Hawaii Medical Service Association Health Insurance Coverage for Alcohol Addiction, Drug Addiction, and Mental Health Treatment

Mental health and substance use disorders are behavioral health conditions that affect Hawaiian residents of all ages. Nearly 3,500 adults received treatment for co-occurring mental health and substance use disorders. Hawaii Medical Service Association (HMSA) Health Insurance coverage commonly includes both inpatient care and outpatient therapy for those experiencing psychological distress.

HMSA insurance coverage can include treatment options for a range of behavioral health conditions, including mental health treatment, substance abuse, and dual diagnosis concerns. While the extent of your coverage is dependent on your policy details, it is often more affordable than paying out of pocket for rehabilitation programs. Learn more about Hawaii Medical Service Association’s rehab options for insured members by reading below.

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What Are Some Stats on Mental Health and Substance Misuse in Hawaii?

Hawaii residents can experience a range of mental health concerns, including substance use disorders and dual diagnosis conditions. A trend worth noticing that has been observed is that there has been a decrease in dual diagnosis treatment since 2023. Reasons that could contribute to this decline include improvements in public mental health, access to care, and stigma associated with treatment.

In 2022, Hawaii had a lower rate of unmet mental health needs compared to the national average. This is an impactful statistic, and shows that treatment options in Hawaii are reaching those experiencing psychological distress. Unfortunately, about 15% of those experiencing mental health distress indicated that treatment costs were a significant concern. Hawaii has seen a statistically significantly higher rate of fatal car accidents involving alcohol compared to other areas of the nation.

Find holistic substance addiction rehabilitation and mental health treatment insurance coverage with the Hawaii Medical Service Association.
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Are Veterans Included in HMSA Health Insurance Coverage?

Hawaii Medical Service Association’s addiction rehab coverage is available for U.S. Veterans. Available policies can vary, allowing customized coverage. As an example, you may choose to have HMSA as your primary insurance provider or use it for supplemental coverage regarding your available VA benefits. VA benefits can vary greatly, explaining why some opt for supplemental or secondary insurance policies.

Veterans who choose to use HMSA in addition to their VA benefits often need to follow the regulations and procedures associated with their VA plan. This can include using VA healthcare facilities and VA-approved treatment providers within the Community Care Network (CCN). HMSA coverage for U.S. Veterans can typically be applied towards inpatient care and various outpatient therapy options for substance abuse and mental health services. 

What is Hawaii Medical Service Association (HMSA) Health Insurance?

Hawaii Medical Service Administration (HMSA) is a nonprofit health insurance provider that provides services for over 700,000 Hawaiian residents. HMSA has a diverse range of products and services for insured members, including employer-sponsored plans, individual, and family health plans. Medicare and Medicaid are typically available to eligible residents.

Insurance plans with HMSA can include coverage for a range of behavioral health services, preventative care, and wellness programs. The Hawaii Medical Service Administration was founded in 1938 and is an affiliate of the Blue Cross Blue Shield Association. This allowed policyholders to access the vast network of healthcare providers that work with the BCBS Association. HMSA has a range of products and services, including options for HMO, PPO, and ACA market plans.

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Is Substance Use Disorder Treatment Health Coverage Included in the Hawaii Medical Service Association Health Plan?

Hawaii Medical Service Association does cover rehab services for those struggling with substance abuse and co-existing mental health conditions. Coverage can include a range of treatment programs, including detoxification services, inpatient care, and outpatient treatment programs. Medication-Assisted Treatment (MAT) and dual diagnosis care are often available when necessary.

Your coverage for rehabilitation programs is dependent on the details of your insurance policy. Coverage for alcoholism and drug dependency can include therapy, support groups, and educational sessions. Treatment commonly includes therapies like motivational interviewing, cognitive-behavioral therapy, and other holistic approaches. Addiction treatment programs are focused on addressing the underlying causes of your substance abuse and developing relapse prevention skills that promote long-term sobriety.

The coverage associated with your HMSA policy is determined during the underwriting process by an actuary. They evaluate the financial risks for treatment options to determine coverage rates, limitations, and exclusions. Those who have supplemental insurance or an umbrella policy can generally receive additional financial support compared to those who don’t.

Yes, rehab centers that take Hawaii Medical Service Association insurance plans can provide inpatient treatment services for mental health and substance abuse concerns.  Inpatient care is ideal for moderate to severe symptoms that significantly affect your everyday functioning. Inpatient treatment takes place in a public healthcare facility.

Hawaii Medical Service Association covers inpatient rehab programs when it is medically necessary. Inpatient programs can vary in length and may offer specialized treatment options like Medication-Assisted Treatment or dual-diagnostic care. Verifying your insurance can help you understand limitations or exclusions for treatment as well as out-of-pocket expenses like copayments, deductibles, and premiums.

