coverage periods, or who prefer confidentiality over filing insurance claims. Many OASAS-certified facilities offer sliding scale fees based on household income, structured payment plans, and limited scholarship beds for those who qualify. State-funded programs through New York OASAS may also be available at little or no cost for uninsured individuals. Self-pay patients typically have more flexibility in facility selection and admission timelines. Our navigators at 631-762-3763 can identify programs with available financial assistance, verify sliding scale eligibility, and arrange same-day or next-day placement — at no cost to you.

Most private health insurance plans — whether through an employer, union, or the NY State of Health Marketplace — are required by federal law to cover addiction treatment at parity with medical and surgical benefits. The Mental Health Parity and Addiction Equity Act (MHPAEA) prohibits insurers from imposing more restrictive limits on substance use disorder treatment than on other health conditions. On Long Island, commercially insured patients typically have access to the full continuum of care: medical detox, inpatient residential rehab, PHP, IOP, outpatient counseling, and MAT. Prior authorization is commonly required for residential levels of care. Our navigators can verify your specific benefits, confirm prior auth requirements, identify in-network Long Island providers, and coordinate admission — call 631-762-3763 for a free, same-day benefits check.

Aetna is one of the nation's largest commercial health insurers, covering addiction treatment at the full continuum of care for Long Island members. Aetna's behavioral health division manages substance use disorder benefits, and prior authorization is typically required for inpatient and residential levels of care. Aetna covers all FDA-approved MAT medications including buprenorphine (Suboxone, Sublocade), naltrexone (Vivitrol), and Brixadi injectable. Under MHPAEA federal parity law, Aetna cannot apply more restrictive prior auth or utilization review criteria to addiction treatment than to comparable medical benefits. Aetna HMO, PPO, and EPO members on Long Island should verify in-network OASAS-certified providers before admission. Call 631-762-3763 for a free same-day Aetna benefits check.

Aetna PPO plans offer the broadest provider flexibility of Aetna's Long Island plan options — members can access both in-network and out-of-network addiction treatment providers, though in-network care carries significantly lower cost-sharing. Aetna PPO covers the full continuum of addiction treatment including detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. Out-of-network benefits are especially valuable for members seeking specialized dual diagnosis programs or facilities not in the standard Aetna HMO network. Prior authorization is typically required for inpatient and residential levels of care. Deductibles and out-of-pocket maximums vary by plan year. Call 631-762-3763 for a free benefits verification — we'll confirm your specific Aetna PPO deductible, copays, and which Long Island facilities are in-network.

Cigna, operating its behavioral health division through Evernorth, provides comprehensive addiction treatment coverage for Long Island members. Cigna covers the full continuum of care — detox, inpatient rehabilitation, PHP, IOP, outpatient counseling, and all FDA-approved MAT medications. Cigna's Collaborative Care Model integrates behavioral health with medical management, often allowing streamlined prior authorization for step-down levels of care (PHP and IOP) when inpatient admission is clinically justified. Cigna also offers EAP-connected pathways for employer-sponsored members, which can facilitate confidential referrals and a limited number of free counseling sessions before insurance benefits are activated. Prior authorization is required for residential levels of care. Long Island members should verify in-network OASAS providers before admission — call 631-762-3763 for a free Cigna benefits check.

Blue Cross Blue Shield plans are accepted at most OASAS-certified addiction treatment facilities on Long Island. The national BlueCard network means that members from any BCBS affiliate — including Empire BCBS (NY), Horizon (NJ), Excellus (Upstate NY), Highmark (WNY), Anthem, and others — can typically access Long Island providers under host-plan rules. Coverage includes the full continuum of addiction treatment: detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. Prior authorization requirements and cost-sharing vary by affiliate and plan type. New York members with Empire BCBS plans have the broadest in-network access across Long Island. Call 631-762-3763 with your BCBS member ID to verify your specific plan's coverage, prior auth requirements, and in-network Long Island providers.

Empire BlueCross BlueShield is New York's largest commercial health insurer and one of the most widely accepted plans at OASAS-certified addiction treatment facilities on Long Island. Empire BCBS covers the full treatment continuum — medical detox, inpatient rehabilitation, PHP, IOP, outpatient counseling, and all FDA-approved MAT medications including Suboxone, Sublocade, Vivitrol, and Brixadi. Under New York's Timothy's Law and federal MHPAEA parity requirements, Empire BCBS is prohibited from applying more restrictive criteria to addiction treatment than to comparable medical benefits. Prior authorization is typically required for inpatient and residential levels of care; IOP and outpatient often do not require prior auth. Empire PPO members have both in-network and out-of-network access. Call 631-762-3763 for a same-day Empire BCBS benefits verification and in-network provider match on Long Island.

