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PA Health & Wellness (Ambetter) Insurance Coverage for Drug and Alcohol Rehab

Ambetter is an insurance company that provides health insurance to over 2 million people in the United States. As part of the Affordable Care Act (ACA), Ambetter provides marketplace insurance plans that cover some or all the costs of drug and alcohol rehab programs. If you have Ambetter health insurance and are searching for a substance abuse treatment facility that is covered by your plan, American Addiction Centers (AAC) is here to help.
Yes. Ambetter from PA Health & Wellness covers drug and alcohol rehab. strives to provide you with the most updated information on each carrier's addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.
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PA Health & Wellness (Ambetter) Covered Alcohol and Drug Rehab Centers in Pennsylvania

When dealing with a drug or alcohol addiction, you can rely on your PA Health & Wellness of Pennsylvania insurance plan to provide coverage. PA Health & Wellness (Ambetter) Pennsylvania healthcare plans are part of the Marketplace Health plans that provide Essential Health Benefits for its members.1

You get more information about your PA Health & Wellness insurance plan by contacting the number on the back of your insurance card. To make the process easier, you can call the rehab facility and ask them to verify your insurance.

What Is PA Health & Wellness (Ambetter)?

PA Health & Wellness (Ambetter) Pennsylvania insurance coverage is managed by Centene Corporation, which is a Marketplace product. Centene offers Marketplace plans to its members and focuses on delivering local coordinated care to the community.2

Centene has operated managing healthcare plans for over 30 years.2 Currently, there are 3 tiers to PA Health & Wellness covered Pennsylvania plans. These are as follows:1

  • Bronze level, Ambetter Essential Care: This tier will provide patients with the essential needs of healthcare and charges a low monthly premium. There may be higher out-of-pocket costs for services.
  • Silver level, Ambetter Balanced Care: The silver tier has higher premium costs but will cover more for services.
  • Gold level, Ambetter Secure Care: The gold tier is the highest cost for premiums and also will be the lowest out-of-pocket costs. Members can count on having ample services paid for.

PA Health & Wellness (Ambetter) rehab coverage is available in Pennsylvania in the following areas:3

  • Bradford
  • Bucks
  • Carbon
  • Chester
  • Columbia
  • Delaware
  • Lackawanna
  • Lancaster
  • Lehigh
  • Luzerne
  • Monroe
  • Montgomery
  • Northampton
  • Philadelphia
  • Schuylkill
  • Sullivan
  • Susquehanna
  • Wayne
  • Wyoming

What Substance Addiction Does PA Health & Wellness (Ambetter) Cover?

With all the various substances that are out there for people to do, you may wonder what medications your PA Health & Wellness (Ambetter) Pennsylvania drug plan covers. Since this is a Marketplace plan, you will have substance abuse coverage, which should handle any substance out taken. However, you may want to check with the PA Health & Wellness (Ambetter) Pennsylvania Insurance rehabilitation centers to see if they can treat that substance.

Some of the most common substances that people misuse include:4

  • Alcohol.
  • Cocaine.
  • Heroin.
  • Meth.
  • Opioids.
  • Marijuana.
  • Prescription painkiller.

What Does PA Health & Wellness (Ambetter) Insurance Cover in Addiction Treatment?

PA Health & Wellness (Ambetter) Pennsylvania rehab coverage offers a wide variety of treatment programs for those in need. These programs are organized to help patients go from dependence to independence over time. So, a patient can start on any level that is suitable for their needs. By working with an admissions navigator at a rehab facility, you can find out the right PA Health & Wellness plan for you.

You can discuss your PA Health & Wellness (Ambetter) Pennsylvania Insurance substance use treatment coverage with the rehab facility also. They can verify the programs that you can participate in with your insurance. However, in many instances, the PA Health & Wellness (Ambetter) Pennsylvania Insurance rehab plan will cover some or all of the following treatments:

  • Inpatient rehab treatment program: In the beginning, patients may consider an inpatient treatment program to be the best starting point for recovery. This program delivers a wealth of treatment services, and it is all offered 24/7. Patients will have doctors and staff on hand throughout their stay, so they are safe in the environment.5(inpatient)
  • Partial hospitalization program (PHP): After completing the inpatient rehab, some patients move on to the PHP. This program is similar to inpatient but begins to offer some independence by sending patients home at night. Otherwise, they have all the therapies and monitoring of an inpatient program.6(partial)
  • Intensive outpatient program (IOP): Even though it is an outpatient program, it is quite intensive. Patients will be involved in therapy a good amount of the week. They have a lot of independence but can get support every day as needed.5(outpatient)
  • Outpatient treatment program and therapy: When patients are ready to live on their own, they still benefit from an outpatient program. This helps them with relapse prevention. They will learn skills during therapy sessions about once a week. 5(outpatient)

Does PA Health & Wellness (Ambetter) Cover Mental Health & Co-Occurring Disorder Treatment?

