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Blue Shield California Exchange Insurance Coverage for Rehab

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What is Blue Shield California Exchange Insurance? “Exchange” is another term for insurance from the Health Insurance Marketplace. Covered California is the marketplace service available to individuals, families, and small businesses to help them shop for and enroll in affordable medical insurance in California. And yes, mental health and substance abuse treatment are both covered.

You can access the Marketplace through call centers, websites, and in-person help. When you apply through the Marketplace, you will find out if you qualify when you sign up for a medical insurance plan. You may discover if you qualify for Medicaid (called Medi-Cal in California). Qualification depends on your income, members of your household, and other pertinent information.

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The Affordable Care Act (ACA)

The ACA was put into effect to reduce health insurance costs so it could be available to more people. Low-income families who sign up through the California Exchange can also qualify for tax credits. These credits lower their monthly premium payments. If there is an overpayment or underpayment, it is figured out when paying taxes. Anyone can sign up for “Obama Care” through Covered California.

All Exchange plans cover substance abuse and mental health treatment services as essential benefits. All plans are required to cover:

  • Behavioral health treatment including counseling and addiction therapy services
  • Behavioral and mental health inpatient services
  • Substance abuse treatment
Exchange plans can’t deny coverage or charge higher premiums because of any pre-existing conditions. Your coverage for treatment of pre-existing conditions begins the day your coverage begins. And exchange plans can’t put lifetime or yearly limits on coverage of any essential health benefit.
The Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 is a federal law. It requires group health plans and health insurance providers to offer equal coverage for mental health and SUD treatment and medical/surgical coverage. The ACA later amended it to include individual plans.
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The California Health Insurance Exchange

California residents can shop for and purchase insurance online, by phone, or in person from the California Health Exchange. Also known as the Marketplace, it is mainly for individuals who:

  • Don’t have Medicare
  • Don’t have any healthcare insurance
  • Don’t have insurance through their workplace
  • Aren’t included in their spouse’s medical insurance through work
  • Have private insurance but want to find better options

There are many health plans on the California Exchange. The two most common types are:

  • PPO–PPO plans are more flexible. On this type of plan, you are allowed to see a primary care provider and any other specialist without needing a referral.
  • HMO–With an HMO plan, you will have your primary care provider. But if you need specialized care, you must be referred by your primary care provider to the specialist.
Both HMO and PPO plans offer access to a network of doctors, specialists, and hospitals that provide medical services at discounted rates. Fundamentally, pricing is dependent mostly on how extensive the network is and whether or not you get referrals from your primary care physician to see a specialist.

Blue Shield Health Insurance

Blue Shield of California is based in San Francisco and has been providing coverage to California residents since 1939. At this time, Blue Shield of California is one of the only two preferred provider organizations (PPOs) that offer plans to all California counties and ZIP codes, serving more than 4 million members. As a nonprofit health plan provider, they pledged in 2011 to only take 2% of their net income as revenue and return the rest to their community and members. This accounts for as much as $560 million being returned so far.

Blue Shield California Exchange Insurance Coverage for Rehab

The metal plan categories help you identify how much you pay of estimated average costs, compared to how much the insurance company pays. It has no bearing on the quality of care and all plans are required by the ACA to cover 10 essential health benefits. As mentioned above, one of those essential benefits is coverage for substance abuse and mental health treatment, including behavioral health.

When the ACA became law, health insurance plans were categorized into 4 levels:

  • Bronze 60–This is best for a healthy person or family that doesn’t have any current medical conditions but wants insurance “just in case.”

The Bronze HDHP 60–this is for a healthy family/individual who wants to take advantage of tax savings by putting money into a special bank account called a Health Savings Account.

  • Silver 70–This silver plan benefits a healthy family/individual who wants an affordable plan with reasonable, set copays for common services.
  • Gold–Best for a healthy family/individual who uses medical services frequently or wants an exchange plan without a deductible.
  • Platinum–Platinum is best for a healthy family/individual who uses medical services often and wants the best Obama Care plan available with the lowest amount of out-of-pocket costs.

449 Recovery is In-Network With Blue Shield

If you or someone you care about is struggling with SUD, there is comprehensive treatment available in Mission Viejo, CA. 449 Recovery is in-network with Blue Shield. If you need medical insurance, you can find Blue Shield California Exchange insurance by looking up Blue Shield of California or Covered California.

About 50% of people with substance use disorder also have a mental health disorder and vice versa. That’s why it’s so important to find a rehab with medical professionals experienced in treating mental disorders as well as SUDs. Our dual diagnosis treatment program addresses both SUDs and mental health disorders simultaneously.

We also have several treatment programs ranging from a standard outpatient program to a Partial Hospitalization Program (PHP) that compares in intensity to a residential program. SUD is a problem that requires professional evaluation and ongoing treatment. Contact us today if you or a loved one is interested in our services.

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Smiling bald man wearing a dark checkered jacket, black shirt, and red tie, posing in a warmly lit indoor setting—an inspiring presence at the Mission Viejo rehab program.

Dr. Barek Sharif, LMFT

(Medical Reviewer)
Dr. Sharif is a Licensed Marriage and Family Therapist who joined 449 Recovery in 2020 and oversees clinical operations as the Chief Clinical Officer. He earned his B.A. in Psychology and M.S. in Clinical Psychology from Vanguard University and completed his Doctor of Psychology from California School of Professional Psychology. Since 2011, Dr. Sharif has been dedicated to helping individuals, couples, and families heal from co-occurring disorders, including mental health, relational, and substance use challenges. He has led workshops on family dynamics, attachment injuries, spirituality in sobriety, and the impact of trauma on relationships.

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