Ambetter Detox & Rehab Benefits Guide
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:
If you or a loved one is struggling with addiction, you may be wondering how you can afford to pay for treatment. Most major health insurance companies offer some form of insurance coverage for rehab, detox, and addiction treatment, but coverage varies widely based on plan type and where you live. Moreover, having health insurance does not guarantee coverage for all forms of detox and treatment.
Please note that this page is for informational use only. You should contact Ambetter Insurance directly to check your benefits and coverage before enrolling in any program to avoid surprise medical bills.
Does Ambetter Insurance Cover Detox?
If you or a loved one is in need of detox, rehab, or therapy, your Ambetter Insurance plan can help you receive the care you need at a price you can afford. Substance abuse health services are EHBs, so Ambetter Insurance will provide coverage at varying levels, based on your location and plan type.
Drug and alcohol detox is typically completed on an inpatient basis to ensure the patient’s safety while they go through withdrawal symptoms. Ambetter detox coverage for drug and alcohol detox is available to members and their dependents, subject to coverage limits and deductibles.
Your plan may also cover multiple types of therapy. To avoid any surprise medical bills, be sure to confirm your levels of coverage with your insurance representative before receiving any drug or alcohol detox and rehab services.
Does Ambetter Insurance Cover Rehab?
After detox is completed, many patients transition into a rehab program on either an inpatient or outpatient basis. Rehab helps people learn the skills they’ll need to cope with their addiction and create strategies for preventing a relapse.
Regardless of whether your rehab program takes place as inpatient or outpatient care, Ambetter rehab insurance coverage is available. The level of insurance coverage for rehab will vary based on the plan selected and where you are located. As with any other medical service, you are responsible for all medical care costs needed to fulfill your deductible, plus any amount of coinsurance. Depending on your plan, your physician may need to provide additional documentation to Ambetter Insurance to indicate medical necessity for a rehab program.
Does Ambetter Insurance Cover Prescription Medications for Detox and Rehab?
If a doctor determines that medication-assisted treatment would benefit your detox and rehab, Ambetter Insurance may provide coverage for such prescriptions. These types of medications are often considered to be specialty drugs and may fall under the most expensive category of prescription drugs. An Ambetter Insurance plan may offer some coverage of specialty drugs, although you may have to pay a higher coinsurance amount on these medications. Your exact coverage will depend on your plan and where you live.
Can Family Members and Dependents Use Ambetter Insurance to Go to Detox or Rehab?
Ambetter drug rehab coverage is generally available for anyone who is covered under your Ambetter Insurance plan. This includes detox or rehab services at any facility, including American Addiction Centers (AAC). It is always important to check your insurance benefits to ensure that your family member is covered under your policy.
How to Check Your Ambetter Insurance benefits
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, summary of benefits and coverage, claims, deductible information, and more. Click here to view all of the resources available for Ambetter Insurance members.
In addition to checking with Ambetter, you should verify with your selected care provider and facility to ensure that they’re covered under your insurance. Because Ambetter insurance is offered in many different states and plans may vary, you should not assume that you will have Ambetter out-of-state coverage without checking first. You can also use AAC’s insurance verifier, an online tool, or contact their 24/7 service line to double-check whether your Ambetter plan covers treatment at an AAC facility.
Types of Ambetter Insurance Plans
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.
What Does Ambetter Cover?
Despite the differences in levels of coverage and cost-sharing, all Ambetter Insurance health plans cover certain basic health services known as essential health benefits (EHBs)2 (You’re covered on essential benefits). Covered EHBs that may come into play during your journey to recovery include the following:
- Emergency health services
- Outpatient or ambulatory services
- Preventive and wellness services
- Mental health and substance abuse health services
- Laboratory screenings and services
- Prescription drugs
- Therapy services
- Hospitalization and associated costs
The exact benefits vary according to your plan, where you live, and whether you use an in-network or out-of-network provider. Typically, in-network providers have a contract with your health insurance plan. This means that you will usually pay less than you would if you sought care from an out-of-network provider.
Remember, having health insurance does not guarantee that services will be covered. Always double-check with your provider and your insurance representative before obtaining care whenever possible.
Ambetter Insurance and Medicare
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 options5. It’s a good idea to reach out to an insurance professional to determine whether Medicare or Ambetter Insurance is right for you.
Detox at American Addiction Centers
AAC accepts a wide array of insurance including Ambetter Insurance. Please note that AAC is not affiliated or sponsored by Ambetter Insurance or any of its licensees.
AAC, which was founded in 20076, is now one of the country’s largest networks of detox and rehab facilities. AAC employs a variety of strategies to help those in need to overcome their addiction(s) and make steps toward long-term recovery. All treatments are research-based, customized for each person, and performed by an experienced team of professionals including physicians, therapists, social workers, nurses, psychologists, and psychiatrists.
In addition to providing a high standard of care, AAC allows patients to use their insurance to make treatment more affordable. In fact, AAC works with a wide variety of insurance providers, including Ambetter Insurance, to help you get the help you need at a cost you can afford. Please note, AAC is not guaranteeing that your treatment will be covered. Review your insurance plan’s details carefully to check whether AAC is a covered option under your plan before seeking treatment.
If you or a loved one is looking for a high-quality and effective detox and rehab center, please give AAC a call. Call us now at 1-888-935-1318 to learn about your treatment options.
- (2020) Home page.
- (2020) About Our Plans.
- gov. (n.d.) Affordable Care Act (ACA) – HealthCare.gov Glossary.
- gov. (n.d.) Medicare and the Marketplace: If You Have Medicare.
- (2020) What Is Ambetter?
- American Addiction Centers. (2020) About American Addiction Centers.