WellSense Health Plan Medicaid
For Addiction Recovery
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The Plymouth House, a Guardian Recovery facility, proudly accepts WellSense Medicaid, making quality addiction treatment more accessible to New Hampshire residents. WellSense, an official provider for NH Medicaid, offers comprehensive benefits including mental health and substance use disorder treatment.Â
Getting started with treatment begins with understanding your coverage options. In this guide, we’ll walk you through how to confirm your eligibility, highlight the treatment programs offered at The Plymouth House, and provide step-by-step support to launch your recovery journey. Our team is here to assist you with both the insurance verification process and your path to healing, offering both expertise and compassionate care.
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WellSense Health Plan Medicaid Details
WellSense Health Plan OverviewÂ
New Hampshire manages its Medicaid system, but recipients receive benefits through healthcare plans offered by WellSense, NH Healthy Families/Ambetter, and Amerihealth Caritas NH. Like the other providers, WellSense Medicaid offers comprehensive substance use treatment, making accessing the care you need easier. The Plymouth House, a top-tier addiction treatment provider, accepts WellSense insurance. This means you can receive exceptional care without the added worry of financial strain.
Most WellSense Medicaid plans cover the following services:
- Inpatient and residential rehab programs
- Outpatient rehab and therapy
- Detox services
- Medication-assisted treatment (MAT)
Your specific coverage and out-of-pocket costs will depend on your individual WellSense insurance plan. These factors include your plan type, deductible, and coinsurance. Moreover, if you have WellSense Health Plan insurance, you have coverage for addiction treatment services. To fully understand your benefits, carefully review your policy or contact WellSense Health Plan directly. You may also access the WellSense New Hampshire Medicaid Handbook here.1
Addiction Rehab & Recovery Services Coverage With WellSense Health Plan
WellSense offers coverage for a wide range of addiction treatment services. Members who qualify based on eligibility criteria often have access to a full spectrum of rehab care. In most cases, this means that individuals enrolled with WellSense can expect coverage for the entire addiction treatment process.
The most suitable treatment for your specific needs is determined through a thorough assessment conducted by a team of addiction treatment professionals. This evaluation takes into account various factors that may influence treatment, including medical, psychiatric, social, legal, and financial considerations.
The treatment process is tailored to each individual and guided by a personalized plan. Recovery may begin with detox services, followed by inpatient or outpatient care. Your treatment journey could involve multiple levels of care, and you may transition between them as your needs change throughout the recovery process.
Behavioral Services & Substance Use Disorder Benefits Covered Under New Hampshire Medicaid
Behavioral services and substance use treatment benefits under New Hampshire Medicaid aim to support individuals in their recovery journeys and improve their overall well-being. These services include:
Assessments
New Hampshire Medicaid addiction treatment typically begins with assessments to diagnose substance use disorders and determine the most appropriate level of care. These include clinical interviews to gather information about the person’s substance use history, medical conditions, and social circumstances as well as urine drug screening to identify the presence of any substances in the body.
Outpatient Services
Outpatient services offer ongoing support and care while allowing individuals to maintain their daily routines. They may include individual, group, or family therapy, as well as medication-assisted treatment.Â
Residential Treatment
Residential (inpatient) treatment is for those requiring more intensive care than outpatient treatment can offer, as these programs provide 24/7 supervision and support in a structured environment. They include a wide variety of therapeutic services, including individual, group, and family therapy, in addition to MAT and recreational and experiential activities.
Opioid Treatment Programs
Medicaid typically covers MAT for opioid use disorder, which combines medication with counseling and traditional therapies. These medications, such as methadone, buprenorphine, or naltrexone, are designed to reduce drug cravings and withdrawal symptoms and reduce the risk of relapse.
Recovery Support Services
Medicaid recognizes the importance of ongoing support in recovery by providing coverage that includes support services, which offer guidance and encouragement following higher levels of care. Also incorporated is case management, which helps individuals navigate the healthcare system, access resources, and maintain their recovery plan. Finally, life skills training is included, which helps individuals develop skills such as budgeting and job searching.
Recovery Monitoring
To ensure treatment is effective, New Hampshire Medicaid also covers regular drug and alcohol screenings to monitor for continued abstinence and ongoing assessments to evaluate progress and adjust the treatment plan as needed.
Mental Health Disorder Treatment & Medicaid Coverage
When substance use co-occurs with a psychiatric disorder, this is referred to as dual diagnosis. It’s crucial to treat these conditions in conjunction to ensure long-term effectiveness. Similar to substance use, New Hampshire Medicaid also offers coverage for mental health disorders in the form of inpatient treatment, outpatient services, and crisis intervention.
