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Ambetter Insurance for Addiction Treatment

Does Ambetter Insurance Cover Drug and Alcohol Rehab?

The short answer is yes, Ambetter Insurance does cover substance abuse treatment for drug and alcohol addiction. However, coverage depends on a variety of factors, including a member’s geographical location and their type of insurance plan. Understanding your plan and knowing your coverage options is essential for a successful recovery journey.

When you are trying to overcome the powerful grip of addiction, navigating the world of health insurance can feel overwhelming. However, getting the help you need doesn’t need to be intimidating. Luckily, insurance representatives and admissions navigators at drug and alcohol rehab centers exist to help you maneuver such matters. If you have an Ambetter Health Insurance policy, there is a strong possibility that your substance abuse treatment will be at least partially covered, if not fully covered. Whether you are struggling with alcohol addiction or drug addiction, Ambetter Insurance can help cover expenses related to rehab.

How to Check Your Ambetter Insurance Benefits

Understanding your Ambetter Insurance coverage can be simple if you know who to contact and what to look for. To speak to an Ambetter representative who can help you understand which addiction treatment providers are in-network with your insurance plan, call the number on the back of your Ambetter Insurance card. With your representative, you’ll be able to discuss the scope of your behavioral health benefits. Ambetter Insurance representatives are available to help answer your questions most business days.

Ambetter Insurance also has online insurance member portals where you can confirm your insurance coverage.

Addiction treatment center coverage vary by the provider’s location, specific services, and a variety of other factors. Therefore, it is recommended that you contact the treatment center you’re interested in to ensure that your services will be covered through Ambetter Insurance.

If you already have a specific rehab center in mind, you can also contact the provider to inquire on whether your addiction treatment services will be covered. American Addiction Centers (AAC) can help you check your Ambetter Insurance benefits. Our admissions navigators are available to assist you 24 hours a day, 7 days a week. Call us at Or you can use our insurance verification tool here. You can rest assured that your information is secure and confidential. Caring specialists are ready and eager to help you, free of commitment or judgment.

Ambetter Coverage Levels

Every health insurance plan with Ambetter Insurance is comprehensive and includes the following essential services:

  • Hospitalization.
  • Mental health and substance abuse services.
  • Emergency services.
  • Outpatient or ambulatory services.
  • Wellness and preventative services.
  • Pediatric services.
  • Therapeutic services (physical therapy and devices).
  • Prescription drugs.
  • Laboratory services.

Couple sits with representative to review insurance benefits and adopt a new insurance plan.

Ambetter Insurance makes it simple to choose a plan that works for you. They offer three comprehensive plan tiers – Bronze, Silver, and Gold – all of which, include the essential services listed above. Specifics within these essential services can vary based on your location and type of insurance plan.

The Bronze Plan is the Ambetter Essential Care Plan and it covers essential services mentioned above. With the lowest monthly premiums and higher out-of-pocket costs, this is a good option for those who do not require a lot of healthcare.

The Silver Plan, known as the Ambetter Balanced Care Plan, is considered to be the best value. It offers a balance between the cost of your monthly premiums and out-of-pocket costs.

With the Gold Plan, known as the Ambetter Secure Care Plan, your out-of-pocket costs are limited because you pay a higher monthly premium.

Does Ambetter Offer Medicare and Medicaid?

If you have coverage under Ambetter Insurance, you may qualify for a Medicare Advantage Plan or Medicaid plan.1 Medicare is a government funded insurance program for individuals 65 years of age and older. Medicaid is a government-funded insurance plan that services families and individuals who are experiencing financial difficulty. 2

Medicaid has two types of coverage: mandatory and optional benefits. The government dictates which benefits are considered mandatory and your particular state determines which benefits are optional.

Depending on the state in which you reside and the services you receive, it is highly likely that Medicaid will cover substance abuse treatment services. You can contact the number on your Medicaid card as well as your treatment provider of choice to ensure coverage. Be aware that your substance abuse treatment services may not be covered by Medicaid if you receive services outside of the state you live.