Excellus BlueCross BlueShield is an Upstate New York BCBS affiliate serving the Rochester, Central New York, and Utica regions. Long Island residents with Excellus coverage — such as dependents of Upstate-employed policyholders or members who have relocated — can access addiction treatment at Long Island facilities through the national BlueCard network, with coverage processed under guest-plan rules. All FDA-approved addiction treatment services are covered subject to prior authorization and applicable deductibles. Cost-sharing for out-of-area care under BlueCard may differ from in-network Excellus rates. Call 631-762-3763 to confirm which Long Island OASAS-certified facilities will accept Excellus BCBS and what your specific out-of-area benefits include.

Highmark BlueCross BlueShield of Western New York serves the Buffalo-Niagara region. Long Island residents with Highmark WNY coverage can access addiction treatment facilities through the national BlueCard network, allowing host-plan processing at most BCBS-participating Long Island providers. Coverage includes detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT subject to prior authorization and plan-specific cost-sharing. Out-of-area care through BlueCard may carry different deductibles and copays than in-territory Highmark rates. Call 631-762-3763 to verify your Highmark WNY out-of-area benefits and identify Long Island OASAS-certified providers that accept BlueCard.

Blue Cross Blue Shield of Massachusetts members can access addiction treatment at select Long Island facilities through the national BlueCard network. This is most relevant for Massachusetts residents seeking treatment in New York, or Long Island residents with family coverage under a Massachusetts employer plan. Coverage for out-of-state care is processed under BlueCard host-plan rules — Long Island BCBS-participating facilities will bill as though the patient has an Empire BCBS plan, with costs reconciled back to BCBS MA. Prior authorization requirements and benefit levels depend on the member's specific BCBS MA plan. Call 631-762-3763 to verify out-of-state BCBS Massachusetts benefits and identify which Long Island treatment providers accept BlueCard.

Horizon BlueCross BlueShield of New Jersey is the state's largest health insurer. NJ residents with Horizon coverage can access Long Island addiction treatment facilities through the BlueCard national network, making Horizon an option for New Jersey residents seeking treatment in New York or Long Island residents covered under a New Jersey employer group plan. Out-of-state addiction treatment benefits are subject to prior authorization and Horizon's behavioral health utilization management. BlueCard processing means Long Island providers will see the claim reimbursed through host-plan rates. Call 631-762-3763 to confirm which Long Island OASAS-certified facilities accept Horizon BlueCard and what your out-of-state benefit levels are.

Anthem BlueCross BlueShield operates in 14 states and is one of the largest BCBS affiliates in the country. Anthem members — primarily from states like Connecticut, Georgia, Virginia, Ohio, and Indiana — can access Long Island addiction treatment through the BlueCard national network, making Anthem relevant for Long Island residents covered under out-of-state employer plans or family members seeking treatment close to home. Anthem's behavioral health division, now operating under the Elevance Health brand, covers the full treatment continuum including detox, inpatient rehab, PHP, IOP, outpatient, and MAT. Prior authorization is required for residential care. Call 631-762-3763 to verify your Anthem BCBS out-of-state benefits and match with in-network Long Island providers.

Highmark BCBS is a major regional Blue Cross Blue Shield affiliate primarily serving Pennsylvania, Delaware, and West Virginia. Long Island residents or patients from Highmark service areas seeking addiction treatment on Long Island can typically access care through the BlueCard national network at BCBS-participating facilities. Highmark covers medically necessary addiction treatment including detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT, subject to prior authorization and plan-specific cost-sharing. Out-of-area claims are processed under BlueCard host-plan protocols. Call 631-762-3763 to confirm Long Island facility participation and verify your specific Highmark BCBS out-of-area benefits.

