Does Ambetter Cover Addiction Treatment?

Posted on March 29th, 2021

  • Ambetter Coverage Levels and Plans
  • Ambetter Insurance for Drug and Alcohol Treatment
  • Checking Your Insurance Benefits
  • Does Your Plan Cover Addiction Treatment?

Ambetter is an insurance company that provides health insurance to over 2 million people in the United States. As part of the Affordable Care Act (ACA), Ambetter provides marketplace insurance plans that cover some or all of the costs of drug and alcohol rehab programs.

If you have Ambetter health insurance and are searching for a drug and alcohol treatment facility that is covered by your plan, American Addiction Centers (AAC) is here to help.

American Addiction Centers (AAC) strives to provide you with the most updated information on each carrier’s addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.


Ambetter Coverage Levels and Plans

Mental health and substance abuse treatment are considered essential health benefits. As a result, all marketplace plans—including Ambetter—must cover some of these costs for those who are seeking treatment. According to the ACA, all health plans in the marketplace must cover behavioral health treatment (e.g. psychotherapy and counseling), mental health inpatient services, and substance use disorder (SUD) treatment.1

Before choosing your Ambetter plan, it is important to take your medical needs and finances into consideration. You want to ensure that you’re selecting the right plan for you, especially if your healthcare needs include addiction treatments and medical care costs associated with addiction.

Ambetter plans include:2

  • Bronze plans: Known as Ambetter Essential Care, these plans cover essential healthcare needs. They have lower monthly premiums but higher out-of-pocket costs if you need a lot of care. Bronze plans are best for those who do not need frequent medical care.
  • Silver plans: Known as Ambetter Balanced Care, these plans provide a balance between monthly premiums and out-of-pocket costs, particularly if you qualify for financial assistance. Silver plans offer the best value and are ideal for those who use their plan occasionally and prefer lower deductibles.
  • Gold plans: Known as Ambetter Secure, these plans offer high monthly premiums to help reduce your out-of-pocket costs. These plans are best for those who have frequent and/or ongoing healthcare needs.

Ambetter currently provides coverage in the following 20 states:3

  • Arizona
  • Arkansas
  • Florida
  • Georgia
  • Illinois
  • Indiana
  • Kansas
  • Michigan
  • Mississippi
  • Missouri
  • New Hampshire
  • New Mexico
  • Nevada
  • North Carolina
  • Ohio
  • Pennsylvania
  • South Carolina
  • Tennessee
  • Texas
  • Washington

Ambetter Insurance for Drug and Alcohol Treatment

If Ambetter is your insurance provider, your policy may cover the following for drug and alcohol addiction treatment:

  • Detox services: Medical detox helps you withdraw safely from drugs and alcohol. Under 24/7 medical supervision, staff will work closely with you—and may prescribe medications to help ensure that you withdraw safely and that your symptoms are addressed as needed.
  • Inpatient or residential care: Inpatient/residential live-in treatment centers provide drug and alcohol rehab onsite. You will live at the facility for 15–90 days, depending on your needs and the program you’re in.
  • Partial hospitalization: These programs allow you to live at home throughout treatment and spend your days at the treatment facility. This is sometimes referred to as day treatment.
  • Intensive outpatient: These programs typically involve attending treatment programs approximately 3 evenings a week. People in these programs are able to live at home and go to work during the day.
  • Outpatient treatment: This is typically for those who have completed inpatient treatment. Patients live at home but attend the treatment center for 10–12 hours a week in order to complete the drug and alcohol rehab program.

Your Ambetter health plan impacts your total cost of drug and alcohol treatment in terms of monthly premiums, copays, deductibles, and potential out-of-network costs. Some parts of treatment may or may not be covered, but you can expect at least partial coverage under Ambetter, regardless of the plan you have.


Checking Your Insurance Benefits

Knowing exactly what your Ambetter plan covers can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Ambetter insurance plans and to check what your plan covers, call the number on the back of your insurance card. Or, you can call AAC at +1 (888) 341-7785 to speak to one of our admissions navigators, who can help you find out your coverage and answer any questions you have.


Verify Your Benefits at an American Addiction Centers Facility

The cost of alcohol or drug addiction treatment may appear to be an obstacle, but we are here to help. Insurance may cover all or some of your rehab.

Find out if your insurance covers long-term addiction rehabilitation.

Check Online Now

Does Your Plan Cover Addiction Treatment?

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the treatment center, the type of program attended, and specific services received.

Before deciding on a rehab center, check your Ambetter policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Ambetter’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our Verify Your Insurance web page, enter your information, and you will immediately be able to see if the center you are considering is in-network with Ambetter. Or, call to speak to one of our admissions navigators to have them check your benefits and help you understand what is covered.


Sources

  1. Healthcare.gov. (2021). Mental Health & Substance Abuse Coverage.
  2. Ambetter Health. (2021). About Our Plans.
  3. Ambetter Health. (2021). Find Ambetter Coverage in Your State.

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