Does Humana Cover Rehab? What Your Plan Pays For

Humana is a major health insurance company covering approximately 17 million Americans, with particularly strong presence in Medicare Advantage (covering 5+ million seniors) and employer-sponsored commercial plans. Humana is headquartered in Louisville, Kentucky, and has significant market share in the Southeast, Midwest, and Texas. Under federal law, all Humana plans must cover substance use disorder treatment, though coverage specifics vary between commercial plans and Medicare Advantage plans.

What Does Humana Cover for Rehab?

Humana covers the full continuum of substance use disorder treatment services when medically necessary:

Covered Services

Medical Detoxification — Medically supervised withdrawal management in hospital or freestanding detox facilities. Covered at 60-80% after deductible (commercial) or per daily copay (Medicare Advantage). Duration based on medical necessity, typically 3-14 days.

Inpatient/Residential Treatment — 24/7 residential treatment programs. Commercial plans cover 60-80% after deductible. Medicare Advantage plans may use daily copays (e.g., $350/day for days 1-5, $175/day thereafter) or coinsurance depending on plan type. Initial authorization typically 7-14 days with concurrent review.

Partial Hospitalization Program (PHP) — Intensive day treatment 6+ hours daily. Covered at 70-90% after deductible (commercial) or per-visit copays (Medicare Advantage).

Intensive Outpatient Program (IOP) — Structured outpatient treatment 9-15 hours weekly. Covered at 70-90% after deductible or per-visit copays.

Outpatient Therapy — Individual and group counseling. Covered at 80-90% after deductible (commercial) or typical copays of $30-$50 per visit (Medicare Advantage).

Medication-Assisted Treatment (MAT) — All FDA-approved medications:

• Buprenorphine products (Suboxone, generic buprenorphine/naloxone, Sublocade)
• Methadone (via certified opioid treatment programs)
• Naltrexone (Vivitrol injection, ReVia tablets)
• Acamprosate (Campral)
• Disulfiram (Antabuse)

Commercial plans: 80-90% after deductible depending on drug tier Medicare Advantage: Covered through Part D with tier-based copays

Humana Plan Types and Rehab Coverage

Humana Commercial PPO

Best for: Under-65 employees with employer-sponsored coverage seeking broad network access

Network: Nationwide network of 1,400+ addiction treatment facilities Out-of-network: Covered at reduced rate (typically 50-60%) Referrals: Not required Typical coverage: 60-80% in-network, 40-60% out-of-network after deductible Average out-of-pocket for 30-day inpatient: $6,000-$20,000

Humana Commercial HMO

Best for: Lower premiums with local network

Network: Regional network varies by location Out-of-network: Not covered except emergencies Referrals: Required from PCP Typical coverage: 70-85% in-network after deductible Average out-of-pocket for 30-day inpatient: $5,000-$17,000

Humana Medicare Advantage PPO

Best for: Medicare beneficiaries (65+) wanting broader facility choices

Network: Regional/national network depending on specific plan Out-of-network: Covered at higher cost-sharing Referrals: Not required Typical coverage: Varies by plan; may use daily copays or coinsurance Average out-of-pocket for 30-day inpatient: $4,000-$15,000

Example cost structure:

• Days 1-5: $350/day copay = $1,750
• Days 6-30: $175/day copay = $4,375
• Total: $6,125

Many plans have benefit period limits (e.g., maximum 60 days per benefit period).

Humana Gold Plus (Medicare Advantage HMO)

Best for: Medicare beneficiaries seeking lower premiums with local coverage

Network: Local/regional network Out-of-network: Not covered except emergencies Referrals: May be required Typical coverage: Varies by plan; copay-based Average out-of-pocket for 30-day inpatient: $3,500-$12,000

Gold Plus plans typically have the lowest premiums among Humana Medicare Advantage options but most restricted networks.

Humana Medicare Advantage: What’s Different?

