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Ambetter Insurance Coverage for Drug and Alcohol Rehab Treatment Near Me

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Does Ambetter Health Insurance Cover Drug & Alcohol Rehab

The opioid crisis in the United States has been getting worse in recent years. The statistics are staggering: overdose (OD) deaths involving opioids increased over 500% from 1999 to 2019, with nearly 50,000 OD in 2020 alone.1

The problem is only getting worse. In 2018, there were an estimated 1.7 million people in the United States who had an opioid use disorder, and 47,600 people died from an overdose involving opioids. That’s an increase of about 10% from the previous year.1 One of the ways to address this crisis is through providing individuals the assistance they need to combat and overcome addiction. One important aspect of treatment is insurance coverage that can help individuals get the treatment they need to recover.2

Ambetter offers affordable plans for health care coverage and benefits in 26 states across the US. Its medical insurance is comprehensive, covering a multitude of mental health and medical needs, which include substance abuse treatment.1 Whether the drug rehab coverage is full or partial will depend on the specific plan.3  

Based on the information you provide them with, rehab centers can check what is covered by the individual’s medical insurance. Additionally, you can also call the Ambetter helpline number on the back of your insurance card for more information regarding your plan. 

What Is Ambetter Insurance Coverage?

Ambetter was founded in 2014, and is a provider of a broad range of health care options to meet the needs of over 2 million members. Every health plan is certified as a Qualified Health Plan on the Health Insurance Marketplace.4

From preventive care, wellness programs, and substance abuse coverage to mental health, newborn care, and pediatric services, Ambetter provides a wide array of health insurance plans and benefits. The insurance plans are divided into three levels of Gold, Silver, and Bronze, with a variety of other options depending on the state.

Ambetter health insurance is available nationwide in nearly 30 rehab centers across 13 states, from the east coast in Florida and Pennsylvania to the west coast in Arizona and Nevada.5 

What Does Ambetter Health Insurance Cover? 

Under the Mental Health Parity and Addiction Equity Act (MHPAEA), since 2008 every insurance provider must provide coverage for medically-necessary mental health treatment, including hospital care for substance abuse. Therefore, Ambetter insurance coverage includes opioid addiction treatment at certain specialized facilities, depending on an individual’s personal coverage.6

What exactly is covered will depend on the plan and the specificities surrounding  The exact scope of coverage will depend on your plan, as well as the specifics of your drug rehab. Each individual requires a tailored approach to treatment to suit their needs. These differences will affect the price and what is covered by Ambetter insurance. The programs include:7

Is Mental Health Treatment Care Covered by Ambetter Health Insurance?

Nearly all Ambetter insurance plans cover mental health. Under the Affordable Care Act (ACA), mental and behavioral health treatment must be covered as essential health benefits. These include counseling and therapy, as well as inpatient mental and behavioral health care and drug rehab.6  

Almost all mental disorders, as well as substance use disorders and alcohol and chemical dependency treatment, are covered by all ACA-compliant Ambetter medical insurance.6

Is Addiction Rehab Treatment Covered by Ambetter?

​​Ambetter will cover at least some of your substance abuse treatment. Based on the plan you have, your treatment may be partially or fully covered.6

The Affordable Care Act (ACA) requires all insurance companies to provide some type of coverage for addiction treatment. The ACA requires all insurance rehabilitation coverage plans to cover behavioral health treatment (e.g., psychotherapy and counseling), mental health inpatient services, and substance use disorder (SUD) treatment.8

The financial responsibility you have for your treatment will depend on the state you live in, the healthcare plan you have, the treatment you need, and if you choose an in-network or out-of-network facility.8

What Type of Substance Addiction Is Covered by Ambetter Health Insurance?

As addiction is a serious disease affecting an individual’s behavior, treatment must be strategically structured and include mental and health services along with additional care in accordance with the specific patients’ needs.9 Ambetter drug rehab coverage offers all clinically proven and tested methods to the treatment of substance abuse addiction and can include:9

  • Medical screening that identifies issues early, increasing the chances of successful treatment.
  • Detox which is a necessary initial step of treatment on the road to sobriety.
  • Inpatient rehab facilities offer a broad range of treatments.
  • Outpatient rehab centers provide the option of going through treatment while living at home.
  • Behavioral therapies that can include individual and group counseling.
  • Treatment for co-occurring disorders for those that suffer from a combination of addiction and diagnosed mental health disorders.10

Contact AAC’s hotline if you’re in need of assistance to better understand your situation and addiction to prescription drugs or other substances. Their dedicated dispatchers will walk you through the rehab process and provide the necessary information so you can make the correct choice for your health.

How Long Is Rehab Covered by Ambetter Insurance?

Most people seek help when the disease is already severe and chronic, which ultimately makes the treatment process last longer. In some cases, individuals may experience a relapse that will necessitate a different approach and adjustment of their rehab.11 

Because of this, recovery from opioid addiction for some patients means long-term structured care at a treatment facility that will help them stop using drugs, maintain sobriety, and make life decisions without the malign influence of drugs.12  In order to successfully finish treatment, patients should stay in treatment for an adequate period of time depending on the state of their mental and physical health, as well as their individual needs and problems.12

Therefore, if you need information on how long your Ambetter insurance coverage will last, call the number that’s written on the back of your insurance card.   