Yes! Hawaii Medical Service Association alcohol and drug rehab coverage commonly includes detoxification services. Detox programs are often a necessary treatment option for those who are struggling with alcoholism, drug dependency, or polysubstance abuse. Detox programs typically take place in an inpatient setting that provides around-the-clock support and supervision.

Detoxification programs tend to have higher treatment expenses compared to other addiction treatment options in Hawaii. This is due to the intensive medical care that is included in treatment. Detox services may be offered in some outpatient care settings for those who are experiencing mild symptoms if a higher level of care is not appropriate for their symptoms. We encourage you to verify your insurance to decrease the risk of your claim being denied. Insurance companies often have reinsurance to provide them with financial support if your overall treatment costs are higher than expected. This can occur at any level of care, especially with detox and inpatient treatment programs.

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Mental Health and Substance Use Disorder Treatments in Hawaii: Which Types of Programs Are Covered by HMSA Health Insurance?

Hawaii Medical Service Association drug and alcohol rehab coverage typically includes a range of treatment programs and services. This allows insured members to access personalized care that is appropriate for their symptoms and overall mental wellness. While this is not an exhaustive list, examples of commonly used recovery programs in Hawaii include:

How to Check Your Health Insurance Coverage from the Hawaii Medical Service Association

When you verify your health insurance, it is important to choose a credible and reliable resource, such as CheckMyInsurance.co.  Our complimentary resource can provide you with a solid understanding of the important details of your insurance policy. With this knowledge, you can make informed decisions regarding available treatment providers.

Our free insurance coverage level checker will examine out-of-pocket costs, limitations, exclusions, required authorizations, and referrals. These details are important to know before selecting a treatment provider, as you can avoid the risk of choosing a provider that HMSA may limit or deny treatment claims for. If you choose to review your policy documents, focus on details related to behavioral health coverage for inpatient or outpatient care.

Intensive Outpatient Programs (IOPs) are an outpatient treatment option that allows you to manage your professional, academic, and personal responsibilities. IOPs often include group sessions and individual therapy, with MAT and dual diagnosis care when needed. These treatment programs are often recommended to ease the transition from inpatient to outpatient care.

Hawaii Medical Service Association drug rehab and mental health coverage can include IOP services. Your plan may require prior authorization because this is considered a specialized treatment option. Treatment typically ranges from one to three weeks, depending on your needs.

Partial Hospitalization Programming (PHP) is an outpatient program that resembles inpatient and residential care. With a full day of structured care, your treatment schedule will likely include individual therapy, support groups, and skill-building sessions. PHPs allow you to try using new skills at home in real time as you learn about them in treatment.

Hawaii Medical Service Association’s rehab options can include PHP services when it is appropriate for your symptoms. Because this is a specialized treatment program, prior authorization can decrease your liability for unexpected or higher treatment costs.

Residential treatment programs resemble inpatient care, with the notable difference being that they take place in a private healthcare facility. Residential treatment programs tend to have smaller treatment sizes, more amenities, and additional holistic approaches available. Residential care can range from a few weeks to a few months, based on your current needs.

Hawaii Medical Service Association alcohol rehab coverage can include residential treatment programs. Your policy may have limitations or exclusions for high-end or luxurious treatment options. You may also be responsible for a range of out-of-pocket expenses.

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A Guide for Getting Substance Addiction and Mental Health Treatment Covered by Hawaii Medical Service Association Health Insurance

The first step of using your HMSA health insurance is to use a trusted resource to verify your insurance coverage. CheckMyInsurance.co offers a reliable and complimentary insurance coverage level checker that can highlight the important details of your insurance coverage. You may need to obtain prior authorization or a referral for necessary treatment services.

Verifying your insurance can bring to your attention exclusions for treatment providers who are outside your insurance network or those that are considered high-end or luxurious. Choosing treatment providers who fall outside the scope of your insurance can reduce the coverage that you receive for treatment. Try to keep records of communication with HMSA and your treatment provider in case there are concerns down the road regarding the claims process.

Health Insurance Coverage Options for Mental Health Treatment in Hawaii

Hawaii Medical Service Association Health Coverage: How Frequently Does HMSA Pay for Mental Health and Substance Misuse Treatments?

There are differences found among HMSA insurance plan options, like HMO, PPO, and employer-sponsored plans. Some plans may have session caps or limitations on treatment, especially regarding inpatient, residential, or other specialized treatment options. Plans that have caps are often based on annual use and reset once per year.

