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Capital Health Plan

Rehabs That Take Capital Health Plan

Capital Health Plan is a health plan based in Tallahassee, Florida, and an affiliate of Florida Blue. Its plans can include coverage for drug and alcohol treatment, varying by plan, network and level of care.Treatment centers in Florida and Pennsylvania list Capital Health Plan on their own websites, sometimes simply as Capital. The Pennsylvania listings may refer to a different Capital plan, so compare the name with your card. Call member services and ask whether the facility is in network, whether prior authorization or a referral is required and what you would owe. Then contact the center before admission.

Rehab Centers Near You

Drug and Alcohol Rehab Centers That Accept Capital Health Plan

STR Behavioral Health – Mahanoy City

5 White Owl Drive, Mahanoy City, PA, 17948

4.8★★★★★~~457~~

Joint Commission

DetoxHospital detoxInpatient+2

Accepts InsuranceSelf-Pay

Co-occurring DisordersMATTrauma-informed+10

STR Behavioral Health is based at 5 White Owl Drive in Mahanoy City, Pennsylvania. Listed provision covers residential treatment and sober living. This is recorded as treating co-occurring conditions rather than one in isolation. The model is residential: people move in for the length of the program. Family involvement is listed as part of the provision. Federal listing is via SAMHSA, and the Pennsylvania Department of Drug and Alcohol Programs handles licensing in this state.

2.5 miBroad Mountain37 miLehigh Valley International AirportServes12 towns

Substances treated

Adderall Rehab · Alcohol Detox · Alcohol MAT Friendly · Alcohol Medication Treatment · Alcohol Only Rehab · Alcohol Rehab · Ativan (Lorazepam) Rehab · Beer Addiction Treatment · Benzodiazepine Rehab · Binge Drinking Treatment · +51 more

Levels of care

14-Day Rehab · 21-Day Rehab · 30-Day Rehab · Addiction Retreat · Aftercare and Continuing Care · Alcohol Detox Program · Anxiety Retreat · Ativan (Lorazepam) Detox Program · Benzodiazepine Detox Program · Buprenorphine-Assisted Detox · +53 more

Therapies

12 Step Rehab · Activity Therapy · Addiction Counseling · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Couples Counseling · Dialectical Behavior Therapy (DBT) · Evidence-Based Therapy · Family Therapy · Group Therapy · +5 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and Trauma · Family Education Programs · Mental Health Conditions · Mental Health Treatment · Psychiatric Medication Management · Psychosocial Rehabilitation · Psychosocial Rehab Services · Social Skills Training · +1 more

Groups served

Active Duty Military Detox · Active Duty Military Dual Diagnosis Rehab · Active Duty Military Rehab · Active Duty Military Suboxone · Active Duty Military Trauma Rehab · Adult Rehab · Couples Rehab · Court Ordered Detox · Court Ordered Dual Diagnosis Rehab · Court Ordered MAT · +45 more

Support services

Case Management · Community Outreach · Employment Support · Health and Wellness Support · Housing and Employment Support · Housing Assistance · Nutrition and Fitness Counseling · Peer Support · Practical Support · Recovery Support Services · +3 more

Insurance accepted

Aetna · Ambetter (Centene) · Capital Health Plan · Cigna Healthcare · ComPsych · Evernorth Health Services · Geisinger Health Plan · Highmark Health · Magellan Health · Quest Behavioral Health · +4 more

STR Behavioral Health – Lancaster

610 Community Way, Lancaster, PA, 17603

5.0★★★★★38

SAMHSA listed

PHPOutpatient

Accepts InsuranceAccepts MedicareAccepts TRICARE+2

Co-occurring DisordersTrauma-informedVeterans+6

Records place STR Behavioral Health at 610 Community Way, Lancaster, Pennsylvania. On record, this provider offers partial hospitalization, intensive outpatient and outpatient care. Substance use and mental health conditions are both treated here. People attend appointments and go home afterwards, which is how outpatient care works. The record notes group sessions alongside individual work. The facility is federally registered and licensed by the Pennsylvania Department of Drug and Alcohol Programs.