UnitedHealthcare is the largest health insurer in the United States and one of the most commonly accepted plans at OASAS-certified addiction treatment facilities on Long Island. UHC covers the full continuum of substance use disorder treatment — medical detox, inpatient residential rehab, PHP, IOP, standard outpatient, and all FDA-approved MAT medications including Suboxone, Sublocade, Vivitrol, and Brixadi. UHC's behavioral health division, Optum, manages substance use disorder benefits and utilization review. Prior authorization is required for inpatient and residential care; IOP and outpatient often proceed without prior auth. UHC employer-sponsored PPO plans typically offer both in-network and out-of-network access. Under MHPAEA federal parity law, UHC cannot apply more restrictive criteria to addiction treatment than to comparable medical benefits. Call 631-762-3763 for a same-day UnitedHealthcare benefits verification.

Oxford Health Plans, now operating as UnitedHealthcare Oxford, is one of the most widely accepted commercial insurance plans at Long Island addiction treatment facilities. Oxford Health originally built a dense New York-area provider network and that coverage depth has been maintained under UnitedHealthcare ownership. Oxford Health covers the full addiction treatment continuum — detox, inpatient rehab, PHP, IOP, outpatient, and MAT including all FDA-approved medications. Behavioral health benefits are managed by Optum. Oxford HMO plans require in-network provider selection; Oxford PPO plans allow both in-network and out-of-network care. Prior authorization is required for inpatient levels of care. New York MHPAEA and Timothy's Law parity protections apply. Call 631-762-3763 for a same-day Oxford Health benefits check and in-network Long Island provider referral.

Humana is a major national health insurer with a significant Medicare Advantage presence on Long Island. Humana commercial and Medicare Advantage plans cover addiction treatment including detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. Humana's behavioral health benefits are subject to medical necessity review and prior authorization for inpatient care. Humana Medicare Advantage plans on Long Island often include enhanced behavioral health benefits beyond Original Medicare, including lower cost-sharing for MAT and outpatient substance use counseling. Long Island residents with Humana employer coverage should verify network participation at specific OASAS-certified facilities. Call 631-762-3763 for a same-day Humana benefits verification and facility referral.

Kaiser Permanente operates as an integrated HMO where members typically receive care within the Kaiser system. Kaiser does not have a large provider footprint on Long Island, which means members seeking addiction treatment locally will need to work directly with Kaiser to obtain an out-of-network authorization or a referral to a contracted Long Island facility. For medically necessary addiction treatment that Kaiser cannot provide within its network in a timely manner, out-of-network authorization may be granted. Kaiser covers medically necessary detox, inpatient rehab, outpatient programs, and MAT. Call Kaiser member services at 1-800-464-4000 to request an out-of-network authorization for Long Island addiction treatment, or call our team at 631-762-3763 for navigator assistance.

EmblemHealth — operating through its HIP and GHI plan brands — is one of New York's largest non-profit health insurers and is widely accepted at OASAS-certified addiction treatment facilities on Long Island. EmblemHealth covers the full continuum of addiction treatment: medical detox, inpatient residential rehab, PHP, IOP, outpatient counseling, and all FDA-approved MAT medications including Suboxone, Sublocade, Vivitrol, and Brixadi. GHI (commercial) and HIP (HMO) members have different network rules — GHI PPO members typically have broader provider access including out-of-network benefits. Prior authorization is required for inpatient and residential care. Timothy's Law and MHPAEA parity protections apply to all EmblemHealth commercial plans in New York. Call 631-762-3763 for a same-day EmblemHealth benefits verification and in-network Long Island facility referral.

MVP Health Care is a regional non-profit health insurer primarily serving the Capital Region, Hudson Valley, and Upstate New York. Long Island residents with MVP coverage — typically through an Upstate employer or family plan — can access addiction treatment at select Long Island providers, with out-of-area care processed under MVP's behavioral health policies. MVP covers medically necessary addiction treatment including detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. New York Timothy's Law and MHPAEA federal parity protections apply. Prior authorization is required for inpatient levels of care. Call 631-762-3763 to confirm which Long Island OASAS-certified facilities are in-network for MVP Health Care and verify your specific plan benefits.

CDPHP (Capital District Physicians' Health Plan) is a physician-founded health plan serving Albany and the Capital Region of New York State. Long Island residents with CDPHP coverage — typically through a Capital Region employer — may access addiction treatment at select Long Island providers. Out-of-area coverage for medically necessary addiction treatment is available subject to prior authorization and CDPHP's behavioral health utilization review. CDPHP covers detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT consistent with New York State mental health parity requirements. Call 631-762-3763 to confirm Long Island OASAS-certified facility participation and verify your specific CDPHP out-of-area benefits.