Ambetter Insurance for Inpatient Treatment

Ambetter Insurance generally covers inpatient substance abuse treatment; however, your coverage will depend on your specific insurance plan, your location, the treatment provider, and services rendered.

Inpatient substance abuse treatment is unique in the sense that it removes someone from their primary environment and places them in a structured, drug-free, and supervised setting to ensure their safe transition from addiction to abstinence. 3 In inpatient treatment, you will receive a team of professionals who help you address your substance abuse issues from a broad viewpoint. This team may may assess the condition of your physical and mental health, as well as determine whether your level of societal functioning is ideal or unsatisfactory.

Detoxification, the process of eliminating drugs and alcohol from your body, is a common part of the substance abuse treatment process. Detox is sometimes a person’s first step before entering a short-term or long-term inpatient substance abuse treatment program. Like inpatient treatment, there is a good chance that your detoxification services are covered by Ambetter Insurance.

Ambetter Insurance for Outpatient Treatment

Ambetter Insurance typically covers outpatient substance abuse rehab programs, but levels of coverage depend on your plan.

Outpatient addiction treatment is a form of drug or alcohol rehab where you go to a treatment center on specific days, at specific times, for individual and group therapy and other treatment sessions. 4 With outpatient programs, you do not live at the rehab center.

Ambetter Insurance can help you cover the costs of outpatient substance abuse rehab. Your coverage and out-of-pocket costs will vary based on your insurance plan, location, treatment plan, and treatment center.

Does Ambetter Cover Medication-Assisted Treatment?

Ambetter Insurance uses the American Society of Addiction Medicine (ASAM) criteria to determine which substance abuse services, including MAT, are considered medically necessary. 5

Medication-Assisted Treatment (MAT) is the use of medications to assist with withdrawal symptoms associated with detoxification from drugs and alcohol. 6 MAT is approved by the Food and Drug Administration (FDA) and is used in combination with therapy to help address the various aspects of a person’s recovery from drugs and alcohol.

The FDA has approved specific medications to treat alcohol and opioid use disorders. MAT may be covered as part of your treatment plan; it depends upon your particular coverage and what the treatment center deems a medical necessity.

Does Ambetter Insurance Cover Sober Living?

Sober living can be another component of substance abuse treatment. Many people choose to go to sober living once they have completed inpatient treatment. It can be thought of as a less restrictive form of treatment than inpatient treatment, and it serves as a transition between inpatient treatment and re-entrance into mainstream society. Your Ambetter Addiction Treatment coverage may include sober living services.

Sober living is designed to be a safe space, free of drugs and alcohol, that provides an opportunity to learn how to navigate life free of substances. Sober living homes have rules and regulations, including a schedule, curfew, and drug and alcohol tests to ensure sober living.

Ambetter Insurance at American Addiction Centers

American Addiction Centers has locations across the country to help you successfully recover from drug and alcohol addiction. Recovery First in Hollywood, Florida and other AAC facilities accept Ambetter Insurance, and many – if not all – of the treatment services they offer may be covered as well.

If you are thinking about getting help for your drug or alcohol abuse issues, now is the time. Getting help for your addiction has never been easier or more accessible. You don’t have to continue to live your life controlled by drugs and alcohol. Support is available to you now.

Sources:

  1. Ambetter. (2020). Becoming Medicare eligible.
  2. Centers for Medicare and Medicaid Services. (n.d.). Substance use disorders.
  3. American Addiction Centers. (2020). How to find the best inpatient drug rehab treatment?
  4. American Addiction Centers. (2020). Outpatient treatment.
  5. Ambetter. (2014). Member handbook.
  6. Substance Abuse and Mental Health Services Administration. (2020). MAT medications, counseling, and related services.
Last Updated on November 19, 2021
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Jacquelyn Buffo, M.S., L.P.C., C.A.A.D.C.
Jacquelyn Buffo, M.S., L.P.C., C.A.A.D.C.
Jacquelyn Buffo, M.S., L.P.C., C.A.A.D.C., is a licensed professional counselor with experience and expertise in substance abuse and mental health issues.

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