6.8 miManor Hills5.8 miLancaster AirportServes12 towns

Substances treated

Adderall Rehab · Concerta Rehab · Dexedrine Rehab · Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Prescription Stimulant Rehab · Ritalin Rehab · Smoking Cessation Counseling · Smoking Cessation Medication · Stimulant Rehab · +2 more

Levels of care

Evening Treatment · Non-12-Step Rehab · Outpatient Rehab · Partial Hospitalization Program (PHP) · Weekend Rehab

Therapies

Activity Therapy · Cognitive Behavioral Therapy (CBT) · Cognitive Remediation Therapy · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy · Integrated Dual Disorder Treatment · +1 more

Mental health

Alzheimer's and Dementia Care · Assertive Community Treatment (ACT) · Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and PTSD · Depression and Trauma · Family Education Programs · First Episode Psychosis · Illness Management and Recovery · Mental Health Conditions · +8 more

Groups served

Active Duty Military Dual Diagnosis Rehab · Active Duty Military Medicare Rehab · Active Duty Military Outpatient Rehab · Active Duty Military PTSD Rehab · Active Duty Military Rehab · Active Duty Military Trauma Rehab · Active Duty Military TRICARE Rehab · Adult Rehab · Couples Rehab · Court Ordered Dual Diagnosis Rehab · +26 more

Support services

Case Management · Chronic Illness Management · Education and Job Training · Health and Wellness Support · Housing and Employment Support · Intensive Case Management · Nutrition and Fitness Counseling · Recovery Support Services · Suicide Prevention Services

Insurance accepted

Aetna · Ambetter (Centene) · Capital Health Plan · Cigna Healthcare · Evernorth Health Services · Highmark Health · Humana · Medicare · Optum · TRICARE

STR Behavioral Health – Bethlehem

1655 Valley Center Parkway, Bethlehem, PA, 18017

4.8★★★★★~~121~~

SAMHSA listed

PHPOutpatient

Accepts InsuranceAccepts MedicareAccepts TRICARE+2

Co-occurring DisordersTrauma-informedVeterans+6

STR Behavioral Health occupies 1655 Valley Center Parkway in Bethlehem, Pennsylvania. According to the federal listing this provider runs partial hospitalization, intensive outpatient and outpatient care. The listing covers both substance use and mental health treatment. Care is provided on an outpatient basis, so people continue living at home. Family involvement is listed as part of the provision. Both federal registration through SAMHSA and Pennsylvania Department of Drug and Alcohol Programs licensing are on record.

3.1 miCamelhump1.5 miLehigh Valley International AirportServes13 towns

Substances treated

Levels of care

Evening Treatment · Non-12-Step Rehab · Outpatient Rehab · Partial Hospitalization Program (PHP) · Weekend Rehab

Therapies

Mental health

Groups served

Support services

Insurance accepted

Aetna · Ambetter (Centene) · Capital Health Plan · Cigna Healthcare · ComPsych · Evernorth Health Services · Geisinger Health Plan · Highmark Health · Humana · Magellan Health · +6 more

UF Health Shands – Gainesville

4305 NW 90th Boulevard, Gainesville, FL, 32606

4.3★★★★☆~~113~~

Joint Commission

DetoxPHPIOP+3

Accepts InsuranceAccepts MedicaidSelf-Pay

Co-occurring DisordersMATTrauma-informed+6

Deaf and HoH

4305 NW 90th Boulevard in Gainesville, Florida is the address held for this provider. According to the federal listing this provider runs detox, intensive outpatient and outpatient care. The listing includes medication-assisted treatment, the approach with the strongest evidence for opioid dependence. Care is provided on an outpatient basis, so people continue living at home. Telehealth appointments are recorded as available, which widens what is reachable for anyone without transport. Veterans and military families are…

13 miNewnans Lake9.9 miGainesville Regional AirportServes3 towns

Substances treated

Levels of care

Aftercare and Continuing Care · Alcohol Detox Program · Ativan (Lorazepam) Detox Program · Benzodiazepine Detox Program · Buprenorphine-Assisted Detox · Carfentanil Detox Program · Clonidine and Lofexidine Detox · Cocaine Detox Program · Codeine Detox Program · Continuing Care · +41 more