Conditions typically covered include:
- Major depressive disorder and other forms of depression
- Generalized anxiety disorder, panic disorder, and other anxiety-related conditions
- Bipolar disorder
- Attention hyperactivity deficit disorder (ADD/ADHD)
- Borderline and other personality disorders
- Post-traumatic stress disorderÂ
- Schizophrenia and schizoaffective disorder
- Autism spectrum disorders
- Obsessive-compulsive disorder
- Eating disorders and other behavioral addictions
Addiction Treatment Levels of Care Covered by WellSense Health Plan
WellSense rehab coverage typically includes the following levels of care:
- Residential programs that provide 24/7 supervision in a structured environment.
- Partial hospitalization programs (PHPs) that offer intensive day treatment with evening and weekend discharge (individuals return home at night).
- Intensive outpatient programs (IOPs) that offer more structured treatment than traditional outpatient care, typically consisting of several hours of therapy sessions per week.
- Outpatient services, including individual, group, and family therapy, case management, peer support services, and MAT.
- Detox services with medical supervision to safely manage withdrawal symptoms.
The Plymouth House Is In-Network With WellSense Health Plan Medicaid
In-network healthcare providers (doctors, clinics, therapists, etc.) are those who have a contract with your insurance company and have agreed to specific terms. Generally, using an in-network provider means paying lower out-of-pocket costs (deductibles, co-payments, etc.) Because The Plymouth House is an in-network provider with WellSense, you’ll typically incur lower costs for New Hampshire Medicaid addiction treatment than with out-of-network providers.
Verifying Your Medicaid Substance Use Disorder Treatment Benefits
You can verify your coverage for addiction treatment in a number of ways. You can contact NH Healthy Families at 1-866-769-3085 to discuss your benefits. Alternatively, you can quickly verify your Medicaid substance use disorder treatment benefits by calling us at 1-888-480-1172. Or you can fill out our easy online form on our website to check your coverage.
WellSense Health Plan Insurance Plans
WellSense offers several insurance plans to fit each individual’s budget and lifestyle whether you’re looking for comprehensive health coverage or personalized Medicaid and Medicare options.
- Individual and Family Plans: Customizable coverage options for individuals and families, with access to a broad network of healthcare providers.
- Medicaid: Medicaid Care Management (MCM), or managed care, provides New Hampshire Medicaid health benefits, behavioral health benefits, and additional services through contracts between the Department of Health and Human Services (DHHS) and managed care organizations (MCOs) or Medicaid Health Plans, such as WellSense Health Plan.2Â
- Medicare:
- Medicare Advantage (Part C) — All-in-one plans that bundle Original Medicare benefits with additional coverage, such as dental, vision, and hearing.
- Prescription Drug Plans (Part D) — Standalone plans that help cover the cost of medications, with options like the Premier Rx plan for comprehensive coverage.Â
- Medicare Supplement (Medigap) — Plans that work alongside Original Medicare to help pay out-of-pocket costs, like Plan G and high-deductible Plan G.
- Special Needs Plans (SNPs) — Customized plans for individuals with specific health conditions or financial situations, designed to provide coordinated care.
Sources
- WellSense Health Plan. (2024). WellSense New Hampshire Medicaid Handbook.
- WellSense Health Plan. (2024). New Hampshire Medicaid.
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Frequently Asked Questions
No. It’s crucial to verify whether a treatment center accepts WellSense to ensure coverage and minimize costs. The Plymouth House is one of the facilities that accepts this insurance.
Yes. WellSense covers a range of behavioral health services, including substance use treatment. However, the specific services covered and the amount of coverage may vary depending on your individual plan.
WellSense Health Plan typically covers detox, residential treatment, partial hospitalization, intensive outpatient programs, and outpatient services. Included in these are traditional therapies, MAT, case management, and peer support services.
This will depend on your specific plan, deductibles, copayments, and coinsurance. It’s essential to review your plan details, contact your insurer directly, or call Guardian Recovery for a free health insurance benefits check to understand your coverage limits.
No, but it’s generally preferable. While using an in-network provider is usually recommended to maximize coverage and minimize out-of-pocket costs, some out-of-network services may be covered under certain circumstances. However, you may need a referral to use an out-of-network provider.
You can contact WellSense by visiting their website or by calling the number on the back of your insurance card to discuss the details of your specific plan and the coverage available for substance use treatment. Alternatively, you can quickly verify your Medicaid substance use disorder treatment benefits by calling us at 1-888-480-1172, or you can fill out our easy online form on our website to instantly check your coverage.
