Does Ambetter Insurance Cover Alcohol and Drug Rehab Centers?

Ambetter insurance offers a wide array of health solutions for members.¹ With healthcare products provided through Centene Corporation, Ambetter delivers local care in the following states:^1,2

• Arizona
• Arkansas
• Florida
• Georgia
• Illinois
• Indiana
• Kansas
• Michigan
• Mississippi
• Missouri
• New Hampshire
• New Mexico
• Nevada
• North Carolina
• Ohio
• Pennsylvania
• South Carolina
• Tennessee
• Texas
• Washington

If you reside in one of these states or plan to participate in an Ambetter rehab in one of these areas, you can find out details about your coverage by calling the number on the back of your card. To make things even easier, you can verify your insurance with the rehab facility you plan to attend. Contact them or use the insurance verification form at the bottom of this page. You will receive an answer immediately upon filling out the brief form.

Take the first step in your recovery by checking your Ambetter insurance for addiction treatment.

Ambetter medical insurance is a Marketplace plan that provides 3 different levels of coverage. Plans include:³

Bronze: Ambetter Essential Care. This level will help with your basic and essential needs. It is a lower monthly premium, but you will have to pay more out-of-pocket fees if you get other care that is not essential.

Silver level: Ambetter Balanced Care. This plan is more balanced in terms of what you pay monthly versus out-of-pocket costs.

Gold level: Ambetter Secure Care. With this level of Ambetter insurance, you will have all your health needs covered. However, you can expect to pay more per month.

You can count on some type of coverage for mental health care and substance abuse services because they are considered “essential” care. The exact details about what is covered depend on your specific plan. You will need to check your Ambetter insurance benefits with a representative.

Some of the Ambetter mental health and substance abuse treatments include:

• Inpatient rehab program: Inpatient treatment is helpful for those with a severe addiction issue. You will have 24-hour monitoring and care.
• Residential rehab program: Residential care includes living at the facility for an extended amount of time to receive full care.
• Intensive outpatient programs (IOPs): This type of treatment program provides more intense treatment on an outpatient basis. You may attend therapy several days a week.
• Partial hospitalization programs (PHPs): PHP is considered a step down from inpatient rehab. You will spend much of your time getting treatment and go home at night.
• Outpatient therapy and counseling: If you have completed an inpatient program, you may be ready for a once-a-week outpatient regimen.⁴

A rehab counselor will evaluate your condition and help determine which program would be best for you.

You may be concerned about other diagnosed or undiagnosed mental illnesses. It’s important to note that substance misuse and addiction are  mental health disorders. However, many people who have a substance use disorder also have another mental illness.⁵ In fact, according to the National Institute on Drug Abuse, it’s common for people to have co-occurring conditions. ⁵

It is not clear whether substance abuse leads to mental illness or mental illness drives people to use substances—it could be a bit of both.⁵ Whatever the case may be, it’s vital to work with one of the Ambetter rehab centers that specialize in co-occurring disorder treatment, as well as treat these two conditions in tandem. Doing so will ensure you receive adequate care for both issues.⁵

The Affordable Care Act, which creates certain mandates for insurance providers, requires that carriers provide for mental health care and substance abuse treatment. ⁶

Even though everyone has differing rehab needs, one thing is certain—you don’t want to stop drug rehab too soon. The National Institutes of Health recommends that you stay in treatment for at least 3 months for maximum effectiveness, although some people may benefit from longer treatment times.⁷

How long does Ambetter cover drug rehab? You will need to check with your carrier for specifics. Each policy type and level has specific coverage provisions. You can check your Ambetter rehabilitation coverage by calling the number on your card, or verify your benefits below. Checking your Ambetter rehab insurance is the first step in seeking treatment and will set you on the right path for healing and recovery.

What if My Ambetter Insurance Policy Does Not Cover Rehab?

If you find out that your Ambetter insurance rehab coverage won’t take care of all the costs (or any of the costs) of treatment, what should you do next? You shouldn’t give up on striving to recover. Many facilities offer some type of assistance or payment plan options. You could check with the rehab you are considering and ask if they offer financial aid, sliding-scale fee, or payment arrangements. Just remember to reach out for assistance; your health and well-being are worth it.

You may be familiar with the terms “in-network” and “out-of-network,” but maybe you’re not sure what they mean. Simply put, an in-network provider is a rehab, doctor, pharmacy, or facility that has contracted with the Ambetter network. This allows you to get services from these facilities for a discounted price, some or all of which will be covered by your insurance. ⁸

An out-of-network provider is a rehab, doctor, pharmacy, or facility that isn’t a part of the Ambetter network.⁸ If you opt for a facility that is out-of-network, you can count on having to pay for the services you receive. ⁸

You can contact a representative to find an Ambetter mental health provider list, or simply call the rehab facility to find out if they are in-network or out-of-network with Ambetter. It makes sense to attend an in-network facility to save additional costs.

American Addiction Centers (AAC) has various rehab facilities around the country that provide drug and alcohol addiction treatment. If you have a Ambetter insurance plan, the following AAC facilities accept Ambetter for drug and alcohol addiction rehab.