Therapies

12 Step Rehab · Addiction Counseling · Anger Management · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Contingency Management · Counseling and Therapy · Couples Counseling · Evidence-Based Therapy · Family Therapy · +5 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and Trauma · Mental Health Conditions · Mental Health Treatment · Psychiatric Medication Management · Psychosocial Rehabilitation · Social Skills Training · Trauma Treatment

Groups served

Adult Rehab · Couples Rehab · Early HIV Intervention · Hepatitis Support Services · HIV and Hepatitis Care · HIV Support Services · Men's Dual Diagnosis Rehab · Men's Outpatient Rehab · Men's Rehab · Men's Telehealth · +19 more

Support services

Case Management · Community Outreach · Education and Job Training · Health and Wellness Support · Health Education · Hepatitis C Treatment · HIV Treatment · Housing and Employment Support · Housing Assistance · Intervention Services · +9 more

Languages

Deaf and Hard of Hearing Detox · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab

Insurance accepted

Aetna · BCBS (Blue Cross Blue Shield) · Capital Health Plan · Cigna Healthcare · Humana · TRICARE

HCA Florida North Florida Hospital – Gainesville

6500 West Newberry Road, Gainesville, FL, 32605

4.1★★★★☆~~4,858~~

SAMHSA listed

InpatientOutpatientWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+4

SeniorsYoung adultsCouples+2

HCA Florida North Florida Hospital occupies 6500 West Newberry Road in Gainesville, Florida. Provision here is recorded as residential treatment and intensive outpatient. This provider is recorded for mental health rather than addiction treatment. This is residential provision, so someone lives at the facility throughout. Family involvement is listed as part of the provision. The provider appears in the federal treatment register, with state licensing through the Florida Department of Children and Families.

11 miNewnans Lake8.6 miGainesville Regional AirportServes2 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Inpatient Rehab · Outpatient Rehab · Rehab Transfers · Walk-In Rehab · Weekend Rehab

Therapies

Activity Therapy · Cognitive Behavioral Therapy (CBT) · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy · Specialized Therapy

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Family Education Programs · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · Psychiatric Walk-In Clinic · Psychosocial Rehabilitation

Groups served

Adult Rehab · Couples Rehab · Court Ordered Rehab · Senior Outpatient Rehab · Senior Rehab · Young Adult Rehab

Support services

Case Management · Education and Job Training · Housing and Employment Support · Recovery Support Services · Suicide Prevention Services

Insurance accepted

Aetna · Align Senior Care · Ambetter (Centene) · American Health Plan of Florida · Avmed · Capital Health Plan · Carelon Behavioral Health · CarePlus Health Plans · CareSource · Cigna Healthcare · +23 more

UF Health Jacksonville – Jacksonville

655 West 8th Street, Jacksonville, FL, 32209

2.7★★★☆☆~~806~~

SAMHSA listed

InpatientOutpatientWalk-in

Accepts InsuranceAccepts MedicaidAccepts Medicare+4

Co-occurring DisordersTrauma-informedVeterans+5

655 West 8th Street in Jacksonville, Florida is the address held for this provider. Services on file are residential treatment and intensive outpatient. The record shows mental health treatment only. Treatment happens in-house, with residents on site day and night. Group and family work are both recorded. Federal listing is via SAMHSA, and the Florida Department of Children and Families handles licensing in this state.

3.4 miTrout River10 miJacksonville International AirportServes7 towns

Substances treated

Nicotine and Tobacco Treatment · Nicotine Replacement Therapy · Smoking Cessation Counseling · Smoking Cessation Medication · Vaping Cessation

Levels of care

Evening Treatment · Inpatient Rehab · Outpatient Rehab · Rehab Transfers · Walk-In Rehab · Weekend Rehab

Therapies

Activity Therapy · Cognitive Behavioral Therapy (CBT) · Cognitive Remediation Therapy · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · ECT Therapy · Evidence-Based Therapy · Family Therapy · Group Therapy · Individual Therapy · +4 more

Mental health

Alzheimer's and Dementia Care · Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and PTSD · Depression and Trauma · First Episode Psychosis · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · Psychiatric Walk-In Clinic · +4 more

Groups served

Support services

Case Management · Chronic Illness Management · Health and Wellness Support · Nutrition and Fitness Counseling · Recovery Support Services · Suicide Prevention Services

