Health First (Commercial plans) may cover drug and alcohol rehab, detox, outpatient care, and mental health treatment — but your exact benefits depend on your plan, network status, and medical-necessity review.

Seeking addiction treatment is hard enough without insurance uncertainty. This guide explains how Health First Commercial rehab coverage typically works, what services may be covered, what affects your out-of-pocket cost, and how to verify benefits quickly. If you’d like help right away, our admissions team can verify your Health First benefits and explain your options for care at Orlando Recovery Center.

Note: This page applies to Health First commercial (employer-sponsored and individual/family) plans and does not address Health First Medicare or Medicaid products.

Quick takeaways (read this first)

  • Coverage varies by plan: Employer-sponsored and individual plans can differ in benefits and cost-sharing.
  • Network matters: Health First plans are typically network-based; out-of-network care may be limited or unavailable except emergencies.
  • Medical necessity matters: Clinical review is commonly used to determine the appropriate level of care.
  • Prior authorization is common: Detox, inpatient/residential, PHP, and IOP often require approval before services begin.
  • You can verify benefits without committing: Verification is informational and helps clarify coverage and next steps.

Health First (Commercial) overview

Health First is a Florida-based health system and insurance provider offering commercial health insurance plans to employers and individuals. Plan design, provider networks, and authorization requirements can affect how behavioral health, substance use disorder treatment, and mental health services are covered.

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Does Health First cover drug and alcohol rehab?

In many cases, yes — Health First commercial plans often include benefits for substance use disorder (SUD) treatment. Coverage and out-of-pocket costs depend on your specific plan, provider network status, and clinical review. Some services may be covered under medical benefits, while others may fall under behavioral health benefits. Medications used in treatment are typically covered under pharmacy benefits.

Important: Coverage does not always mean “no cost.” Many plans include deductibles, copays, coinsurance, prior authorization rules, or visit limits. Verifying benefits is the most reliable way to understand your coverage.

Levels of care Health First may cover

Addiction treatment is not one-size-fits-all. Health First may cover different levels of care depending on clinical needs, safety considerations, and treatment history. Common levels include:

  • Medical detox: Medically supervised withdrawal management when withdrawal may be unsafe or severe.
  • Inpatient / residential rehab: 24-hour structured treatment for stabilization and intensive therapy.
  • Partial Hospitalization Program (PHP): High-intensity day treatment while living at home or in supportive housing.
  • Intensive Outpatient Program (IOP): Multi-day per week therapy that allows patients to maintain daily responsibilities.
  • Standard outpatient: Ongoing counseling, therapy, and medication management.
  • Aftercare: Continued recovery support following higher levels of treatment.

How Health First determines coverage: medical necessity & authorization

Coverage decisions are generally based on medical necessity. Health First reviews clinical information to confirm that the requested level of care is appropriate. Like many insurers, Health First may reference nationally recognized guidelines such as The ASAM Criteria when evaluating treatment placement and duration.

During benefit verification or authorization, you may be asked about:

  • Substance use history and patterns
  • Withdrawal risk and prior complications
  • Medical and mental health conditions
  • Previous treatment attempts and relapse history
  • Home environment and support system
  • Safety risks or functional impairment

If a higher level of care is not approved initially, there may be options such as step-down recommendations, peer-to-peer review, or appeal depending on the plan.

What affects your out-of-pocket cost with Health First

Your total cost depends on several plan-specific factors, including:

  • Plan type: Employer-sponsored or individual plans may differ in cost-sharing.
  • Deductible: What you pay before the plan begins sharing costs.
  • Copays and coinsurance: Your share of costs after meeting the deductible.
  • Network requirements: In-network care is typically much less expensive.

Tip: If you are close to meeting your deductible or out-of-pocket maximum, treatment costs may be lower than expected.

Does Health First cover dual-diagnosis treatment?

Many Health First commercial plans include benefits for co-occurring mental health and substance use treatment. This may include therapy, psychiatric services, and medication management for conditions such as depression, anxiety, PTSD, or bipolar disorder when clinically appropriate.

Does Health First cover medication-assisted treatment (MAT)?

Medication-assisted treatment (MAT) may be covered when medically appropriate. Coverage depends on both medical and pharmacy benefits, and some medications may require prior authorization.

  • Buprenorphine/naloxone
  • Methadone (often provided through specific programs)
  • Naltrexone (including long-acting injectable forms)
  • Alcohol use disorder medications when indicated

How to check your Health First rehab benefits

To get accurate information, have your Health First member ID card available.

Option 1: Verify benefits with our admissions team (recommended)

We can confirm network status, authorization requirements, and estimated costs by contacting Health First directly or using eligibility tools when available. Verify your insurance online.

Rehab accepting Health First (Commercial) in Florida

If you’re seeking addiction treatment in Florida and have Health First commercial coverage, Orlando Recovery Center can help you understand your benefits and available treatment options before you begin care.

Disclaimer: This page is for informational purposes only and does not guarantee coverage or payment. Benefits vary by plan and are subject to authorization and medical-necessity review.