Guide to Ambetter Health Coverage for Addiction Treatment

Last Edited: December 29, 2023

Author
Patricia Howard, LMFT, CADC
About

Clinically Reviewed
Jim Brown, CDCA
About

All of the information on this page has been reviewed and certified by an addiction professional.

Addiction Treatment Coverage by Ambetter Health

Click Here for a confidential benefits check or call (866) 578-7471 to speak to a addiction specialist.

When you decide you need alcohol and drug rehabilitation, the cost of treatment quickly comes to mind. The Affordable Care Act mandates that marketplace health insurance plans include mental health treatment in their coverage. That includes substance abuse. Ambetter Health agrees that addiction treatment is essential to overall good health.

For coverage details that pertain to your specific policy, contact an Ambetter Health agent. He or she can answer your questions, give you coverage information, and tell you what to expect. Armed with this information, you can then turn your focus and attention to the important task at hand: substance abuse treatment.

Let Ambetter Health find the best treatment solution for you for the least out-of-pocket costs. On the other hand, if you decide on a treatment facility yourself, Ambetter Health agents can detail their coverage of the program you’ve chosen. Most drug and alcohol treatment services align with Ambetter Health’s dedication to your overall well-being. Either way, with Ambetter Health, you don’t have to shoulder the financial burden of treatment alone.

How Does Ambetter Health Work for You?

Ambetter Health covers targeted alcohol and drug treatment for its customers. The levels of coverage generally vary based on the type of plan you have. Similar to most insurance companies, Ambetter requires a preauthorization process.

The process is led by one of their specially trained substance abuse experts. These experts are experienced medical professionals. They determine what level of drug and alcohol treatment you need. They also decide what treatment approach will benefit you the most.

All substance abuse treatment programs consist of a variety of therapies and activities. They can include medical detox, individual counseling, cognitive behavioral therapy, and much more. Each treatment plan is individually tailored for every patient. Regardless of the therapeutic makeup of your treatment plan, Ambetter covers at least some of it.

Basic Benefits of Ambetter Health’s Substance Abuse Coverage

Every Ambetter Health insurance policy varies based on price and coverage. That includes coverage for substance abuse treatment, as well. No matter the price of your policy, every Ambetter Health customer can expect to receive the following in their addiction program:

  • Therapy and addiction education (including individual, group, family, etc.)
  • Addiction medications
  • Outpatient treatment
  • Hospitalization (inpatient and outpatient)
  • Laboratory services
  • Medical detox

Ambetter Health Sober Living

Ambetter Health covers medication-assisted detox. In fact, they cover it throughout treatment and into sober living if you need it. The type of treatment they cover is partially based on what you need. It’s also partially based on the policy you have. Regardless, these treatments usually include detox services, inpatient rehabilitation, outpatient care, and more. The medical professionals who do the initial evaluation may conclude that you need other treatments, as well.

Ambetter offers gold, silver, or bronze healthcare plans. For example, consider a customer with a bronze plan. Although he or she enjoys lower monthly premiums, there may be more out-of-pocket expenses. On the other hand, the gold plan has a higher level of treatment coverage. But, gold plan-holders may have higher premiums. Contact your facility to see how they can work with you to maximize your benefits.

Ambetter Health In-Network vs. Out-of-Network Providers

With Ambetter Health insurance policies, you may have the choice between substance abuse recovery providers that are in-network or out-of-network. Customers that choose in-network providers will pay less out-of-pocket. If your policy covers out-of-network providers, you’ll need to pay a little more out-of-pocket.

Whether you choose a provider in-network or out-of-network, be sure you choose one that offers the following services:

  • Medical detox (if you need it)
  • Addiction education
  • Individual counseling
  • Group counseling
  • Treatment for co-occurring disorders

The Three C’s

Remember the three Cs when you need substance abuse treatment.

  1. Call

Call Ambetter Health to find out what your policy covers. Plans often vary from state to state. Some may cover longer terms of aftercare, while others cover longer terms of inpatient care. If you’ve already chosen a facility, talk to the admissions clerk. He or she is insurance-savvy and can help you match your policy to their services.

  1. Contact

Next, contact the treatment center(s) that your Ambetter Health agent recommends. Ask questions about the facility and their rules. Talk to them about what to pack and get their website address for your family. Give them your insurance information, so they can verify your benefits. Some facilities are willing to make payment arrangements for your out-of-pocket costs, if necessary.

  1. Confirm

Finally, during the initial phone call with your treatment facility, give them your insurance information. Confirm that they accept Ambetter Health. Also, verify that they can offer you the full range of services that your policy pays for.

Ambetter Health has over thirty years of experience providing exemplary healthcare services to its customers. Find the healthcare plan that best meets your needs, so you can ensure a future of recovery. A life in recovery holds no limits to the things you can achieve.