Insurance accepted

Aetna · Ambetter (Centene) · AmeriHealth · Avmed · Capital Health Plan · Carelon Behavioral Health · CareSource · Cigna Healthcare · Community Care Plan · Devoted Health · +17 more

UF Health Psychiatric Hospital – Gainesville

4101 NW 89th Boulevard, Gainesville, FL, 32606

2.3★★☆☆☆76

Joint Commission

DetoxHospital detoxInpatient+2

Accepts InsuranceAccepts MedicaidAccepts Medicare+4

Co-occurring DisordersMATTrauma-informed+9

Spanish spokenDeaf and HoH

Records place UF Health Psychiatric Hospital at 4101 NW 89th Boulevard, Gainesville, Florida. The services listed are detox and residential treatment. Medication-assisted treatment forms part of the provision listed here. Treatment happens in-house, with residents on site day and night. Support for veterans appears on the record. The facility is federally registered and licensed by the Florida Department of Children and Families.

13 miNewnans Lake9.9 miGainesville Regional AirportServes3 towns

Substances treated

Levels of care

Therapies

12 Step Rehab · Activity Therapy · Addiction Counseling · Brief Intervention · Cognitive Behavioral Therapy (CBT) · Contingency Management · Counseling and Therapy · Dialectical Behavior Therapy (DBT) · ECT Therapy · Evidence-Based Therapy · +6 more

Mental health

Co-Occurring Mental Health Conditions · Depression and Anxiety · Depression and Trauma · Family Education Programs · Mental Health Conditions · Mental Health Crisis Services · Mental Health Treatment · Psychiatric Medication Management · Psychiatric Walk-In Clinic · Psychosocial Rehabilitation · +3 more

Groups served

Adult Rehab · Couples Rehab · Court Ordered Detox · Court Ordered Dual Diagnosis Rehab · Court Ordered MAT · Court Ordered Medicare Rehab · Court Ordered Rehab · Court Referral Accepted · Hepatitis Support Services · HIV and Hepatitis Care · +53 more

Support services

Case Management · Health and Wellness Support · Health Education · HIV Treatment · Intervention Services · Peer Support · Practical Support · PrEP Services · Recovery Support Services · Self Help Groups · +1 more

Languages

Deaf and Hard of Hearing Detox · Deaf and Hard of Hearing Dual Diagnosis Rehab · Deaf and Hard of Hearing MAT · Deaf and Hard of Hearing Rehab · Spanish Speaking Rehab

Insurance accepted

Aetna · BCBS (Blue Cross Blue Shield) · Capital Health Plan · Cigna Healthcare · Humana · Medicare · TRICARE

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Common questions

Answered from what is listed here.

Does Capital Health Plan cover rehab?

Yes. Capital Health Plan covers substance use treatment, including inpatient care with detoxification, residential treatment, partial hospitalization and outpatient counseling. It is an HMO, so care must come from participating providers in its nine-county North Florida network, and inpatient, residential and PHP admissions need prior authorization first.

The State of Florida Standard HMO charges $250 per inpatient admission and $20 per outpatient visit, while the HDHP option pays 20% of the contracted rate after the deductible.

Inpatient Rehabhttps://rehabseekers.com/programs/inpatient/

Does Capital Health Plan cover detox?

Yes. Detoxification is included within inpatient alcoholism and substance use care on the State Employees' HMO plan, and all inpatient services require prior authorization before admission. Programs must be Joint Commission accredited or meet state standards and must participate in the plan's network.

Pre-admission review runs through Capital Health Plan, Inc. at 850-383-3311, and the 24-hour Health Information Line, (850) 383-3400, is staffed around the clock for urgent questions.

Detox Centershttps://rehabseekers.com/programs/detox-centers/

Does Capital Health Plan need prior authorization for rehab?

Yes. Prior authorization is required for all inpatient services, residential substance abuse treatment and partial hospitalization for substance use. Requests go to Capital Health Plan at 850-383-3311 on the universal prior authorization form, and reviewers apply the plan's own criteria plus Florida Blue medical coverage guidelines.

For Medicare members, residential substance use treatment is reviewed under the CMS national coverage determination for inpatient psychiatric care rather than commercial criteria.

Residential Rehabhttps://rehabseekers.com/programs/residential/

Does Capital Health Plan cover residential treatment?

