Using Ambetter Health Insurance for Addiction Rehab

Ambetter Insurance Coverage Levels and Plans

Ambetter insurance offers a range of healthcare solutions, including medical care, mental healthcare, and substance use care. Ambetter medical insurance is operated through Centene Corporation and has locations in 20 states.¹ With easy access to coverage, people dealing with substance addiction can seek treatment at a covered facility. Ambetter health plans are offered in the following states:²

Ambetter health has 3 different plan levels from which patients may choose, including:³

Bronze Ambetter Essential Care Plan offers essential insurance benefits. The monthly premium costs less, but you pay more for services.

Silver Ambetter Balanced Care Plan balances monthly premiums with your out-of-pocket costs for various services.

Gold Ambetter Secure Care Plan covers your healthcare services, but you will pay higher premiums.

If you’re unsure what plan you have, you can check your Ambetter insurance substance use treatment coverage, or call the number on the back of your insurance card to get more information.

Types of Rehab Programs Covered by Ambetter

Within the essential services for substance use treatment, specific levels of care may be at least partially covered, including:

Detoxification. Medically managed detox is the process in which the body rids itself of substances. Done under the supervision of a healthcare provider, the process is safe and individuals can be kept as comfortable as possible as they experience withdrawal symptoms. Detox is often the first step in a person’s comprehensive treatment plan.

Inpatient treatment. Inpatient treatment, sometimes called residential care, removes an individual from their environment and provides round-the-clock care at the treatment center, where they remain for the duration of their treatment. Inpatient care typically involves a combination of individual and group therapies, psychoeducation, and medication (if necessary).

Outpatient treatment. Outpatient programs vary in intensity but allow individuals to live at home or in a sober living environment and attend counseling and therapy sessions at the treatment center.

Partial hospitalization programs (PHPs). PHPs often look similar or identical to to residential or inpatient treatment in terms of structure, meaning counseling, therapy, and psychoeducation sessions usually last for several hours most days each week. However, individuals still return home or to a sober living facility at the end of treatment each day.

Intensive outpatient programs (IOPs). While no two IOPs are exactly the same, treatment generally includes a combination of therapy, counseling, and psychoeducation, delivered in 3, 3-hour sessions each week. This allows individuals in IOPs to continue fulfilling responsibilities at home, work, or school while in treatment.

To find the level of care that’s appropriate for your needs, schedule an appointment with your primary care physician, mental healthcare provider, or an addiction care specialist, who can perform an evaluation and help you create a treatment plan.

Does Ambetter Insurance Cover Mental Health Care?

Comorbidities, or co-occurring disorders, are common with people who are dealing with problematic substance use.⁵ A co-occurring disorder involves having 2 or more conditions at the same time.⁵ A mental health disorder—which may include generalized anxiety, depressive disorders, or something else—often occurs when you are struggling with substance use disorder.⁵

According to the National Institute on Drug Abuse (NIDA), mental illness is a risk factor for substance misuse.⁵ Conversely, substance misuse can lead to the development of mental health disorders.⁵ That’s why NIDA recommends a comprehensive treatment program that addresses both conditions at the same time.⁵ Integrated treatment may help resolve the root causes of both disorders.

Your Ambetter coverage for substance use and mental health treatment must abide by the Affordable Care Act mandate.⁶ This requires insurance carriers to treat mental health and substance use disorders the same way they would provide coverage for other chronic medical conditions.⁶ Thus, care for co-occurring disorders will be covered to some degree. The amount that your Ambetter insurance will cover depends on your policy. That’s why it’s a good idea to verify the specifics with a rehab provider or an insurance agent.

Types of Mental Health Treatment Covered by Ambetter Insurance

As previously mentioned, Ambetter insurance covers mental health treatment, including various therapies and substance use treatment. Depending on the specifics in a plan, mental health coverage through Ambetter may include therapies commonly used to treat substance use disorders as well as many mental health disorders. Some of these may include:^7-9

• Cognitive-behavioral therapy (CBT). CBT provides education and skills training that can help individuals modify their thoughts and behaviors to help them reduce their relapse risk, sustain recovery, and achieve a sense of self-efficacy.
• Dialectical behavioral therapy (DBT). This multidimensional approach relies on learning skills to change unhelpful thoughts and behaviors. This is done through mindfulness, interpersonal effectiveness, emotional regulation, and distress tolerance.
• Motivational interviewing (MI). MI helps individuals resolve their ambivalence to change by learning problem-solving strategies, promoting an internal belief in one’s ability to change, and taking responsibility for making desired life changes.
• Eye movement desensitization and reprocessing (EMDR). EMDR uses eye movements to help desensitize individuals and help them reprocess the emotional stress associated with traumatic experiences or events.
• Seeking safety and other trauma-focused therapies. This present-focused therapy helps individuals attain safety from trauma—including post-traumatic stress disorder and substance misuse—by emphasizing coping skills, grounding techniques, and education.