If you find yourself needing coverage beyond the scope of your plan’s coverage, you can work with your treatment provider to submit a prior authorization or appeal for additional coverage. Behavioral health conditions are individualized, which means that there are personal differences in treatment needs and schedules. Those who experience chronic or progressive conditions may require additional treatment for comprehensive care.

The Cost of Health Insurance in Hawaii: How Much Does Mental Health and Drug/Alcohol Addiction Treatment Cost With HMSA Health Plans?

Hawaii Medical Service Association’s rehab coverage can vary greatly based on the type of plan that you have. There are distinct differences between HMO and PPO plans that can have a direct impact on your out-of-pocket costs. This allows insured members to choose a plan that aligns with their needs and budget.

You can learn about the treatment expenses that were outlined in the details of your plan by verifying your coverage with CheckMyInsurance.co. You may be responsible for copayments, deductibles, and premiums. Individuals who are interested in adjusting the details of their insurance policy can often do so during annual open enrollment periods.

The Cost of Health Insurance in Hawaii: How Much Does Mental Health and Drug/Alcohol Addiction Treatment Cost Without HMSA Health Plans?

Hawaii was ranked as the 41st most expensive state in the United States for residential drug rehab treatment according to the National Center for Drug Abuse Statistics (NCDAS). On average, Hawaiian residents who engage in residential treatment pay an average of $58,810. Traditional outpatient care typically costs $1,536 in Hawaii.

It is important to note that the cost of treatment can vary greatly, and is heavily based on the care you receive. This includes the specific treatment program you’re in, the location, available amenities, and the use of specialized services like MAT and dual diagnosis care. Those who receive extended-duration care tend to increase the cost of treatment. In most cases, inpatient and residential programming have higher costs than outpatient treatment options.

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Mental Health Treatment Centers in Hawaii That Are Accepted by HMSA Health Insurance Coverage

  1. The Queen’s Medical Center – Behavioral Health Services: 1301 Punchbowl St, Honolulu, HI 96813
  2. Sand Island Treatment Center: 1240 Sand Island Pkwy, Honolulu, HI 96819
  3. Wellness Partners Mental Health: 6700 Kalaniana’ole Hwy Suite 201, Honolulu, HI 96825
  4. Providence Treatment – Honolulu: 1188 Bishop St, Suite 1008, Honolulu, HI 96813
  5. Bobby Benson Center: 56-660 Kamehameha Hwy, Kahuku, HI 96731
  6. Mana Recovery Center: 1063 Lower Main St, Suites C-211A/213, Wailuku, HI 96793
  7. Waianae Coast Comprehensive Health Center – Behavioral Health: 86-260 Farrington Hwy, Waianae, HI 96792
  8. Kaiser Permanente Behavioral Health Services – Honolulu: 1010 Pensacola St, Honolulu, HI 96814
  9. Hawaii Pacific Health – Straub Medical Center Behavioral Health: 888 S King St, Honolulu, HI 96813
  10. Hale Na’au Pono – Waianae Coast Mental Health Center: 86-226 Farrington Hwy, Waianae, HI 96792

Substance Addiction Treatment Centers in Hawaii That Are Accepted by HMSA Health Insurance Coverage

  1. The Ohana Addiction Treatment Center: Kailua-Kona, HI 96740
  2. Sand Island Treatment Center: 1240 Sand Island Pkwy, Honolulu, HI 96819
  3. Hina Mauka: 45-845 Pookela St, Kaneohe, HI 96744
  4. Bobby Benson Center: 56-660 Kamehameha Hwy, Kahuku, HI 96731
  5. Ho’omau Ke Ola: 85-761 Farrington Hwy, Waianae, HI 96792
  6. CARE Hawaii – Pearl City Office: 94-837 Waipahu Depot St, Waipahu, HI 96797
  7. Salvation Army Addiction Treatment Services: 3624 Waokanaka St, Honolulu, HI 96817
  8. Aloha House, Inc.: 200 Ike Dr, Makawao, HI 96768
  9. Maui Recovery: 22 Waimahaihai St, Kihei, HI 96753
  10. Hawaii Island Recovery: 75-170 Hualalai Rd, Kailua-Kona, HI 96740
  • There has been a gradual decrease in the number of Hawaiian residents engaging in dual diagnosis treatment since 2023.
  • The prevalence of unmet mental health needs in Hawaii was lower than the national rate in 2022.
  • Over 15% of adults in Hawaii who were unable to access the mental health treatment they needed indicated that the cost of care was their main barrier. About four percent of Hawaiian adults are uninsured, which can create significant financial barriers to treatment.
  • Suicide was the leading cause of death for Native Hawaiians and Pacific Islanders between the ages of 15 and 24 during 2019.
  • The prevalence of adults in Hawaii who consumed alcohol before driving in a fatal car crash was more than twice the national average.Â