Yes, with prior authorization. Residential substance abuse treatment sits on Capital Health Plan's prior authorization list, and its provider directory includes residential treatment facilities and inpatient psychiatry. Approval rests on medical necessity criteria developed by the plan, with Florida Blue guidelines used for commercial reviews.

Concurrent review continues during a stay, alongside case management and discharge planning, so additional days are reassessed as treatment progresses.

Residential Rehabhttps://rehabseekers.com/programs/residential/

Does Capital Health Plan cover out-of-network rehab?

No, generally not. Capital Health Plan is an HMO, so apart from emergencies all services must come from participating providers, and non-participating care is not covered unless arranged in advance by written referral or authorization. Medicare members face the same rule.

Worldwide emergency and urgently needed care travels with you through BlueCard and Blue Shield Global Core, but planned treatment outside the nine-county network needs advance approval.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

Does Capital Health Plan cover therapy?

Yes. Outpatient mental health coverage includes diagnostic evaluation, psychiatric treatment and individual and group therapy. On the State of Florida Standard HMO the copay is $20 per visit, and Medicare Advantage therapy visits cost $20 to $30 in 2026 depending on which plan you hold.

No session limit appears in the plan documents; the State Employees' plan states that treatment required by mental health parity rules is covered when medically necessary.

Counseling and Therapyhttps://rehabseekers.com/therapies/counseling-and-therapy/

Does Capital Health Plan cover Suboxone?

Yes. On the 2027 Advantage Plus and Preferred Advantage Medicare formulary, generic buprenorphine-naloxone sublingual tablets sit on Tier 2 and the film on Tier 4, both with quantity limits and no prior authorization listed. Tier 2 costs $7; Tiers 4 and 5 are 25% coinsurance.

Commercial and individual formularies are administered by Prime Therapeutics and posted at myprime.com, where buprenorphine coverage can differ from the Medicare list.

Suboxonehttps://rehabseekers.com/medications/mat/buprenorphine/suboxone/

Does Capital Health Plan cover Vivitrol or naltrexone?

Yes, both. The 2027 Medicare formulary for Advantage Plus and Preferred Advantage lists naltrexone 50 mg tablets on Tier 2 and the Vivitrol 380 mg injection on Tier 5, with no prior authorization shown. Acamprosate is Tier 4 and disulfiram Tier 3.

Tier 2 drugs cost $7, while Tier 4 and 5 drugs run 25% coinsurance until you reach $2,400 out of pocket, after which covered drugs are $0.

Vivitrol Shothttps://rehabseekers.com/medications/mat/naltrexone/vivitrol-shot/

Does Capital Health Plan cover methadone?

Methadone 5 mg and 10 mg tablets appear on the 2027 Medicare formulary at Tier 3 with quantity limits, costing $45 after the Part D deductible. Methadone dispensed for opioid use disorder at an opioid treatment program is billed as a medical service, not a pharmacy benefit.

Opioid treatment program coverage is not spelled out in published plan documents, so call Member Services at (850) 383-3311 before starting at a clinic.

Methadone Medication Clinichttps://rehabseekers.com/medications/mat/methadone/

Does Capital Health Plan have Medicaid?

No. Capital Health Plan does not offer a Florida Medicaid managed care plan and is not among the Statewide Medicaid Managed Care options. In Region 2, the Big Bend area, Medicaid members choose from Florida Community Care, Humana Medical Plan, Simply Healthcare, Sunshine Health and UnitedHealthcare.

Capital Health Plan instead sells employer, individual and family, Medicare Advantage, and State of Florida employee and retiree coverage across its nine-county service area.

Medicaid Rehabhttps://rehabseekers.com/insurance-accepted/medicaid/

What Medicare plans does Capital Health Plan offer?

Capital Health Plan offers Silver Advantage, Advantage Plus, Preferred Advantage, Giveback Advantage and Retiree Advantage HMO plans, plus CHP Retiree Advantage for State of Florida retirees, all under Medicare contract H5938. Members need Part A and Part B and must live in the nine-county service area.

2026 premiums run $0 for Silver Advantage and Giveback Advantage, $34 for Advantage Plus and $96 for Preferred Advantage; the plans earned 4.5 stars in the 2025 CMS ratings.

