MagnaCare Insurance for Drug & Alcohol Rehab
Is Rehab Covered by MagnaCare Insurance?
Yes, MagnaCare insurance may be able to cover all or at least part of the cost of rehab treatment. It is still important to determine what benefits you have and what portion of your treatment will be covered.
How to Verify MagnaCare Coverage
Call us at Or use our online insurance checker below to see if you may qualify for addiction treatment coverage.
What is MagnaCare Insurance?
MagnaCare was founded in 1992 to help labor unions that struggled to pay for radiology and laboratory medical services. Over time, the company branched out to serve members in New York, New Jersey, and Connecticut. It offers health plans, medical management, and a large network of more than 225 hospitals and 130,000 doctors.1,2 MagnaCare offers a variety of networks and plans including: PPO, HDHP/CDHP, EPO, and POS plans.
MagnaCare Insurance Eligibility
MagnaCare is not actually an insurance company. The company is a health plan management company that provides a wide range of products and services to meet the needs of organizations and their members.3 Eligibility for coverage is based on each employer’s specific group plans but generally include:4
- Full-time employees who work 30 or more hours per week.
- Employees’ spouse.
- Dependent children (through age 26), a requirement under the Patient Protection and Affordable Care Act (ACA).
Some employers might choose to extend benefits to part-time employees, defined as individuals who work 20-29 hours per week, too.4
Additionally, employers can offer coverage to unmarried employees’ domestic partners as well. In this case, benefits must mirror coverage offered to spouses, and an affidavit is generally required stating that domestic partners live together, are in a committed relationship, and intend to stay together.4
MagnaCare Insurance Health Plans
MagnaCare offers customizable health plans, including:5
- Self-funded health plans. MagnaCare offers a basic-, enhanced-, and premier-level health plan. Each covers preventative services, which include cancer screenings, diet counseling, and mental health counseling. The employer sets up a fund for its employees’ claims and hires a third-party administrator, like MagnaCare, to administer it.
- Ancillary health plans. Vision, dental, and integrated pharmacy programs can be added to a medical health plan.
- Employee assistance program (EAP). EAP counselors are qualified to assist employees confidentially with personal and work-related challenges that may adversely affect their health and well-being. Areas where EAP counselors can help include child care or elder care issues, relationship problems, financial and legal concerns, work stressors, mental health, addiction and recovery, and more.
Which Addiction Are Covered by MagnaCare Insurance?
Sunrise House Treatment Center is In-Network With MagnaCare
American Addiction Centers’ Sunrise House Treatment Center is located in Lafayette, NJ. Lafayette is a small and rural community in northern New Jersey with a relaxing atmosphere away from the hustle and bustle of nearby New York City. You’ll enjoy the lovely grounds and walking trails while at Sunrise House. Sunrise House Treatment Center is about an hour from the Newark Liberty International Airport.
Does MagnaCare Cover Mental Health Disorder Treatments?
Co-occurring disorders, also known as comorbid disorders, are multiple illnesses that occur in the same person at the same time and usually affect one another.6 An example of co-occurring disorders include an individual diagnosed with a mental health disorder and a substance use disorder (SUD), a medical condition defined by the uncontrollable use of one or more substances despite the negative consequences. Sometimes, a mental health disorder can lead to an addiction and vice versa.
Co-occurring SUDs and mental health conditions may be best treated simultaneously.6 In most cases, MagnaCare will cover the treatment of co-occurring disorders.
Which Types of Addiction Treatments Are Covered by MagnaCare Insurance?
Treatment looks different for everyone. Thus, there are various types of treatment available, including:
- Detox. Medically managed detox provides around-the-clock monitoring, support, and medications for individuals to safely and comfortably remove a substance from their body as they experience substance withdrawal symptoms. Detoxification is a key component of early recovery, but it is not, on its own, a comprehensive treatment for addiction.
- Inpatient treatment. Also called residential treatment, inpatient treatment provides 24-hour care. While attending inpatient rehab, individuals learn to manage their substance use and any co-occurring disorders with the help of individual and group therapy, psychiatric care, education, medication, and social services.
