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Using Ambetter Insurance for Drug and Alcohol Treatment

Does Ambetter Cover Rehab or Detox?

Ambetter insurance provides some coverage for drug and alcohol addiction treatment. There are many detox centers that take Ambetter insurance throughout the United States, as well as inpatient and outpatient rehab centers that take Ambetter insurance.

You may be able to use your Ambetter insurance plan to cover some or all of the cost of rehab and detox when it has been deemed medically necessary by your primary care physician or another healthcare professional. Exactly how much and what is covered depends on your plan, as well as what types of addiction treatments you need.

Ambetter health plans offer a comprehensive package of services, known as essential health benefits. Substance use disorder services, including rehab and detox, are considered to be essential health benefits, though coverage may vary depending on if the provider is in-network or not, and on what plan you have.3

Ambetter addiction treatment and detox coverage varies from plan to plan, so it’s important to understand exactly what your Ambetter plan covers prior to entering detox or rehab.

Types of Addiction Treatment Covered by Ambetter

Types of addiction treatment that may be covered by your plan include:3

  • Detox. Detox is the process of the body removing substances, such as drugs and alcohol, from your system. Medical detox may involve the use of prescribed medications to help you alleviate withdrawal symptoms. Your Ambetter plan may cover detox services if it has been deemed medically necessary by a healthcare professional.
  • Inpatient rehab. In inpatient rehab, you will live at the rehab facility for a set amount of time (anywhere from weeks to months) while attending individual and group counseling. Support is provided by trained staff 24/7 in order to meet all of your physical and mental health needs. Some inpatient rehab facilities offer extra amenities, such as massage, yoga, and other fitness classes. The term inpatient rehab also encompasses residential rehab programs, which are less intensive than inpatient programs, but also can last for several months to over a year.
  • Outpatient rehab. With outpatient rehab, you can work at home while attending treatment. The number of hours you attend rehab depends on the program. Some allow you to work and attend to family responsibilities during the day, while others require you to be at the rehab facility, hospital, or clinic during the daytime hours to complete the program.
  • Medication-assisted treatment (MAT). Medication-assisted treatment involves the use of medications, counseling, and behavioral therapies that assist with detoxification from drugs and alcohol as well as ongoing medicinal support to help you get and stay sober. Ambetter may cover MAT when it has been deemed medically necessary by a healthcare professional.
  • Sober living facilities. After completing detox, inpatient, and/or outpatient rehab programs, some people like to have ongoing support. Sober living houses are a place for individuals recovering from addiction to live in a supportive environment that encourages sobriety. Ambetter may provide coverage for sober living under certain circumstances.

The specific addiction treatments you receive will be tailored to your needs, how long you’ve been using, the substances you are using, and any other co-occurring disorders you may have (anxiety, depression, etc).

How to Use Your Ambetter Insurance

There are a few things you’ll need to consider in order to use your Ambetter insurance to pay for detox and rehab:

  • Pre-authorization. Many insurance plans require pre-authorization before insurance coverage kicks in. This means you will need to visit your primary healthcare physician or another doctor and discuss your substance use disorder and that you want help. They must determine that detox and/or rehab is medically necessary and complete a preauthorization form to submit to insurance so they can provide coverage for the treatments you receive.
  • In-network vs out-of-network. You’ll likely come across a lot of “in-network” and “out-of-network” language when reading about insurance. In-network rehab and detox facilities have an agreement with Ambetter to provide services at a discounted rate. Out-of-network providers do not. To have more of your treatments covered by insurance, choose a rehab facility that is in-network with Ambetter whenever possible.
  • Out-of-pocket expenses. Out-of-pocket costs are the treatment costs you are responsible for paying for. This may include reaching your insurance plan’s deductible—this is a pre-determined amount that you must pay before coverage kicks in (e.g., $2,000).6 There are also co-pays to consider, which are a set amount that you must pay when you receive a healthcare service (e.g., $35/per doctor visit).6 Co-insurance is a percentage of all treatments received that you must pay (e.g., 10%). Coverage varies from plan to plan.6

Understanding exactly what you will need to pay in regards to deductibles, copays, and co-insurance can help you put together a plan to pay your out-of-pocket costs before beginning detox and rehab.

Ambetter Health Insurance Plans

Over 2 million people in the United States have health insurance with Ambetter, which sells insurance plans on the United States Health Insurance Marketplace.1  Ambetter offers a wide variety of health insurance plans for individuals and families that have different coverage and monthly premiums. Ambetter’s tiered health insurance plans include:4

  • Bronze plans. Ambetter Essential Care bronze plans cover your basic healthcare needs. These plans have lower monthly premiums, but you may have higher out-of-pocket costs when accessing healthcare. Bronze plans are best for people who do not see the doctor frequently. If you end up needing a lot of care, you may need to pay a high deductible and co-pays with bronze plans.
  • Silver plans. Ambetter Balanced Care silver plans provide the most value and balance between monthly premiums and out-of-pocket costs. If you access healthcare occasionally and prefer lower deductibles and co-pays, silver plans may be best for you.
  • Gold plans. Ambetter Secure gold plans come with the highest monthly premiums and lowest deductibles. These plans are ideal for those who have ongoing medical needs and want to keep their out-of-pocket costs lower when accessing healthcare.

When you are selecting a detox and rehab facility, look for rehab centers that are in-network with Ambetter. In-network facilities have an agreement with Ambetter to offer addiction treatment to Ambetter members at a discounted rate. Working with in-network healthcare providers and drug and alcohol rehabs keeps your out-of-pocket expenses lower and requires less paperwork to complete on your end in order to get insurance approval for treatment.

Does Ambetter work with Medicare and Medicaid

Ambetter offers health insurance Marketplace, Medicare, and Medicaid plans.1, 7, The plans vary depending on the state you live in. Ambetter also provides coverage for those who qualify for Medicare and Medicaid through a company called Allwell, a Medicare advantage plan.7

Detox Centers Accepting Ambetter Near Me

Ambetter operates in twenty states across the nation.2 Many treatment providers, like American Addiction Centers (AAC), accept Ambetter health insurance for addiction treatment services like detox or rehab. There are many online resources you can use to find a detox or rehab center that accepts your Ambetter coverage.  If you would like to speak to someone, you can also call a 24/7 detox or rehab hotline that can help you check your insurance and answer any questions you may have about finding treatment near you.