Medicare Rehabhttps://rehabseekers.com/insurance-accepted/medicare/

Is Capital Health Plan the same as Florida Blue?

No. They are separate companies with separate networks, though both are Blue Cross and Blue Shield licensees and both are GuideWell businesses. Capital Health Plan is a Tallahassee not-for-profit HMO, and it applies Florida Blue medical coverage guidelines to some commercial reviews.

It is also unrelated to Capital Blue Cross in Pennsylvania or CDPHP in New York, so compare the exact wording on your member card.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

Does Capital Health Plan cover online therapy?

Yes. Amwell telehealth gives members 24-hour access to network providers for non-emergency medical and behavioral health concerns, and the provider directory has a telehealth filter. Amwell urgent care visits are $0 on State of Florida plans and $15 for Medicare members in 2026.

Video visits with your own primary care physician or a specialist are charged at the same copay as the equivalent in-person office visit.

Online Rehab and Telehealthhttps://rehabseekers.com/programs/online-rehab-and-telehealth/

How do I find a rehab that takes Capital Health Plan?

Use the Find a Doctor/Facility directory at capitalhealth.com and filter by facility type for Substance Abuse or Residential Treatment Facility, or by specialty for Addiction Medicine or Chemical Dependency. Member Services can also check participation at (850) 383-3311 or 1 (877) 247-6512.

Because this is an HMO, confirm the program participates and has prior authorization before admission; centers accepting the plan are listed here by level of care.

Private Insurance Acceptedhttps://rehabseekers.com/insurance-accepted/private-insurance-accepted/

What areas does Capital Health Plan cover?

Capital Health Plan serves nine North Florida counties around Tallahassee: Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor and Wakulla. Members must live or work in that service area, and Medicare members must live in it. The plan sells no coverage outside Florida.

Madison and Taylor counties were added in 2020 for employer group and individual marketplace plans; elsewhere in Florida the Blue brand is Florida Blue.

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Capital Health Plan is a not-for-profit HMO based in Tallahassee that sells coverage in nine North Florida counties and nowhere else. Addiction treatment is a covered benefit, but because the plan is an HMO built around its own Big Bend network, where care is delivered matters as much as what the benefit says.

CHP opened on June 1, 1982 and now reports over 135,000 members. It is unusual in being both insurer and care provider, running the CHP Physicians Group and health centers in Tallahassee. It is an independent licensee of the Blue Cross and Blue Shield Association, and GuideWell, the holding company behind Florida Blue, lists CHP among its businesses. CHP uses Florida Blue medical coverage guidelines for parts of its commercial review work.

This guide covers which levels of addiction care CHP pays for, which ones need prior authorization, what a stay or a therapy visit costs under the State of Florida and Medicare Advantage plans, how medication for opioid and alcohol use is covered, and how to tell whether a program sits inside the CHP network.

Does Capital Health Plan Cover Drug and Alcohol Rehab?

Yes. The State Employees’ HMO plan document covers “Mental Health, Alcoholism, and Substance Abuse Care”, including inpatient care with detoxification, outpatient care, and any other treatment or setting that mental health parity requires. CHP’s prior authorization list also names Residential Substance Abuse Treatment and partial hospitalization for substance use treatment, so those levels are covered once authorized.

The State of Florida plan adds one condition worth knowing before a call to admissions: a program has to be Joint Commission accredited or state approved. CHP’s provider directory lists facility types including Inpatient Psychiatry, Residential Treatment Facility and Substance Abuse, and specialties including Addiction Medicine, Chemical Dependency, Behavioral Health, Psychiatry and Psychology.

Where the coverage works. CHP sells only in Calhoun, Franklin, Gadsden, Jefferson, Leon, Liberty, Madison, Taylor and Wakulla counties, and a member has to live or work in that area. Elsewhere in the state the Blue brand is Florida Blue, a separate GuideWell company with its own network.

What Does Capital Health Plan Pay For at Each Level of Care?

The ladder runs from withdrawal management through residential care, partial hospitalization and outpatient therapy, with the level matched to clinical need at assessment. Commercial reviews use CHP’s own medical necessity criteria alongside Florida Blue coverage guidelines; Medicare reviews of residential substance use treatment follow CMS national coverage determination 130.6.

