Ambetter is an insurance company that offers health insurance plans on the health insurance marketplace. Currently, Ambetter serves more than two million members.
People in need of addiction treatment can use Ambetter insurance to help cover the cost of a rehab program.
Health insurance for substance abuse treatment may cover detox, inpatient care, mental health services, and outpatient treatment.
What Factors May Affect Ambetter Drug Rehab Program Coverage?
Ambetter insurance coverage includes access to essential health services. Among these essential health benefits is mental health and substance use treatment.
There are several factors that may affect the coverage a person receives for addiction recovery through Ambetter.
Factors that may affect Ambetter health insurance plans for rehab programs:
- prior authorization requirements
- level of coverage your addiction treatment plan requires
- any copayments or deductibles you may have to pay
- the specific insurance benefits in your plan
- your diagnosis
- state of residence
- the type of treatment center
Currently, Ambetter offers health insurance to 20 states in the U.S. including Florida, Mississippi, Texas, Arizona, and others.
If you live in a state without treatment providers that accept your plan’s rehab coverage, your Ambetter insurance policy may cover out-of-state addiction treatment services.
Some policyholders may be eligible to receive out-of-network addiction treatment, but higher out-of-pocket costs should be anticipated.
What Addiction Treatment Services Does Ambetter Health Insurance Cover?
When enrolled with an Ambetter insurance provider, you’ll have the option to choose one of three of their plans. These plans are categorized as Bronze, Silver, and Gold.
Behavioral health treatment options covered by Ambetter include:
- outpatient treatment
- methadone maintenance
- support groups for alcohol addiction
- inpatient treatment
- sober living homes
- short-term and long-term residential treatment
- intensive outpatient programs (IOP)
- partial hospitalization programs (PHP)
- medical detox
- group therapy for people addicted to prescription drugs
- dual diagnosis treatment for co-occurring disorders
- medication-assisted treatment (MAT)
All of the above substance abuse treatments are eligible for coverage by Ambetter insurance, but copay and deductible amounts may vary based on your plan details, location, and more.
Health Insurance Questions To Consider Before Choosing A Rehab Center
Before you or your loved ones choose a rehab program, it’s a good idea to contact your Ambetter insurance representative (usually listed on the back of your insurance card) to make sure your coverage is adequate.
Questions you may want to ask include:
- How much will I have to pay if my rehab center is not in-network?
- Do I need to receive precertification before I enroll in the treatment program?
- Are there any limits to how long I can stay in an inpatient rehab program?
- How much will my copay or deductible be?
- Will my monthly premiums be affected?
- Do I need any referrals from healthcare providers before I can start drug addiction treatment?
- What is the difference between Ambetter balanced care, Ambetter essential care, and Ambetter secure care plans?
- Will my plan cover all levels of care?
- How does insurance verification work?
- Will I get reimbursed for procedures that are out-of-network?
Even if Ambetter is not listed as an accepted form of health insurance coverage, you can still communicate with the rehab center and Ambetter to see if there’s a way to negotiate coverage.
If you find that you cannot afford a substance use treatment program through Ambetter, you may be eligible to enroll in free drug rehab programs in your area.
Find Substance Use Disorder Treatment Covered By Ambetter Today
Call our helpline today for more information on addiction treatment coverage and substance abuse services in your area. Our team can help you find a treatment facility that works for you.
Published on October 7, 2022
Free Rehab Centers aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- National Institute on Drug Abuse (NIDA) — Types of Treatment Programs
https://nida.nih.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states/types-treatment-programs - National Institute of Health (NIH) — Private health insurance coverage of drug use disorder treatment: 2005-2018
https://pubmed.ncbi.nlm.nih.gov/33035265/ - National Institute of Health (NIH) — Why health insurers should pay for addiction treatment
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071416/ - Substance Abuse and Mental Health Services Administration (SAMHSA) — What Does the Affordable Care Act (ACA) Mean for Behavioral Health?
https://www.samhsa.gov/sites/default/files/samhsa_infographic2_final_banner_rev_r111314b.pdf
