West Virginia Affordable Healthcare Insurance Coverage

The tiny state of West Virginia provides its residents with insurance plans that meet the standards set by the Affordable Care Act. Having the right insurance plan in place for you and your family allows you to seek out the drug and alcohol treatment help you need and find the path back to sobriety.

Highmark BlueCross BlueShield of West Virginia

The most prevalent provider in the state is the Blue Cross Blue Shield subsidiary, Highmark. They offer health care consumers access to 16 different plans. The exact number may vary by county, though.

BlueCross/BlueShield provides only PPO plans in West Virginia, meaning you do not need to go through a primary care physician for your substance abuse treatment. At the Bronze level, West Virginia residents choose from plans designed to work with a health savings account. The deductibles are high, from $4,000 to $6,500, in order to keep the monthly premiums down. Thankfully, all Bronze level plans pay the full amount for substance abuse treatment. This includes inpatient and outpatient care at any facility, whether it is in-network or not.

With some policies, like the Health Savings Blue PPO 6450, you do not need to meet the deductible for preventive care services (such as a visit to your primary care doctor) but you would need to cover it for in and outpatient drug rehabilitation. They are labeled either “Base Plan” or “Limited Cost Sharing.” With programs that carry the “Zero Cost Sharing” label, such as the Health Savings Blue PPO 6450, the deductible is not a factor for any service.

The Silver plans have the same cost-sharing deductible structure. With Silver plans, like Balance Blue PPO 1200 ONX (Base Plan) or any labeled “Limited Cost Sharing,” you do not need to meet the deductible for drug treatment. For inpatient care, you pay a $750 copay for the first three days and 40% if you go out of network. You need pre-authorization prior to being admitted. For outpatient treatment, the copay is $50 a visit with no pre-authorization necessary. Silver plans marked “Zero Cost Savings” require no deductible and BCBS pays the full cost of treatment.

With Base or Limited Sharing Gold Plans, you pay $1,500 per admission for inpatient substance abuse treatment and a $25 copay for office visits. If you go out of network, expect to cover 30% of the total cost. There is no deductible to pay either and zero cost sharing pays the full bill at the Gold level.

CareSource Just4Me

If you prefer an HMO plan, you will choose a policy from CareSource Just4Me, a company that has insurance in four states including West Virginia. This provider offers six plans, two at each metal level with one covering dental and vision, as well.

The Bronze plans come with a $6,650 deductible and $6,850 out-of-pocket maximum. For outpatient substance abuse treatment, you pay $40 per visits and 40% coinsurance fee after you meet the deductible. Inpatient care requires only a coinsurance payment of 40%. There are no benefits for out-of-network treatments and pre-authorization is required for any hospitalization including detox.

With a Silver Just4Me plan, you enjoy lower deductibles but a higher monthly premium. For both in and outpatient care, you must meet the deductible and stay in-network. Your contribution is 30% for outpatient treatment and a $500 flat fee per admission for inpatient service. The Gold plans follow the same format but with a 20% coinsurance charge and $250 flat fee.

Contact us to get the help you need.The residents of West Virginia are lucky enough to have options for both PPO and HMO healthcare networks and many require a deductible. Finding the right plan means you have someone on your side when facing a drug or alcohol problem. Please contact us at RehabCenter.net to learn more about how you can get the help you need.

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