GEHA Insurance for Rehab

Does GEHA Insurance for Rehab Cover Addiction Treatment?

You may have heard of GEHA insurance if you’ve ever inquired about different coverage providers. Government Employees Health Association is an insurance provider that delivers coverage solely for current and past federal employees, military service members, and their immediate families. GEHA Insurance for rehab does offer coverage for both mental health and addiction treatment in many cases, so read on to learn more!

If you or someone you know has a policy through GEHA, you may have been curious regarding their coverage for drug and alcohol abuse rehab. Because they’re a significant provider, GEHA offers substance abuse treatment coverage. However, the specific benefits you receive depend heavily on your policy.

You’ll need to speak with the Admissions team at Icarus Behavioral Health to find out exactly what your policy covers for treatment. But let’s get you prepared to discuss the specifics regarding navigating rehab for GEHA insurance members.

Checking Your GEHA Insurance Benefits for Rehab

Checking Your GEHA Insurance Benefits

Understanding precisely what your plan covers gives you relief in knowing that you or your family is receiving the coverage they need. When it comes to rehab, it’s essential to be assured that whatever treatment you’re receiving is covered by your provider, so you know the answers to important questions like, “Does GEHA cover mental health counseling?”

One of the best things about rehab insurance is that nearly every health plan in the United States, GEHA included, allows some type of coverage for substance abuse treatment. Under the classifications according to our government, behavioral health and substance abuse treatment are considered essential.

This means that all insurance providers must provide coverage for these services. Residential and outpatient services are included under these regulations, ensuring that you have access to multiple levels of care.

However, just because your GEHA plan provides coverage for rehab, it doesn’t mean that the entire cost is covered. The coverage they’re willing to provide heavily depends on your policy, the facility offering treatment, and the state you live in.

In some cases, a GEHA prior authorization form may be required, which simply means you need prior approval for treatment. Even as an out-of-network provider, Icarus can help make sure this is done without any hassles or hiccups for a smooth and worry-free beginning to your treatment with us.

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Does My Treatment Center Need to Be In-Network?

One of the biggest questions regarding any insurance provider and rehab is whether the facility needs to be in-network. These in-network providers sign contracts with the insurance companies, establishing a set price for any services provided.

This allows the health insurance company to provide a uniform set of coverage, meaning all customers know exactly what their deductibles, copays, and other expenses will be. Though this can be helpful, due to the fact that it is a federal government insurance provider, few facilities are ‘in-network’ with GEHA.

Icarus Behavioral Health accepts GEHA as an out-of-network option, often at reduced costs in comparison with most other providers, both in New Mexico and on a national level.

What are the GEHA Prior Authorization Requirements?

Preauthorization can be required for obtaining rehab services with your GEHA policy. But do not worry, the Admissions team at Icarus Behavioral can help make this process as smooth and seamless as possible.

In many cases, GEHA reauthorization can be accomplished through a call to Icarus, without having to jump through hoops or collect supporting paperwork on your own. A quick call to the Admissions staff can provide answers and let you know policy coverage details as well as any authorizations needed.

Different Coverage Levels for GEHA

Establishing what type of care someone needs when entering rehab is necessary. The medical care provided is essential, but the comfort and quality of the facility can be equally important.

Unfortunately, in most cases, the nicer the facility is, the more you’re required to pay out of pocket. However, in the case of GEHA, there’s a cap placed on the total amount of out-of-pocket expenses clients are required to pay each year. If your plan covers special treatment, your out-of-pocket costs will never exceed a specific limit.

This cap allows customers to budget better for medical and rehab expenses. The cap for out­-of-pocket expenses is as follows:

  • Standard Plan: $5,000
  • Standard Out-of-network: $7,000
  • High option: $4,000
  • High option out-of-network: $6,000
  • HDHP option for individuals: $5,000
  • HDHP option for families: $10,000

Your state of residence also matters. Other factors that come into play include your length of stay and the level of your plan, although costs always vary depending on the facility’s services. You don’t need to call your GEHA insurance card number to find out costs and details for attending treatment at Icarus, just give our Admissions team a confidential call today and we can let you know the exact details of your coverage.

What Types of Addiction Treatment Does GEHA Provide Coverage For?

Partial Hospitalization Programs

You might require a certain level of care depending on how severe your alcohol or drug addiction is. Regardless of what you need specifically, GEHA provides coverage for the following levels of care:

Medically Assisted Detox

This level of care includes physicians and nurses watching over a client 24/7 while they recover physically from the side effects of detox and withdrawal. The medical staff keeps clients safe during medical detox and helps them avoid the discomforts involved in this recovery stage.

Inpatient Rehab

Inpatient rehab using your insurance policy from GEHA will often entail 30, 60, or 90 days, depending on the recommendations of counselors and physicians. Clients receive personalized treatment plans according to their care team.

In the case of mental illness that also requires residential treatment, GEHA also often offers coverage here as well. With a full team of mental health professionals offering counseling services that include dialectical behavioral therapy (DBT) as well as other evidence-based treatments, you or your loved ones are in good hands at Icarus Behavioral Health for all forms of inpatient mental health treatment.