Medical Detox

Detoxification is named inside inpatient alcoholism and substance use care in the State of Florida plan document, and all inpatient services need prior authorization. Alcohol and benzodiazepine withdrawal can produce seizures, so an emergency department is the right destination during acute withdrawal regardless of the authorization question. A planned medical detox admission is authorized before the date.

Residential and Inpatient

Residential Substance Abuse Treatment sits on CHP’s prior authorization list, as does every inpatient service. CHP also performs concurrent review of hospitalized patients, including in psychiatric facilities, along with case management and discharge planning, so an approved admission is reviewed in blocks rather than signed off once for an open-ended stay.

PHP, IOP and Outpatient

Partial hospitalization for substance use treatment is covered with prior authorization. No fetched CHP document lists intensive outpatient separately, so a member stepping into IOP should ask Member Services how that level is authorized and billed. Outpatient care covers diagnostic evaluation, psychiatric treatment, and individual and group therapy, with no session limit stated in the plan documents.

Does Capital Health Plan Need Prior Authorization for Rehab?

Yes, for all inpatient services, Residential Substance Abuse Treatment and partial hospitalization for substance use treatment. Residential eating disorder treatment, ABA therapy and TMS also require it. Authorization and pre-admission requests go to Capital Health Plan, Inc. on 850-383-3311; a treating provider uses Network Services on (850) 523-7361, and the Universal Prior Authorization Form has been required since January 1, 2017.

Do I Need a Referral From My Primary Care Physician?

For outpatient behavioral health on the State of Florida plan, the 2025 brochure says care is covered when it is medically necessary and authorized by the primary care physician, even though most specialist office visits need no referral. That single sentence is the one that delays admissions, so the conversation with the PCP is worth having early rather than at intake.

Out-of-network care on an HMO. Except for emergency services, the State of Florida HMO covers only participating providers, and non-participating care is not covered unless CHP arranges it in advance by written referral or authorization. Medicare Advantage follows the same pattern, with exceptions for emergencies, urgently needed services, out-of-area dialysis and care the plan authorizes.

How Much Does Rehab Cost With Capital Health Plan?

It depends on the plan named on the card. On the State of Florida Standard HMO, inpatient mental health and substance use care is $250 per admission and then covered in full, with outpatient visits at $20. The HDHP, or Health Investor option, charges 20% of the contracted rate after the deductible, which in 2026 is $1,700 single and $3,400 family.

On the Medicare Advantage side, 2026 outpatient individual or group therapy is $30 on Silver Advantage, Advantage Plus and Giveback Advantage, and $20 on Preferred Advantage, rising in 2027 to $50, $45, $60 and $35. The 2026 out-of-pocket maximums are $5,500 on Silver Advantage, $4,500 on Advantage Plus and Preferred Advantage, and $6,700 on Giveback Advantage. For 2027, inpatient hospital stays run $300 a day for days 1–7 on Silver, $275 on Advantage Plus, $200 a day for days 1–5 on Preferred and $400 on Giveback, each capped per stay.

Typical US market rates before insurance
Level of care	Monthly	Daily
Medical detox (7–14 days)	$1,500 – $5,200 per week	$215 – $745
Residential inpatient	$6,200 – $26,000	$205 – $865
PHP	$7,200 – $14,000	$240 – $465
IOP	$2,700 – $9,200	$90 – $305
Outpatient	$1,300 – $5,200	$45 – $175

Those are the sums billed without coverage. With CHP the figure that matters is the plan copay or coinsurance above, measured against the annual out-of-pocket maximum, which is why the authorization step decides more than the advertised price. Behavioral health cost shares for the Individual & Family metal plans were not published on CHP’s fetched pages, so a marketplace member should ask Member Services for the summary of benefits line on inpatient and outpatient behavioral health.

Does Capital Health Plan Cover Suboxone, Methadone and Other Addiction Medication?

On the 2027 Medicare formulary for Advantage Plus and Preferred Advantage, buprenorphine sublingual tablets and buprenorphine-naloxone tablets sit at Tier 2 with quantity limits, buprenorphine-naloxone film at Tier 4, and no prior authorization is listed for either. Naltrexone 50 mg tablets are Tier 2 and Vivitrol 380 mg injection is Tier 5.

