Ambetter Insurance Coverage for Alcohol and Drug Rehab

Ambetter is an insurance company that provides health insurance to over 3 million people in the United States.¹ Ambetter offers bronze, silver, and gold healthcare plans.² Each plan level provides access to Ambetter’s in-network providers in 27 states nationwide.³ Ambetter offers “affordable healthcare designed for you – with the benefits, tools and coverage you want.”³

You may be wondering if your Ambetter insurance plan covers drug and alcohol addiction treatment. The answer is yes. 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.

The Affordable Care Act (ACA) requires that all insurance companies provide some type of coverage for addiction treatment. The ACA requires that all health insurance plans cover behavioral health treatment (e.g., psychotherapy and counseling), mental health inpatient services, and substance use disorder (SUD) treatment.⁴

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. Regardless of what rehab facility you choose and what insurance policy you have, you will likely be responsible for paying some out-of-pocket costs.

Before choosing a rehab treatment program, it is important to take your medical needs and finances into consideration. You want to ensure that you’re selecting the right plan for you.

Ambetter plans include:²

• Bronze plans: Known as Ambetter Essential Care, these plans cover essential healthcare needs. They have lower monthly premiums but higher out-of-pocket costs if you need a lot of care. Bronze plans are best for those who do not need frequent medical care.
• Silver plans: Known as Ambetter Balanced Care, these plans provide a balance between monthly premiums and out-of-pocket costs, particularly if you qualify for financial assistance. Silver plans offer the best value and are ideal for those who use their plan occasionally and prefer lower deductibles.
• Gold plans: Known as Ambetter Secure, these plans offer high monthly premiums to help reduce your out-of-pocket costs. These plans are best for those who have frequent and/or ongoing healthcare needs.

Ambetter currently provides coverage in the following 27 states:³

Mental health and substance abuse treatment are considered essential health benefits. As a result, all marketplace plans—including Ambetter—must cover some of these costs for those who are seeking treatment.

Behavioral therapy and counseling are an important aspect of addiction treatment. Mental health and substance use disorders (SUDs) commonly occur together; this is known as dual diagnosis. Getting to the root of why you misuse drugs or alcohol plays an important role in treatment.

Those who suffer from co-occurring mental health conditions such as post-traumatic stress disorder (PTSD), anxiety, or depression along with a substance use disorder can benefit greatly from a dual diagnosis treatment program, since treating both disorders at the same time improves one’s chance for a successful recovery.

Types of Therapy That May Be Covered by Ambetter

There are several types of behavioral therapy that could be incorporated into your addiction treatment program:

• Cognitive behavioral therapy (CBT).
• Contingency management (CM).
• Dialectical behavioral therapy (DBT).
• Eye movement desensitization and reprocessing (EMDR).
• Family therapy.
• Matrix model.
• Motivational interviewing (MI).
• Rational emotive behavioral therapy (REBT).

If Ambetter is your insurance provider, your policy may cover the following for drug and alcohol addiction treatment:

Detox Services Covered by Ambetter

Medical detox helps you withdraw safely from drugs and alcohol. Under 24/7 medical supervision, staff will work closely with you, and may prescribe medications to help ensure that you withdraw safely and that your symptoms are addressed as needed. Learn more about Medical Detox Centers Near Me.

Inpatient or Residential Care Covered by Ambetter

Inpatient/residential live-in treatment centers provide substance abuse rehab onsite. You will live at the facility for 15, 30, 60 or 90 days, depending on your needs and the program you’re in. Learn more about Residential Inpatient Programs.

Ambetter Coverage for Partial Hospitalization Programs (PHPs)

These programs allow you to live at home throughout treatment and spend your days at the treatment facility. This is sometimes referred to as day treatment. Learn more about Partial Hospitalization Programs (PHP).

Ambetter Coverage for Intensive Outpatient Programs (IOPs)

These programs typically involve attending treatment programs approximately 3 evenings a week. People in these programs can live at home and go to work during the day. Learn more about Intensive Outpatient Care.

Outpatient Treatment with Ambetter Coverage

This is typically for those who have completed inpatient treatment. Patients live at home but attend the treatment center for 10–12 hours a week to complete the drug and alcohol rehab program. Learn more about Outpatient Programs.

Your Ambetter health insurance plan impacts your total cost of substance abuse treatment in terms of monthly premiums, copays, deductibles, and potential out-of-network costs. Some parts of rehab treatment may or may not be covered, but you can expect at least partial coverage under Ambetter, regardless of the plan you have.

In most cases, you will need to seek treatment at a rehab facility that is in-network with Ambetter to receive your full benefits. Even if you choose a center or program that is in-network, you may still be responsible for some of the treatment costs.

If you choose a facility that is out-of-network, you may be responsible for all the costs of your drug and alcohol addiction treatment. You may be able to discuss financing options such as a payment plan or scholarships offered by the treatment center.

If your Ambetter insurance policy does not cover all your addiction rehabilitation expenses, it’s important not to let that stop you from getting treatment. Some substance abuse facilities offer payment plans so you can gradually pay your costs back over time. Others offer grants and scholarships to those with financial need. You should contact the rehab center you are interested in to find out about their financing and scholarship options.

Here are additional resources that provide more information about other ways to pay for rehab with or beyond what Ambetter covers:

• How to Pay for Rehab Without Insurance
• FAQs about Paying for Rehab
• What is the Cost of Drug Rehab?

Choosing to attend rehab for an SUD is one of the most important steps on your path to recovery. There is help available and your Ambetter policy and benefits can help you pay for treatment so you can focus on what matters–your sobriety and long-term recovery.

Questions About Using Ambetter Insurance for Rehab?

Get personalized support and have your questions answered via text message.

American Addiction Centers (AAC) has 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: 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 telehealth, 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 telehealth, 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.

Before deciding on a rehab facility, check your Ambetter policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. You can call the phone number on your insurance card or log in to your account on Ambetter’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the rehab center you are considering is in-network with Ambetter. Or, call to speak with one of our admissions navigators to have them check your benefits and help you understand what is covered.

Knowing exactly what your Ambetter insurance plan covers can give you peace of mind while you or your loved one is in rehab for addiction. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles.

1. Ambetter Health. (n.d.). What is Ambetter?
2. Ambetter Health. (n.d.). About Our Plans.
3. Ambetter Health. (n.d.). Home: Find Ambetter Coverage in Your State.
4. Healthcare.gov. (2021). Mental Health & Substance Abuse Coverage.