- Partial hospitalization. Also known as day treatment, this program allows individuals to receive treatment and monitoring during the day but return home at night. Programs are very similar to residential/inpatient rehab.
- Intensive outpatient. Intensive outpatient programs provide care for patients who do not need 24-hour monitoring but still require considerable care and attention during recovery. Patients attend several hours of treatment a week when participating in an intensive outpatient program.
- Outpatient treatment. Outpatient treatment requires that the patient visit the facility at specific times (either daily or a few times a week) to receive assessments, medication, and/or therapy.
In addition to assessments, exams, therapy, and the costs associated with the various treatment types, MagnaCare may also cover medications that are incorporated into the treatment and recovery process.
In 2018, nearly 2 million people had an opioid use disorder (OUD), a medical condition defined by an uncontrollable use of opioids despite negative consequences.7 This includes individuals taking prescriptions containing opiates and heroin. The Food and Drug Administration (FDA) has approved several medications as part of the treatment for OUD (along with behavioral therapies and counseling), including:8
- Buprenorphine, which works to suppress and reduce cravings for opioids.
- Methadone also reduces cravings and withdrawal symptoms and blocks the effects of opioids.
- Naltrexone blocks the euphoric effects of opioids.
For individuals with alcohol use disorder (AUD), a medical condition defined by the uncontrollable use of alcohol despite the negative consequences, the FDA has approved medications to aid in their recovery, including:8
- Acamprosate for individuals in recovery who no longer want to drink alcohol.
- Disulfiram may be prescribed after detox when individuals enter the initial stages of abstinence. Drinking even a small amount of alcohol while taking disulfiram can cause nausea, headache, vomiting, chest pains, and difficulty breathing.
- Naltrexone also blocks the euphoric effects of intoxication.
Individuals experiencing withdrawal symptoms may be prescribed medications that include:9
- Benzodiazepine, which helps reduce anxiety and irritability, two symptoms of withdrawal. The drug has also shown to reduce the incidence of seizures and delirium tremens with those with alcohol withdrawal syndrome.
- Anticonvulsants help decrease the risk of withdrawal seizures.
- Clonidine may be used to treat symptoms such as dizziness, elevated blood pressure, and sweating associated with alcohol withdrawal.
- Antidepressants to help with depression.
How Does MagnaCare Insurance Coverage Work for Rehab?
MagnaCare coverage depends on the state you live in as well as the plan you have. In most cases, you will need to seek treatment in a facility that is in MagnaCare’s network in order to receive full benefits. If you choose not to receive treatment at an in-network facility, you might have to pay some or all of your treatment expenses out-of-pocket.
If you decide to seek treatment for your SUD at a treatment facility that is out of MagnaCare’s network, you may be able to discuss a payment plan with the provider. There may also be other payment options available to you.
In many cases, you will require preauthorization for your treatment. During this process, MagnaCare determines whether your substance abuse treatment is medically necessary. In addition, your authorization may include only a certain amount of days in the calendar year that you can spend in either inpatient or a certain number of visits you are allowed in outpatient care.
Even if you decide to choose a treatment facility in MagnaCare’s network, you may still have out-of-pocket expenses. The most common include:
- A deductible. The amount you are required to pay out-of-pocket before your insurance begins to provide coverage.
- A copay. A fixed amount that you pay when you receive a covered service.
- Coinsurance. A fixed percentage of the treatment costs that you are required to pay before or after you meet your deductible.
How Do I Get Started?
Seeking addiction treatment for yourself or for a loved one can be extremely difficult. We understand the burden of doing so and want to make the process as easy as possible for you.
Contact us to verify your benefits with MagnaCare and find out what kind of coverage you are eligible for through American Addiction Centers. You can call our free, 24-hour hotline at
Not Sure If You Need Rehab?
Take our free, 5-minute substance abuse self-assessment below if you think you or someone you love might be struggling with substance abuse. The evaluation consists of 11 yes or no questions that are intended to be used as an informational tool to assess the severity and probability of a substance use disorder. The test is free, confidential, and no personal information is needed to receive the result.