How Long Does Ambetter Insurance Cover Rehab?

You may be wondering if Ambetter covers drug rehab for the length of time needed and how long treatment lasts. Addiction is a complicated disease that affects both the brain and the body.¹⁰ The brain undergoes structural changes over time, which may explain why some people who misuse drugs struggle with relapse after treatment.¹⁰

NIDA states that not only is the type of treatment important, but the length of treatment as well.¹⁰ For the most effective outcome, individuals should remain in treatment for the duration of their individual treatment plan.¹⁰

The length of time that Ambetter insurance covers varies depending on the policy. However, insurance coverage shouldn’t necessarily dictate a person’s treatment plan. While it’s helpful to know the length of time a policy covers, there are other ways to cover the remaining cost of treatment.

What if My Ambetter Insurance Policy Does Not Cover Rehab? 

In some cases, Ambetter insurance may not cover the costs of addiction treatment. If, for instance, you choose an out-of-network treatment center, you may be responsible for more out-of-pocket costs than if you opted for an in-network facility. Beyond using insurance, some facilities offer financing plans or a sliding scale fee.

Check with facilities about other ways you can pay for treatment.

Ambetter Insurance In-Network vs. Out-of-Network Rehab Centers 

You may have heard people discuss a facility being in-network or out-of-network. These are important terms to understand since they can impact your cost of care. Ambetter insurance contracts with in-network providers¹¹—facilities that give Ambetter a discounted price—so you can access these services at the best price.¹¹

Facilities that don’t accept Ambetter insurance are considered out-of-network treatment centers.¹¹ If you go to an out-of-network facility, you will likely be responsible for most of the costs. You can check with Ambetter’s treatment providers’ list by using the provider tool to find an in-network facility near you.

What Rehab Centers Take Ambetter Insurance?

American Addiction Centers (AAC) has various rehab facilities around the country that provide drug and alcohol addiction treatment. If you have an Ambetter insurance plan, the following AAC facilities accept Ambetter for drug and alcohol addiction rehab:

• Greenhouse Treatment Center: Greenhouse offers individualized treatment plans and many levels of care, including detox services, residential treatment, co-occurring disorder treatment—all in a luxurious setting with high-end amenities in Grand Prairie, Texas. The outpatient treatment center in Arlington, provides intensive outpatient services and partial hospitalization services.
• Oxford Treatment Center: Oxford offers evidence-based therapies and an opportunity to connect with nature and try new activities. Provided care includes detox, residential treatment, and co-occurring disorder treatment at the treatment center in Etta, Mississippi. In nearby Oxford, at the outpatient treatment center, intensive outpatient and partial hospitalization programs are offered. There will soon be another outpatient facility opening in Southaven, which will provide services to the Memphis metropolitan area.
• Recovery First Treatment Center: The South Florida treatment facility in Hollywood, Florida, offers multiple levels of substance use treatment, including medically managed detoxification, inpatient/residential care, day treatment (also called partial hospitalization), intensive outpatient care, and aftercare planning.
• River Oaks Treatment Center: Located in Riverview, Florida, River Oaks provides top-level care for addiction and mental health disorders. River Oaks provides a complete personalized continuum of care, which includes detox, residential treatment, co-occurring disorder treatment, intensive outpatient services, and a partial hospitalization program.
• Desert Hope Treatment Center: Located in Las Vegas, Nevada, Desert Hope provides individualized care programs as well as a full continuum of care, including detox services, residential treatment, co-occurring disorder treatment, and intensive outpatient services.

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. There are rehabs that can provide the treatment you need.

How to Check Ambetter Insurance Rehab Coverage

If you are experiencing substance addiction, mental health illness, or both, you can use your Ambetter insurance to help cover at least a portion of the cost of rehab.⁴

Take the first step in your recovery by verifying your coverage with AAC. Call and speak to a compassionate and knowledgeable admissions navigator who can answer your questions, check your coverage, and explain your treatment options.

Frequently Asked Questions About Ambetter Insurance