Medicare Advantage plans have unique characteristics compared to commercial insurance:

Medicare Advantage Basics

Eligibility: Age 65+ or under-65 with qualifying disability

Structure: Replaces Original Medicare (Parts A & B) with private plan that includes additional benefits

Substance abuse coverage: Must include mental health and substance use disorder services as supplemental benefits

Coverage Structure

Unlike commercial plans with percentage-based coinsurance, many Humana Medicare Advantage plans use copay structures:

Example Humana Medicare Advantage plan:

• Inpatient detox/rehab: $350/day for days 1-5, $175/day for days 6-60
• Outpatient therapy: $40 copay per visit
• IOP/PHP: $65 copay per day
• MAT medications: Part D copays (tier-dependent: $0-$47 for generic buprenorphine, $100-$200 for Vivitrol)

Benefit periods: Some plans limit inpatient days per benefit period (e.g., 60 days per benefit period).

Part D and MAT

Medicare Part D (prescription drug coverage) covers medication-assisted treatment:

• Generic buprenorphine: Often Tier 1 or 2 ($0-$20 copay)
• Brand Suboxone: Tier 3 or 4 ($47-$100 copay)
• Vivitrol injection: Tier 4 or 5 ($100-$200 copay)
• Coverage gap (donut hole): Copays increase after spending threshold

Preauthorization Requirements

Humana requires preauthorization for all inpatient and residential substance abuse treatment:

Before Treatment

1. Clinical assessment — Intake evaluation at treatment facility
2. Facility submits request — Utilization review team sends preauthorization to Humana Behavioral Health
3. Humana reviews — Clinicians assess medical necessity using ASAM criteria
4. Authorization decision — Typically 24-72 hours depending on urgency

Medical Necessity Criteria

Humana uses ASAM (American Society of Addiction Medicine) criteria evaluating:

• Acute intoxication and withdrawal risk
• Biomedical conditions and complications
• Emotional, behavioral, cognitive conditions
• Readiness to change
• Relapse and continued use potential
• Recovery environment

During Treatment

Concurrent review: Humana conducts ongoing reviews every 3-7 days. The facility provides clinical updates demonstrating continued medical necessity.

Length of stay: Initial authorizations typically 7-14 days. Extensions require clinical justification showing progress and ongoing need.

Step-down planning: Humana emphasizes appropriate level of care transitions (e.g., residential → PHP → IOP → outpatient).

Typical Out-of-Pocket Costs with Humana

Costs vary significantly between commercial and Medicare Advantage plans:

Example: Humana Commercial PPO

Plan details:

• Deductible: $2,500 (individual)
• Coinsurance: 80/20 (Humana pays 80%, you pay 20%)
• Out-of-pocket maximum: $8,700 (individual)

30-day inpatient program:

• In-network negotiated rate: $35,000
• You pay: $2,500 (deductible) + 20% of $32,500 ($6,500) = $9,000
• Actual: Capped at out-of-pocket max of $8,700

Example: Humana Medicare Advantage PPO

Plan details:

• No deductible for inpatient behavioral health
• Daily copays: $350/day (days 1-5), $175/day (days 6-30)

30-day inpatient program:

• Days 1-5: $350 × 5 = $1,750
• Days 6-30: $175 × 25 = $4,375
• Total: $6,125

MAT Medication Costs

Commercial plans:

• Generic buprenorphine: $25-$75/month
• Brand Suboxone: $100-$200/month
• Vivitrol injection: $50-$250/month

Medicare Advantage (Part D):

• Generic buprenorphine: $0-$20/month (Tier 1-2)
• Brand Suboxone: $47-$100/month (Tier 3-4)
• Vivitrol injection: $100-$200/month (Tier 4-5)

Verifying Your Humana Coverage

Call Humana Behavioral Health

Humana Behavioral Health: 1-877-877-6059 (commercial) Humana Medicare: 1-800-448-6262

Information to have ready:

• Member ID number
• Group number (if employer plan)
• Facility name and location you’re considering

Questions to ask:

• Is this facility in-network for my plan?
• What is my deductible/copay structure?
• How much have I met toward my deductible and out-of-pocket max?
• What are my out-of-pocket costs for 30-day inpatient treatment?
• How does preauthorization work?
• How many days will be initially authorized?
• Does my plan cover MAT medications, and what are copays?
• Are there benefit period limits for inpatient treatment?