If you are dealing with a mental health problem and a substance use disorder at the same time, then you have a co-occurring disorder. Many people have co-occurring disorders that consist of mental health and substance misuse disorders. 7(top) However, the reason for the correlation is unknown. Experts can’t say for sure that one condition causes the other, but only that if you have one condition, you may be more predisposed to get the other condition.7(why)

Some speculation has been made that mental illness causes people to use substances to mask the discomfort they feel. 7(why)Other speculation has been made that substance misuse can change the brain over time, leading to mental health problems. 7(why)Whatever the case may be, experts recommend that patients get treatment for both conditions simultaneously. 7

Your PA Health & Wellness (Ambetter) Pennsylvania mental health operates under the direction of the Affordable Care Act (ACA) because it is a Marketplace Health plan. Consequently, it will follow the guidelines and mandates of the ACA. One mandate is that all providers must cover Essential Health Benefits that include mental health and substance misuse services.8 You can find out what your specific policy tier will cover by contacting your insurance company for more information.

How Long Does PA Health & Wellness (Ambetter) Cover Inpatient Alcohol and Drug Rehab programs?

When you go into one of the PA Health & Wellness (Ambetter) Pennsylvania Insurance drug treatment programs, your stay length will depend on various factors. How long your insurance will cover your stay depends on the tier level of your policy. You can look up your policy tier on the back of your insurance card or call the rehab facility and ask them to verify your insurance.

However, it is recommended that people with a substance misuse issue, seek inpatient rehab treatment for at least three months.9

What if My PA Health & Wellness (Ambetter) Policy Does Not Cover an Inpatient Drug Rehab Program?

Some people may find that their specific PA Health & Wellness (Ambetter) Pennsylvania drug plan tier doesn’t cover inpatient rehab, or maybe the coverage isn’t enough for what is needed. If that happens, you can take other steps to find ways to still get treatment. Some PA Health & Wellness (Ambetter) Pennsylvania Insurance drug treatment providers will provide financial options for people who don’t have insurance or don’t have the coverage necessary for rehab.

Check with the rehab facilities about what financial aid they offer. If there is an application to fill out, do so and see if you are eligible for any assistance. There are often many programs that can help. You don’t want to give up, even if you run into a roadblock.

PA Health & Wellness (Ambetter) In-Network vs. Out-of-Network Inpatient Drug Rehab Centers

If you are looking for treatment at one of the PA Health & Wellness (Ambetter) Pennsylvania blue cross rehab facilities, check with the admissions navigator to see if they are in-network or out-of-network. You want to find a place that is in-network with your insurance because it will cost less out of pocket.

In-network PA Health & Wellness (Ambetter) Pennsylvania Insurance drug treatment rehabs have a negotiated contract with the provider, so you get that rate passed down to you.10 That means the insurance can offer the consumer additional savings. By using in-network providers, you may have many of the services you need covered through your insurance.

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 a Ambetter insurance plan, the following AAC facilities accept Ambetter for drug and alcohol addiction rehab.

  • Greenhouse Treatment Center: Located in Grand Prairie, Texas, Greenhouse offers individualized treatment plans and many levels of care including detox services, residential treatment, dual-diagnosis treatment, intensive outpatient services, outpatient services, and tele-health, all in a luxurious setting with high-end amenities.
  • Oxford Treatment Center: Located in Etta, Mississippi, Oxford offers gender-specific rehab while offering an opportunity to connect with nature and try new activities. Provided care includes detox, residential treatment, dual-diagnosis treatment, inpatient and outpatient treatment, intensive outpatient services, and tele-health, all with individualized treatment programs.
  • Recovery First Treatment Center: Located in Hollywood, Florida, Recovery First treats substance use disorders by combining evidence-based therapeutic modalities with top-level care. Recovery First provides a personalized continuum of care including detox services, residential treatment dual-diagnosis treatment, intensive outpatient services, outpatient services, and telehealth.
  • River Oaks Treatment Center: Located in Riverview, Florida, River Oaks treats substance use disorders through combining evidence-based therapies with world-class amenities. Provided care includes detox, residential treatment, behavioral disorder treatment, dual-diagnosis treatment, outpatient services, and telehealth, all with individualized treatment programs.

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 near me that can provide the treatment you need. Check out the directory to find a list of facilities and programs. You can search by location and filter by Ambetter insurance.

How Can I Check My PA Health & Wellness (Ambetter) Coverage for Inpatient Drug Rehab Centers in Pennsylvania?

Begin your journey to a new future by taking the first step to recovery. With the help of American Addiction Centers (AAC), you can find out quickly if your insurance is in-network with one of the many quality rehabs they have across the country. AAC has leading rehab facilities around PA that you can get information about. The Sunrise House Treatment Center is one such facility that offers high-quality rehab services.

Contact the PA Health & Wellness (Ambetter) Pennsylvania helpline for more information today.


  1. Ambetter from PA Health & Wellness. (2022). About our plans.
  2. Ambetter from PA Health & Wellness. (2022). About us.
  3. Ambetter from PA Health & Wellness. (2022). Coverage area map.
  4. National Institute on Drug Abuse. (2020). Commonly used drugs.
  5. National Institute on Drug Abuse. (2019). Treatment approaches for drug addiction DrugFacts.
  6. National Institute on Drug Abuse. (2020). Treatment settings.
  7. National Institute on Drug Abuse. (2018). Comorbidity: substance use disorders and other mental illnesses DrugFacts.
  8. (n.d.). What marketplace health insurance plans cover.
  9. National Institute on Drug Abuse. (2020). Principles of effective treatment.
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