Partial Hospitalization Program

This is a combination of inpatient and outpatient treatment. Clients usually come for six to eight hours daily and go home at night. They’re also usually allowed to return home on the weekends.

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Outpatient Programs

This includes a client’s participation in group therapy for a variable amount of time during the week, along with individual therapy as needed.

Life skills and life coaching can also be more heavily involved at this point, depending on client’s needs and desires.

Intensive Outpatient Programs

Intensive outpatient programs are a step up from regular outpatient treatment. Clients are generally required to attend for 20 hours per week instead of nine, in an intense version of an outpatient setting.

Aftercare Programs

Aftercare programs help clients to support continued sobriety after they exit treatment. This is when most clients are put to the ultimate test and can decide whether they experience long-term sobriety.

Does GEHA Cover Medication-Assisted Treatment?

Methadone-assisted treatment

Technically, medication-assisted treatment could fall under the category of rehab care and even aftercare services. Regardless of the designation, GEHA does provide coverage for medication-assisted treatment.

Again, the coverage depends on the package the customer chose and the state. The total a client pays also depends on the type of medication-assisted treatment prescribed by physicians.

Currently, there are three forms of medication-assisted treatment programs.

  • Methadone
  • Buprenorphine
  • Naloxone


Methadone-assisted treatment allows clients to function in a standard, healthy setting and return to the benefits of everyday life. The methadone enables them to operate without worrying about being sick or going through withdrawal, enabling them to keep their mind on healing.

When clients have to worry about detox, healing and experiencing recovery are nearly impossible. This is what prevents most individuals from entering rehab, especially in the case of opioids.

Methadone must be administered daily and can only be received at a methadone maintenance clinic in the client’s state. They must appear daily to receive their daily regimen but have the opportunity to earn take-home doses if they satisfy specific requirements.


Buprenorphine is administered in the form of Suboxone, Subutex, and Zubsolv. Like methadone, buprenorphine is issued daily. It affects clients the same way as methadone, allowing them to function without worrying about the worst side effects of withdrawal. The primary difference between the two is that a physician can prescribe buprenorphine in their practice. Methadone can only be prescribed for opioid maintenance within the confines of a clinic, specifically in business for opioid abuse.

This allows clients to receive a prescription of buprenorphine monthly, eliminating the need to visit a clinic daily. However, many methadone clinics also offer buprenorphine as an alternative to methadone, in which case clients would be required to appear daily for dosing.


Naltrexone is administered monthly and marketed under the brand name Vivitrol. This medication is different in that it’s not prescribed daily, and clients must be completely free from opioids for at least ten days before taking it.

Buprenorphine and methadone are made for post-acute withdrawal symptoms. At the same time, Naltrexone is designed for the post-acute withdrawal period, assisting clients in eliminating cravings that occur months after the detox process is over.

Does GEHA Cover Prescription Medications?

Does GEHA Cover Prescription Medications

Many clients question whether GEHA insurance covers prescription medication. The answer is yes, but the coverage depends on the situation and your specific policy.

They prescribe relief for the cost of prescriptions but may not cover the entire cost. Speaking with your agent will help you to figure out what percentage of prescription medication costs will be covered.

What Specific Forms of Treatment Does GEHA Cover?

GEHA covers all forms of therapy you participate in, assuming you’re attending an approved facility, whether in or out-network. Remember, if it’s out-of-network, you’ll likely be required to provide a pre-authorization form in most cases.

A pre-authorization form is filled out by an authority figure or physician at the rehab, describing the treatment they provide and why this form of therapy is most beneficial for you. GEHA requires a reasonably detailed description of what takes place during treatment. This allows them to ensure that the coverage they provide is going toward a worthwhile cost that will help you recover.

Some of the forms of treatment GEHA would cover include:

  • Cognitive-behavioral therapy. During CBT, clients work with counselors to change how they respond to certain feelings. They learn to eliminate dangerous and damaging behavior as a response to negative emotions and learn how to replace them with positive responses and healthy ways to cope.
  • Holistic therapy: Holistic therapy includes elements that provide healing for the mind, body, and spirit. These take an unconventional approach to substance abuse treatment and include activities like art therapy, equine therapy, surf therapy, and other holistic forms of healing. Despite what many argue, several types of holistic treatment are evidence-based and provide significant benefits.
  • Dual-diagnosis treatment: Dual-diagnosis treatment includes several types of therapy rolled into one. This healing process helps clients who suffer from substance abuse disorder in conjunction with a mental health disorder.

Covering several types of treatment and levels of care allows GEHA to give their clients access to multiple options for substance abuse recovery.

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Find Long-term Sobriety with GEHA and Icarus

At Icarus Behavioral Health, we work closely with insurance providers like GEHA to provide you with the treatment you need and the coverage you deserve. We’re available seven days per week for more information regarding GEHA and how we bill insurance or other inquiries.

We believe that long-term recovery is possible with the right team by your side, and this includes your insurance provider. When your support pillars come together to provide the highest quality encouragement, your odds of recovery are incredibly high.

Contact a member of our admissions team today to learn more about how we can provide you with the tools you need for long-term recovery.

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