Independent Health is a Western New York health plan headquartered in Buffalo, serving primarily the eight-county WNY region. Long Island residents with Independent Health coverage — typically through a Western New York employer or family plan — may access addiction treatment at select Long Island facilities. Out-of-area care is subject to Independent Health's behavioral health prior authorization process. Coverage includes medically necessary detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT consistent with New York State MHPAEA parity requirements. Call 631-762-3763 to identify which Long Island OASAS-certified providers accept Independent Health and verify your out-of-area benefit levels.

MagnaCare is a regional third-party administrator (TPA) and PPO network serving self-insured employers, union funds, and municipal employee plans throughout New York and New Jersey. MagnaCare is particularly common among Long Island union members, construction trade workers, and local government employees. MagnaCare covers addiction treatment consistent with plan sponsor benefit designs — most self-insured MagnaCare plans include detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. Because MagnaCare administers claims for multiple self-insured plans, specific benefit levels and prior authorization requirements vary by employer group. MHPAEA federal parity protections apply to MagnaCare-administered self-insured plans. Call 631-762-3763 to verify your specific MagnaCare plan's addiction treatment benefits and identify in-network Long Island OASAS-certified providers.

ConnectiCare is a Connecticut-based health plan serving members in Connecticut and Massachusetts. Long Island residents with ConnectiCare coverage — typically through a Connecticut employer or family plan — may access addiction treatment at select Long Island facilities. Out-of-state addiction treatment is subject to ConnectiCare's prior authorization process and behavioral health utilization review. Coverage includes medically necessary detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. Call 631-762-3763 to verify which Long Island OASAS-certified providers accept ConnectiCare and confirm your specific out-of-state benefit levels before pursuing admission.

Harvard Pilgrim Health Care, now part of Point32Health alongside Tufts Health Plan, is a major New England health insurer serving Massachusetts, New Hampshire, and Maine. Long Island residents with Harvard Pilgrim coverage — typically through a New England employer or family plan — may access addiction treatment at select Long Island providers. Out-of-state addiction treatment is subject to Harvard Pilgrim's prior authorization process. Coverage includes medically necessary detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. ACA parity requirements mandate that Harvard Pilgrim cover substance use disorder treatment as an Essential Health Benefit. Call 631-762-3763 to verify out-of-state Harvard Pilgrim benefits and identify Long Island OASAS-certified providers that accept your plan.

Tufts Health Plan, now part of Point32Health alongside Harvard Pilgrim Health Care, is a prominent New England health insurer serving Massachusetts, Rhode Island, and New Hampshire. Long Island residents with Tufts coverage — typically through a New England employer or family plan — may access addiction treatment at select Long Island providers. Out-of-state addiction treatment is subject to Tufts' prior authorization and behavioral health utilization management. Coverage includes medically necessary detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT, consistent with ACA Essential Health Benefit mandates for substance use disorder treatment. Call 631-762-3763 to verify your out-of-state Tufts Health Plan benefits and identify Long Island OASAS-certified facilities that accept your plan.

Blue Cross and Blue Shield of Texas (BCBSTX) is the largest health insurer in Texas, serving nearly 6 million members through a statewide network of over 80,000 physicians and 500 hospitals. BCBSTX is a division of Health Care Service Corporation (HCSC) and an independent licensee of the Blue Cross Blue Shield Association, giving members access to the BlueCard nationwide network — including Long Island OASAS-certified addiction treatment providers. Behavioral health services for BCBSTX members are managed in partnership with Magellan Health Services, using ASAM Criteria to determine the appropriate level of care for substance use disorder treatment. Coverage includes medically necessary detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT medications including buprenorphine and Vivitrol. The Mental Health Parity and Addiction Equity Act (MHPAEA) requires BCBSTX to cover SUD treatment comparably to medical and surgical benefits. Prior authorization is required for inpatient and residential levels of care. Texas families relocating to or seeking treatment in New York can access Long Island facilities through the BlueCard host-plan arrangement. Call 631-762-3763 to verify your BCBSTX benefits and connect with an in-network Long Island provider.

