Ambetter Insurance for Alcohol and Drug Rehab - Treatment Solutions

Does Ambetter Insurance Cover Alcohol and Drug Rehab?

Ambetter Insurance for Addiction Treatment

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. 1With easy access to coverage, people dealing with a substance misuse issue can seek treatment at a covered facility. Ambetter health plans are offered in the following states:2

  • 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 health has 3 different plan levels from which patients may choose: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 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 abuse treatment coverage directly. Look at the back of your card for one of these levels or call the phone number to get more information.

What Will Ambetter Insurance Cover?

All Ambetter insurance plans cover a variety of services in differing degrees. Ambetter Health has a list of services they consider to be essential care, which include:4

  • Emergency services
  • Outpatient services
  • Wellness checks
  • Therapy services
  • Substance abuse services
  • Mental health services

Within the essential services for substance abuse, specific levels of care may be covered, including:

  • Inpatient treatment
  • Residential rehab
  • Outpatient therapy
  • Intensive outpatient programs
  • Partial hospitalization programs

You will need to discuss your specific care needs with an admissions navigator to determine the exact type of treatment program that would work best for you. Everyone’s needs vary. In the meantime, it’s a good idea to verify your insurance with the rehab facility to get started.

Does Ambetter Insurance Cover Mental Health Care?

Comorbidities, or co-occurring disorders, are common with people who are dealing with a substance use issue.5 A co-occurring disorder involves having 2 or more conditions at the same time.5 A mental health disorder —which could be anything from generalized anxiety to depressive disorder—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.5Conversely, substance misuse can lead to the development of mental health disorders.5 That’s why the NIDA recommends a comprehensive treatment regimen that considers both conditions.5 Integrated treatment may help resolve the root causes of both types of disorders.

Your Ambetter rehabilitation coverage must abide by the Affordable Care Act mandate.6 This states that insurance carriers must treat mental health care and substance misuse treatment as any other chronic medical condition.6 You can count on some level of care for co-occurring disorders. The amount that your Ambetter rehab insurance will cover depends on your policy and tier level. That’s why it’s a good idea to verify the specifics with a rehab provider or an insurance agent.

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 should treatment be. Addiction is a complicated disease that affects both the brain and the body.7 The brain undergoes structural changes over time; this could explain why some people who misuse drugs may struggle with relapse after treatment.7

The NIDA states that not only is the type of treatment important, but the length of treatment is, too. 7 For the most effective outcome, you should remain in treatment for a minimum of 3 months, according to the NIDA. 7 Even though every patient’s needs are different, it’s most helpful to have at least 3 months to get established in sober living habits.

The length of Ambetter drug rehab coverage varies depending on what type of policy and tier level you have. Of course, you can always stay longer than your insurance will cover if you pay out of pocket. However, it’s helpful to know beforehand how long your policy will cover rehab treatment. Check for your plan information on the back of your card and contact the number to find out specifics.

What if My Ambetter Policy Does Not Cover Rehab?

In some cases, Ambetter Insurance may not offer drug treatment program coverage for addiction. If this happens, what should you do? You may have other options; it’s always worth investigating those. Some facilities will offer incentives and assistance for people seeking treatment who don’t have insurance coverage. There may be financing plans or a sliding scale fee discount that would help you pay for the treatment.

Don’t procrastinate getting help even if you don’t have the coverage for rehab. Check with facilities about other ways you can pay for treatment.

Ambetter 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 could affect your cost of care. Ambetter Insurance drug detox treatment nationwide contracts with in-network providers8 —those who give Ambetter a discounted price—so you can access these services at the best cost.8

Facilities that don’t accept Ambetter insurance are considered out-of-network because their providers are not in the network. 8If you go to an out-of-network facility, you will likely have to pay for the costs yourself. You can check the Ambetter Insurance drug treatment providers list by using the provider tool to find an in-network facility near you.

Check Ambetter Insurance Coverage for Addiction Treatment

Ambetter Insurance rehab centers can assist you if you are experiencing substance misuse. With even the Essential Care Plan, which is a Bronze level plan, you can receive coverage for substance abuse treatment.4 Whether you are dealing with substance addiction, mental health illness, or both, you can seek co-occurring disorder treatment using your Ambetter Health insurance.

Take the first step in your recovery by verifying your coverage with American Addiction Centers (AAC). At AAC, we can give you an immediate answer about your Ambetter insurance coverage. We’ll let you know whether or not Ambetter is in-network with our facilities. Complete the form on this page and find out now. If you’d rather speak to an admissions navigator, you can contact the helpline for insurance verification. Call today.