Check Online

MyHumana Portal: Log in at Humana.com

• Find providers using behavioral health provider search
• View benefits and coverage
• Check deductible and out-of-pocket progress
• Review claims

Medicare Advantage members: Also check Medicare.gov plan finder for detailed benefit information.

Have the Facility Verify Benefits

Treatment facilities have insurance specialists who will:

• Call Humana on your behalf
• Obtain benefits breakdown
• Provide estimated out-of-pocket costs
• Initiate preauthorization
• Explain payment options

Humana’s Behavioral Health Network

Network size: Approximately 1,400 contracted addiction treatment facilities

Geographic strengths:

• Strong presence in Southeast (Kentucky, Tennessee, Georgia, Florida)
• Extensive Texas network
• Growing Midwest coverage (Illinois, Indiana, Ohio)
• National coverage through Medicare Advantage

Types of facilities:

• Hospital-based detox and inpatient programs
• Residential treatment centers
• Intensive outpatient programs (IOP)
• Partial hospitalization programs (PHP)
• Medication-assisted treatment providers
• Opioid treatment programs (methadone clinics)

Network considerations:

• Rural areas may have fewer options
• Medicare Advantage networks are often more limited than commercial networks
• HMO plans have smallest networks

What Makes Humana Different

Integrated Care Management

Humana emphasizes integrated medical and behavioral health care:

• Care coordinators for complex cases
• Coordination between physical and behavioral health providers
• Support for co-occurring medical conditions
• Telephonic case management during and after treatment

Humana at Home

Some Humana Medicare Advantage plans include home health services that can support recovery after residential treatment.

Bold Goal Initiative

Humana’s corporate wellness initiative focuses on addressing social determinants of health, including substance use, which influences their approach to addiction treatment coverage.

What If Humana Denies Coverage?

You have federal appeal rights:

Internal Appeals

1. File appeal within 180 days of denial
2. Submit clinical documentation supporting medical necessity
3. Request peer-to-peer review (physician-to-physician)
4. Timeline: 30 days for standard appeals, 72 hours for urgent

External Review

If internal appeal denied:

1. Request independent review by external organization
2. Timeline: 60 days for standard, 72 hours for urgent
3. Binding decision on Humana

Medicare Appeals (for Medicare Advantage)

Medicare Advantage has specific appeal process:

1. Reconsideration by Humana
2. Independent Review Entity (IRE) if denied
3. Administrative Law Judge (ALJ) if amount in controversy exceeds threshold
4. Medicare Appeals Council and Federal District Court for higher-level appeals

Don’t Have Humana (or Any Insurance)?

If you’re currently uninsured and under 65, obtaining ACA marketplace coverage is often the most cost-effective path to treatment. If you’re 65+ without coverage, enrolling in Medicare with a Medicare Advantage plan that includes strong behavioral health benefits can provide comprehensive addiction treatment coverage.

Monthly premiums for commercial PPO plans typically cost $400-$750, compared to $15,000-$50,000 for a 30-day program without insurance. Medicare Advantage plans often have low or $0 premiums.

A licensed insurance specialist can help you:

• Navigate Medicare Advantage options if you’re 65+
• Compare ACA marketplace plans if under 65
• Understand special enrollment periods
• Navigate subsidies and cost-sharing reductions

Sources

• Humana. “Behavioral Health Benefits.” Member Resources. 2026.
• Centers for Medicare & Medicaid Services. “Medicare Advantage Benefits.” 2026.
• Medicare.gov. “Mental Health and Substance Abuse Services.” 2026.
• Healthcare.gov. “Substance Use Disorder Coverage.” 2026.