BlueCross BlueShield of South Carolina is the state's oldest and largest health insurer, offering individual, family, group, Medicare, and Medicaid plans through a preferred network of over 10,000 providers statewide. BCBS of South Carolina is an independent licensee of the Blue Cross Blue Shield Association, providing BlueCard nationwide network access for members seeking addiction treatment outside South Carolina — including Long Island OASAS-certified facilities. Behavioral health benefits for BCBS SC members are administered by Companion Benefit Alternatives, Inc. (CBA), a specialized behavioral health management company that facilitates referrals to in-network addiction treatment providers nationwide. CBA uses ASAM Criteria to determine medically appropriate levels of care. Coverage includes detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT medications. South Carolina families with members in New York can access Long Island addiction treatment through the BlueCard host-plan arrangement. The MHPAEA and ACA mandate parity and essential health benefit coverage for substance use disorder treatment under all BCBS SC commercial plans. Call our behavioral health line at 1-800-868-1032 or reach our team at 631-762-3763 to verify your benefits and find a Long Island provider.

Blue Cross and Blue Shield of Illinois (BCBSIL) is a division of Health Care Service Corporation (HCSC), the largest customer-owned health insurer in the United States, and an independent licensee of the Blue Cross Blue Shield Association. BCBSIL serves millions of members across Illinois through individual, family, employer, Medicare, and Medicaid plans, with BlueCard network access extending nationwide — including Long Island OASAS-certified addiction treatment facilities. Behavioral health services are managed directly by BCBSIL's licensed clinical team using MCG Care Guidelines for mental health conditions and ASAM Criteria for addiction disorders, ensuring evidence-based level-of-care determinations. Coverage includes medically necessary detox, inpatient rehab, PHP, IOP, standard outpatient counseling, and MAT medications. Prior authorization is required for inpatient, residential, and PHP levels of care. Illinois families with members relocating to or seeking treatment in New York access Long Island providers through the BlueCard host-plan system. For behavioral health member services, call 1-877-860-2837, or reach our team at 631-762-3763 to verify your BCBSIL benefits and identify covered Long Island providers.

Meritain Health is a third-party administrator (TPA) and independent subsidiary of Aetna, a CVS Health company, headquartered in Buffalo, New York. Founded in 1983, Meritain administers self-funded health benefit plans for employers nationwide, serving over 1.5 million members with access to the Aetna Choice POS network of 690,000+ credentialed providers — including Long Island OASAS-certified addiction treatment facilities. As a TPA rather than a direct insurer, Meritain administers benefits on behalf of employers who self-fund their health plans, meaning coverage specifics vary significantly by employer contract. Under ACA mandates, Meritain-administered plans must include essential health benefits for substance use disorder treatment, including detox, inpatient rehab, PHP, IOP, outpatient counseling, and MAT. The MHPAEA requires parity between mental health/SUD benefits and medical-surgical benefits across all Meritain-administered plans. Prior authorization is typically required for inpatient and residential levels of care, with ASAM Criteria guiding level-of-care determinations. Because plan design varies by employer, members should call the number on the back of their insurance card to confirm specific benefit details, or call our team at 631-762-3763 for a no-cost benefits verification.

NYSHIP Empire Plan covers NYSHIP drug rehab and all levels of addiction treatment for NY State employees, retirees, and dependents on Long Island. Our independent navigation team helps you understand every option — from sober coaching and peer mentorship to detox, IOP, and inpatient — and connects you with the right fit. Call 631-762-3763 or visit interventionny.com. Free, confidential, 24/7.

Ambetter from Fidelis Care is New York's Marketplace health insurance plan available through the NY State of Health exchange, underwritten by Fidelis Care. Ambetter covers addiction treatment at OASAS-certified Long Island facilities consistent with ACA Essential Health Benefit requirements — meaning substance use disorder treatment is a mandatory covered benefit. Coverage includes medical detox, inpatient rehab, PHP, IOP, outpatient counseling, and all FDA-approved MAT medications. Ambetter plans come in Bronze, Silver, and Gold metal tiers with varying premiums, deductibles, and copays; Silver plans may offer Cost Sharing Reductions (CSR) for eligible members, significantly lowering out-of-pocket costs. Premium tax credits through the ACA may further reduce monthly costs. Prior authorization is typically required for inpatient and residential levels of care. Call 631-762-3763 to verify your specific Ambetter plan benefits and identify in-network Long Island providers.