What if My Ambetter Policy Does Not Cover Rehab?

There are instances where Ambetter Insurance may not provide coverage for addiction treatment. If this occurs, there may be other options at your disposal worth investigating. Some rehab centers provide assistance and incentives for individuals in need of treatment who may not have insurance. They may offer free treatment plans or significant discounts to encourage getting the necessary help.  

Don’t hesitate in reaching out for help even if you don’t have insurance to cover the drug rehab. Check with your local facilities about programs they offer and payment options for treatment.  

What Are the Differences Between Ambetter In-Network and Out-of-Network Treatment Centers?

There is a difference between facilities which are in-network and those which are out-of-network. It’s vital to understand their differences as they can dictate the cost of your rehabilitation treatment. Ambetter rehab insurance contracts with in-network facilities that offer Ambetter with a discount price, with the benefit of accessing your treatment solution with the best overall cost.13

Providers that Ambetter insurance doesn’t have a contract with are out-of-network as they offer services that are not in their network. If you opt for an out-of-network treatment center, the cost of treatment will likely fall on your shoulders. You can check the closest in-network provider of Ambetter medical insurance near you by calling the carrier’s helpline.13

How Do I Check Ambetter Medical Insurance Coverage for Substance Abuse Treatment?

American Addiction Centers have facilities conveniently positioned nationwide and can verify the Ambetter insurance coverage for you. AAC’s helpline service is available to answer callers’ inquiries, help them better understand various phases of the rehab process, and walk them through the entire procedure.

Frequently Asked Questions

Does Ambetter Insurance Cover Rehab for Alcohol and Drug Addiction?

Yes, Ambetter insurance does provide affordable options for drug and alcohol treatment at one of their numerous in-network facilities located in 26 states across the country. Depending on the exact type of drug rehab or treatment you wish to enter and your insurance plan, Ambetter will provide either complete or partial coverage of the costs associated with the program.3

What Happens if Ambetter Doesn’t Offer Complete Rehab Coverage?

As stated, Ambetter provides either complete or partial rehab insurance for different types of drug treatment programs in various in-network rehab centers. The only requirement is that the treatment is deemed medically necessary and approved by the FDA. However, there are some aspects of drug rehab that Ambetter doesn’t cover, including:14

  • Holistic care
  • Food delivery
  • Private rooms
  • Recreation programs
  • Private mobile phone and TV

In case you don’t receive complete insurance coverage from your Ambetter you can always find alternative or additional financing options or choose to stay at a state-owned or free facility and overcome your addiction there.14

Does Ambetter Insurance Offer Medicaid and Medicare?

Centene is the company that owns Ambetter, and they serve both Medicare and Medicaid members. This means that Ambetter Medicare insurance plans do provide complete or partial coverage for drug and alcohol treatment programs. The factors that will determine the cost of rehab are the duration of the program, the administered level of care, as well as the amenities and services provided within the treatment facility.15

Will Ambetter Cover MAT?

Depending on the exact details and benefits of the health insurance plan you have with Ambetter, you will receive either partial or full coverage of medication-assisted treatment.16 MAT is one of the main segments of addiction treatment and it provides behavioral therapies and counseling sessions alongside administering the required medication to alleviate withdrawal symptoms. This is why all major insurance providers offer some capacity of coverage for MAT.17

Can I Enter Outpatient Rehab With Ambetter Insurance Coverage?

Yes, you can enter an outpatient treatment program if you have Ambetter health insurance coverage. Most drug and drug rehabilitation facilities in different states accept Ambetter insurance and will very likely cover the costs of the treatment. However, whether you’ll receive full or partial coverage depends on your plan and benefits, as well as the details of the program you wish to enter.16

If you’re unsure if your insurance plan will provide the coverage you need, it’s best to reach out to the Ambetter hotline by calling the number on the back of your card and inquire about all the necessary details.16

Can Ambetter Cover Sober Living Facility Costs?

Ambetter insurance can provide coverage for sober living homes. However, whether your insurance benefits will cover sober living facilities and the exact amount of coverage you can receive solely depend on your plan.3

Sober living facilities are designed for providing continuing care and allowing individuals to return to an independent lifestyle after undergoing different and more demanding types of drug rehab and treatment. These centers usually serve as a bridge between normal daily life and inpatient treatment, preparing individuals for a return to normal by reinforcing the knowledge gained from other forms of treatment.7

Do Only In-Network Centers Accept Ambetter Insurance?

Ambetter mainly provides drug and alcohol treatment coverage for numerous in-network facilities across more than 26 states. However, this insurance provider will also partially cover programs at out-of-network treatment centers, providing your plan benefits support the desired facility.4

In case you need additional information regarding your Ambetter insurance covering out-of-network drug treatment facilities, reach out to their helpline with the telephone number located on the back of your card and they’ll give you the information you need.16

Does Ambetter Offer Nationwide Coverage for Mental Health and Drug Abuse Treatment?

Ambetter does provide nationwide coverage for both drug abuse and mental health treatment under the auspices of the ACA (Affordable Care Act). However, when it comes to coverage for any mental health problems, it’s essential to receive preauthorization from an Ambetter representative before entering a facility to make sure you receive complete coverage for the rehab program.8, 18