More About Rehabs Accepting Ambetter
More About Rehabs Accepting Ambetter
If you’re struggling, Ambetter may cover treatment for addiction and mental health conditions.
Since 2014, Ambetter has offered Affordable Care Act (ACA) Marketplace health plans, which are required to include essential health benefits like mental health and substance use disorder (SUD) services.(1)
Today, more than 2 million members use Ambetter plans for their healthcare needs. Coverage details, such as what types of rehab are included, which providers are in-network, and how much you’ll pay, depend on your specific plan and state.(2)
Does Ambetter Cover Addiction and Mental Health Treatment?
Yes, Ambetter covers addiction and mental health treatment as part of the essential health benefits required by the Affordable Care Act (ACA).(1) This means services like therapy, counseling, inpatient rehab, and substance use disorder treatment are included.(2) However, coverage details, including copays, deductibles, and in-network providers, can vary depending on your specific Ambetter plan and state.(2)
To understand exactly what your policy covers and avoid unexpected costs, it’s best to review your plan documents or call Ambetter directly. Speaking with a representative ensures you get clear information about your benefits and available treatment options.(2)
Ambetter Insurance Coverage Levels and Plans
Ambetter insurance plans are offered in three main tiers.(3) Each tier offers different monthly premium amounts and out-of-pocket expenses to align with your health and financial needs.(3)
Within each tier, there are plans for different income levels and varying levels of coverage. The three main levels are:(3)
- Bronze: The bronze tier, or the Ambetter Essential Care package, provides healthcare with a low monthly premium (the amount a customer must pay each month to retain coverage). However, rates for services and emergencies with these plans will generally be higher than the two other levels.
- Silver: The second level, known as the Ambetter Balanced Care package, requires customers to pay higher monthly premiums. In return, Ambetter will pay a higher share of most medical bills.
- Gold: The final tier, Ambetter Secure Care, demands the highest premium, but the coverage provided in cases of emergency or necessary health services exceeds the previous levels.
It’s important to consider these options carefully when deciding on an insurance plan.
While it can be tempting to choose a plan with the lowest possible monthly premium, there’s always the possibility this approach will cost more in the long term if an emergency or need for expensive care arises.
Rehab that accept Ambetter insurance coverage are currently located in 26 states across the nation.(4) States may offer different plans, so be sure to contact Ambetter to learn more about Ambetter drug rehab coverage in your area.
To compare pricing and Ambetter insurance coverage, visit Healthcare.gov or the Ambetter website. Visiting Healthcare.gov will allow you to compare Ambetter plans to other health insurance providers.
Which Types of Addiction and Mental Health Treatment Does Ambetter Cover?
Ambetter covers addiction and mental health services in multiple treatment settings.(4)
Rehab and other substance use and mental health services are covered by Ambetter insurance.(2) However, out-of-pocket costs and coverage may vary depending on the specific plan chosen and the customer’s state of residency.(2)
The level of care and services offered will depend on the needs of each patient and may include:(5)
- Detox: This is often the first step in treatment before a patient transitions to another level of care. Patients attend detox to help them stop using substances while under medical supervision.
- Inpatient/residential programs: During inpatient/residential treatment, patients reside at the facility while undergoing treatment for addiction or mental health disorders. These programs provide a safe, supportive living environment with 24/7 support during treatment.
- Therapies: Addiction and mental health professionals use evidence-based therapeutic interventions, like cognitive behavioral therapy (CBT) and motivational interviewing (MI), to help patients address the underlying causes of mental health conditions.
- Outpatient programs: With outpatient care, patients can live at home and attend treatment at a facility. Various levels of outpatient care are available, including partial hospitalization programs (PHPs), intensive outpatient programs (IOPs), and standard ones. Each differs in intensity and required attendance frequency but offers similar approaches to inpatient rehab.
- Aftercare: Mental health professionals agree that remaining in care after completing an initial program benefits long-term recovery. Some common types of addiction aftercare include ongoing therapy, sober living homes, and 12-Step programs.
Does Ambetter Cover Medication-Assisted Treatment (MAT)?
Yes, Ambetter may cover medication-assisted treatment (MAT) if it’s considered medically necessary.(6)
Because coverage can differ by plan and state, it’s important to confirm your benefits with Ambetter before starting treatment for yourself or a loved one.
MAT, sometimes called medications for opioid use disorder (MOUD) or addiction treatment with medication, combines FDA-approved medications with counseling and behavioral therapies to support long-term recovery from alcohol or drug use.(6) This differs from short-term use of medication during detox or withdrawal management, which is not the same as ongoing MAT.
Does Ambetter Cover Co-Occurring Disorder Treatment?
Yes, Ambetter often covers co-occurring disorder treatment.(1)
Patients who struggle with with mental health disorders, such as anxiety, depression, or post-traumatic stress disorder (PTSD), also struggle with a substance use disorder (SUD) at the same time.(5) Mental health professionals recommend treating both conditions simultaneously with an integrated approach to support long-term recovery.(5)
Because mental health care is an essential health benefit under the ACA, patients may receive partial or full coverage for co-occurring disorder treatment costs at a rehab that takes Ambetter.(1)
Does Ambetter Cover Sober Living?
Sober living homes, or recovery housing, may be covered by Ambetter insurance depending on your plan and coverage. Sober living is a type of continuing care that allows people to transition back into a more independent lifestyle after other types of treatment. It can serve as a bridge between inpatient treatment and daily life, reinforcing what was learned during previous treatment.(5)
It may be a form of step-down care after inpatient treatment, or step-up care from less intensive treatment. While less structured than inpatient treatment, sober living still provides a sober environment in which to continue the recovery journey and navigate life free of drugs and/or alcohol.(5)
How to Use Ambetter for Addiction and Mental Health Treatment
To learn information specific to your Ambetter health insurance plan, you can:
- Login to your Ambetter account. If you have not already registered for online services, you may have to create an account.
- Call a customer service representative in your state to ask specific coverage questions.
- Look through the paperwork supplied by Ambetter when you enrolled in the healthcare plan.
[sources]
- HealthCare.gov. (n.d). Mental health & substance abuse coverage.
- Ambetter. (2020). What is Ambetter?
- Ambetter. (2020). About our plan.
- Ambetter. (2020). Plan brochures & benefits & coverage.
- National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction DrugFacts.
- Substance Abuse and Mental Health Services Administration. (2020). MAT medications, counseling, and Related Conditions.