Acamprosate is Tier 4, disulfiram Tier 3, naloxone injection Tier 2, and Kloxxado and Rextovy nasal sprays Tier 4. Methadone 5 mg and 10 mg tablets appear at Tier 3 with quantity limits; methadone dispensed for opioid use disorder inside an opioid treatment program is a program service rather than a pharmacy fill, and CHP’s fetched documents do not describe how that is billed, so ask Member Services before starting at a clinic.

What the Drug Tiers Cost

For 2027 on Advantage Plus and Preferred Advantage, Tier 1 is $0, Tier 2 is $7, Tier 3 is $45 and Tiers 4 and 5 are 25% coinsurance, with nothing payable after $2,400 out of pocket. The Part D deductible applies to Tiers 3 to 5 and is $400 on Advantage Plus and $300 on Preferred Advantage.

Where the Prescription Is Filled

Prime Therapeutics administers CHP pharmacy benefits, and commercial and individual formularies are posted at myprime.com and updated monthly. The State of Florida plan is the exception: the 2022 plan document names CVS Caremark while the 2025 brochure lists OptumRx on 1-800-547-9767, so a state employee should confirm which pharmacy administrator is current before a discharge prescription is written.

Which Rehab Centers in Florida Are In-Network With Capital Health Plan?

A program is in-network when it holds a participating contract with CHP for the product named on the member card and, under the State of Florida plan, is Joint Commission accredited or state approved. Network status is settled in CHP’s Find a Doctor/Facility directory and by Member Services on (850) 383-3311, not by a program’s own advertising.

Florida has 740+ listed treatment programs, 404 of which accept Medicare, concentrated in Miami, FL, Orlando, FL, Fort Lauderdale, FL and Tampa, FL. Programs that accept Capital Health Plan are gathered on the Capital Health Plan page, with level-of-care pages for residential rehab and outpatient rehab. Each listing shows the payments the program says it accepts, its licensing and accreditation, and how far it sits from the nearest airport. Counts updated October 2026.

How Do I Find a Rehab That Takes Capital Health Plan?

Start with the provider directory at capitalhealth.com, filtering by facility type for Substance Abuse or Residential Treatment Facility, or by specialty for Addiction Medicine or Chemical Dependency, then call Member Services on (850) 383-3311 or 1 (877) 247-6512. Medicare members use (850) 523-7441; State of Florida members use 1 (877) 392-1532. TTY is 711.

The 24/7 Health Information Line on (850) 383-3400 or 1 (844) 383-3400 is staffed by health care professionals and is the route when care is needed outside office hours, since no dedicated behavioral health line is published. Amwell gives 24-hour access to network providers for non-emergency behavioral health, and the directory has a filter for telehealth providers. CHP does not operate a Florida Medicaid managed care plan, so anyone covered through Florida Medicaid in the Big Bend region is enrolled with a different plan, and the wider Florida network sits outside CHP’s nine counties.

Is Capital Health Plan the Same as Florida Blue or Capital Blue Cross?

No. Capital Health Plan is its own company and its own network, an independent licensee of the Blue Cross and Blue Shield Association, and GuideWell lists it alongside Florida Blue, Florida Health Care Plans, Truli for Health and Triple-S Salud. Capital Blue Cross in Pennsylvania and CDPHP in New York are unrelated plans with similar names, which is why a program outside North Florida that lists “Capital” is usually describing one of those.

Before you call a program: have the plan name from the card ready, ask whether the program participates with CHP for that product, and ask whether the PCP authorization and the prior authorization request have been filed. Those three answers settle the cost before anyone discusses an admission date.

References and Citations

Capital Health Plan — about, service area, provider directory, prior authorization list and medical necessity criteria pages.
State of Florida, Division of State Group Insurance — State Employees’ HMO Plan summary plan description and 2025–2026 Capital Health Plan brochures.
Capital Health Plan — Medicare Advantage summaries of benefits and comprehensive formulary, contract H5938, 2026 and 2027 plan years.
GuideWell Mutual Holding Corporation — list of businesses and affiliates, including Capital Health Plan and Florida Blue.
RehabSeekers directory listings and market rate research, United States, 2026. Ranges are indicative and vary by program, length of stay and coverage.