Understanding Ambetter Insurance Coverage for Rehab Centers

You can use Ambetter health insurance for substance abuse treatment. Drug & alcohol rehab coverage is generally available for anyone who is covered under an Ambetter Insurance plan. This may include rehab services like detox, inpatient, and outpatient treatment.  Ambetter Insurance will provide rehab coverage for addiction treatment at varying levels, based on your location and plan type.

How to Use Ambetter to Cover the Cost of Rehab

Before using your coverage benefits from any insurance provider, including Ambetter, you should review your benefits to know exactly what is covered. The level rehab coverage Ambetter will provide varies based on the plan selected and the Ambetter network coverage available relative to your location. Depending on your plan, you may need to produce additional documentation—known as a pre-authorization—provided by your physician or rehab provider to Ambetter Insurance to indicate the medical necessity for rehab coverage.

To avoid any surprise medical bills for your treatment, be sure to confirm your level of coverage provided for rehab and other addiction services with your insurance representative before receiving any drug or alcohol detox and rehab services. Generally speaking, however, you can expect some level of coverage for the following types of treatment.

Types of Addiction Treatment Covered by Ambetter Insurance

Ambetter Health insurance may provide coverage for a wide range of medically necessary addiction treatments and therapies. While everybody’s treatment plan will ultimately be unique, there are a few common types of treatments you may experience. Some treatment types include:

• Medical Detox.
• Inpatient Care.
• Outpatient care.
• Aftercare and Sober living.

How Do I Check My Ambetter Insurance Coverage for Rehab?

To check your rehab benefits provided by your Ambetter plan, Ambetter Insurance provides members with an online portal in which they can securely and confidentially access their health information and important plan details. This is where you can find your explanation of benefits, a summary of benefits and coverage, claims, deductible information, what states you can use your Ambetter coverage in, and more.

Additionally, many facilities, like American Addiction Centers (AAC) allow you to either check your coverage online or over the phone. To speak with someone at American Addiction Centers, you can call our detox hotline or you can text us any time. It’s confidential and available 24/7.

How Much Does Ambetter Cover?

The Affordable Care Act (ACA) requires all health insurance plans, including Ambetter plans, to provide some degree of coverage for the medically necessary treatment of behavioral and mental health disorder. This generally includes some coverage for the treatment of substance use disorders. However, the exact coverage you receive from your Ambetter health plan may vary depending on a few factors. These factors may include:

• Type of Ambetter plan.
• Where you attend treatment.
• Whether a rehab is in-network with Ambetter.
• How long treatment lasts.
• Intensity of treatment.
• Accommodations and amenities offered by a rehab.

It’s important to reach out to an Ambetter health representative in order to check your coverage before committing to treatment.

Do Rehab Centers Need to Be In-Network with Ambetter?

In order to take advantage of your full Ambetter Health benefits, you may need to receive treatment at an in-network rehab center. In-network facilities work directly with Ambetter Health to provide their members with quality care. You may still attend treatment at an out-of-network facility, but Ambetter may not provide as much coverage if you do so. It’s important to reach out to any potential rehab centers to confirm that they are in-network with Ambetter Health.

Types of Ambetter Insurance Plans

Ambetter Insurance is a private insurance company that provides health plans that are qualified under the Health Insurance Marketplace. According to their website, approximately 2 million people from 20 different states are covered by an Ambetter health plan¹:

Ambetter Insurance offers 3 different levels of Marketplace health plans, varying in cost and breadth of coverage.

The 3 major plan types offered by Ambetter Insurance are as follows²:

• Bronze: Amber Essential Care—This plan covers essential health care needs. The monthly premiums are lower, but the deductible is higher than the other 2 plans, which means your out-of-pocket costs will be higher.
• Silver: Ambetter Balanced Care—According to Ambetter’s website, the Balanced Care plans offer the best value to enrollees, particularly those who are eligible to receive financial assistance in the form of premium tax credit subsidies. In comparison to the other 2 plans offered by Ambetter Insurance, the monthly premiums and out-of-pocket costs are considered to be in the middle of the road.
• Gold: Ambetter Secure Care—The highest-tier plan option provides the most comprehensive level of coverage. Monthly premiums with this plan are expensive, but enrollees pay lower deductibles and subsequently, lower out-of-pocket costs.

The exact costs for each plan will vary based on your location and whether you qualify for any financial assistance. Those who are healthy and can afford higher out-of-pocket costs if they get sick may benefit from choosing the Amber Essential Care plan to save on monthly premium costs. Those who have a chronic condition or need more substantial coverage may benefit from choosing the Ambetter Secure Care plan and paying more per month in premiums in exchange for overall lower out-of-pocket costs.

Ambetter, Medicare & Medicaid

Because Ambetter Insurance health plans are Marketplace health plans, they do not coordinate with certain aspects of Medicare. Under the Affordable Care Act³ (ACA), which was enacted in March 2010, it is illegal⁴ for anyone to have a Marketplace health plan and a Medicare health plan. This is true even if you have only Medicare Part A or Medicare Part B. Those who have Medicare will need to work with the Centers for Medicare & Medicaid Services to expand their coverage options.

In certain situations—for example, if you are paying a premium to be enrolled in Medicare Part A or you’re eligible for Medicare but haven’t yet enrolled in a plan—you may be permitted to enroll in a Marketplace plan such as one of the Ambetter Insurance options.⁵ It’s a good idea to reach out to an insurance professional to determine whether Medicare or Ambetter Insurance is right for you.

Find Rehab Centers That Take Ambetter Insurance

Many rehab providers, like American Addiction Centers (AAC), accept Ambetter insurance coverage for drug & alcohol treatment. But where you can use your coverage really depends on your specific plan’s details. While some Ambetter plans offer out-of-state coverage, your best bet at finding a rehab center that accepts Ambetter insurance would be to look in the 20 states they provide coverage in.  For more information on how to find a rehab that accepts Ambetter, select your state’s guide from the list below: