If you’re exploring whether drug rehab covered by Oscar can support your recovery or that of a loved one, you’re not alone. Oscar Health plans are legally required to cover substance use disorder treatment as one of the 10 essential health benefits under the Affordable Care Act [1]. Depending on your plan tier—Secure, Bronze, Silver, Gold or Platinum—your share of costs will vary, but you can expect coverage for inpatient and outpatient programs, detox services, and behavioral therapies.
At Kemah Palms Recovery, we partner with Oscar Health to reduce financial hurdles. Our admissions team handles benefit verification and preauthorization on your behalf, so you can focus on healing. Here’s what you need to know to access high-quality drug rehab through your Oscar plan.
Verify your coverage
Understand plan tiers
Oscar Health offers five main tiers, each with different cost-sharing requirements:
| Plan tier | Typical cost responsibility |
|---|---|
| Secure/Bronze | Full deductible, then coinsurance |
| Silver | Deductible plus moderate coinsurance |
| Gold/Platinum | Little to no out-of-pocket expenses |
This table highlights that Gold and Platinum members usually pay minimal fees for inpatient addiction treatment, while Secure and Bronze members must first meet an annual deductible.
Check network requirements
To minimize your out-of-pocket costs, confirm that Kemah Palms Recovery is in-network with your Oscar plan. In-network providers negotiate contracted rates, which often results in lower coinsurance and copays. If you’re unsure, call your Oscar member services number or share your insurance details with our admissions team for confirmation.
Review covered treatments
Inpatient and outpatient programs
Oscar Health plans cover a full continuum of care, including residential rehab and outpatient tracks such as partial hospitalization and intensive outpatient programs. At Kemah Palms Recovery, you’ll find structured environments and flexible scheduling that align with your treatment needs. For alcohol-focused residential care, see alcohol rehab oscar insurance accepted. If you require outpatient support, see outpatient rehab with oscar insurance.
Detox and medication assistance
Medical detoxification and medication-assisted treatment (MAT) are critical steps in many recovery journeys. Oscar Health plans often cover these services under their mental and behavioral health benefits. To verify specifics, check drug detox oscar coverage and alcohol detox oscar health insurance.
Dual diagnosis support
Approximately 50 percent of individuals with substance use disorders also face co-occurring mental health conditions such as depression or anxiety. Oscar Health plans may cover dual diagnosis treatment, enabling you to receive integrated care for both addiction and mental health concerns [2]. At Kemah Palms, our multidisciplinary team ensures you get comprehensive support.
Calculate out-of-pocket costs
Deductibles and coinsurance
Your plan’s deductible determines the amount you pay before insurance starts sharing costs. After you meet the deductible, coinsurance typically ranges from 10 to 30 percent, depending on your tier.
Out-of-pocket maximums
Oscar Health plans cap your total annual spending on covered services. Once you hit your out-of-pocket maximum, Oscar covers 100 percent of in-network care for the rest of the plan year.
Gold and platinum benefits
If you’re on a Gold or Platinum plan, inpatient rehab and outpatient treatments often come with minimal or zero copays and coinsurance, making high-quality care more accessible.
Coordinate your benefits
Benefit verification process
When you contact Kemah Palms Recovery, our team will collect your insurance details and reach out to Oscar Health to obtain a benefits summary. This summary outlines exactly what services are covered, any cost-sharing requirements, and the duration of approved treatment.
Preauthorization and assessments
Some services require preauthorization before you can begin treatment. We handle this process for you, working directly with Oscar to secure approvals and schedule any necessary clinical assessments, so you can start your recovery without delay.
Explore financial assistance
Scholarships and payment plans
If your plan does not cover the full cost of care, Kemah Palms offers need-based scholarships and flexible payment plans to help bridge any gaps. You can also consider options such as loans or fundraising to cover out-of-pocket expenses.
Out-of-state coverage
Even if you live outside the state where Kemah Palms Recovery is located, your Oscar Health plan may still cover treatment at our facility. To avoid unexpected charges, request preapproval for out-of-state care from Oscar before admission [3].