• Greenhouse Treatment Center: Located in Grand Prairie, Texas, Greenhouse offers individualized treatment plans and many levels of care including detox services, residential treatment, dual-diagnosis treatment, intensive outpatient services, outpatient services, and tele-health, all in a luxurious setting with high-end amenities.
• Desert Hope Treatment Center:  Located in Las Vegas, Nevada, Desert Hope provides individualized care programs as well as offering a full continuum of care including detox services, residential treatment dual-diagnosis treatment, intensive outpatient services, and tele-health.
• Oxford Treatment Center: Located in Etta, Mississippi, Oxford offers gender-specific rehab while offering an opportunity to connect with nature and try new activities. Provided care includes detox, residential treatment, dual-diagnosis treatment, inpatient and outpatient treatment, intensive outpatient services, and tele-health, all with individualized treatment programs.
• Recovery First Treatment Center: Located in Hollywood, Florida, Recovery First treats substance use disorders by combining evidence-based therapeutic modalities with top-level care. Recovery First provides a personalized continuum of care including detox services, residential treatment dual-diagnosis treatment, intensive outpatient services, outpatient services, and tele-health.
• River Oaks Treatment Center: Located in Riverview, Florida, River Oaks treats substance use disorders through combining evidence-based therapies with world-class amenities. Provided care includes detox, residential treatment, behavioral disorder treatment, dual-diagnosis treatment, outpatient services, and tele-health, all with individualized treatment programs.

There are various treatment programs for individuals struggling with drug or alcohol addiction, so don’t give up if the first program you check out doesn’t meet your individual needs. There are rehabs near me that can provide the treatment you need. Check out the directory to find a list of facilities and programs. You can search by location and filter by Ambetter insurance.

Now, it’s up to you to move forward with your health and recovery by checking your Ambetter insurance. You can find out more details about what is covered in your plan by contacting sources that can provide specific information. If you have the gold plan, Ambetter Secure Care, you most likely will have a good deal of the costs covered.³ The silver plan, Ambetter Balanced Care, is a great option for those who want to balance expenses with care. ³Even the bronze plan, Ambetter Essential Care, will ensure you get the basic coverage, and the lower monthly premium means you’ll have saved money.³

You can also contact American Addiction Centers (AAC). They will verify your insurance coverage right away. All you need to do is fill out the brief form below to find out whether Ambetter is covered with AAC facilities. If you’d rather talk to someone in person, call our helpline at any time, 24/7, to get more information. Don’t put off getting the help you need.

Ambetter Covered Local Rehab Coverage Guide

Local Alcohol Rehab Near Me

Local Opioid Rehab Near Me

Does Ambetter Cover Addiction Treatment Therapy?

Since the treatment of substance use disorders is considered to be essential care under the Affordable Care Act, everyone who has an Ambetter healthcare insurance plan can expect some degree of coverage for these services.9,10 The specifics of your coverage depend on your plan. You can check the details of your coverage, deductible, and co-pay by getting in touch with Ambetter.10

Does Ambetter Insurance Cover Medication-Assisted Treatment?

Yes, Ambetter plans cover a wide range of mental health and substance use services, which may include coverage for medication-assisted treatment (MAT).9 This type of treatment combines medication with behavioral therapies to aid recovery. Depending on the specifics of their plans, members can expect a varying degree of coverage.9

Does Ambetter Insurance Cover Suboxone Treatment?

If suboxone (buprenorphine) is prescribed by a certified rehab facility and as a part of a tailored, medically necessary treatment plan, your Ambetter plan will likely cover it at least in part.10

Does Ambetter Insurance Cover Sober Living?

Depending on the details of your Ambetter plan, sober living may be covered. You can contact Ambetter to confirm that your coverage meets your needs for transitional housing.11

What Should I Do if Ambetter Won’t Cover the Total Cost of Rehab?

Even if Ambetter doesn’t cover the entire cost of treatment, this should not deter you from seeking support as there may still be other available options. Many rehab centers provide payment plans that can help patients cover their treatment expenses.12 For example, they may offer sliding scale payment or another form of financial aid.12

What Should I Do if My Ambetter Insurance Doesn’t Cover the Full Cost of Treatment?

Ambetter may cover all or part of your rehab costs, depending on the specific plan you have and the level of coverage it provides. If your policy does not cover the full cost of your individually tailored recovery program, you may have to pay additional costs yourself.14
If this turns out to be the case, you should look into potential financial aid options, or subsidies, that usually depend on your income and household size. Substance abuse facilities generally offer various payment plan options, like installments or sliding scale fees. The best way to get accurate information about what your options are is to contact your chosen substance abuse treatment facility and ask about available payment arrangements.15

Does Ambetter Insurance Cover Drug and Alcohol Detox?

All marketplace healthcare plans, including Ambetter’s, are required to comply with Affordable Care Act provisions. This means that they must provide coverage for behavioral health services as one of the essential health benefits and this includes substance abuse disorders.1 SUD treatment, whether the substance of abuse is alcohol or various types of illicit or prescription drugs, usually starts with medically monitored detoxification.16
Detoxification can last for a few days, up to a week, depending on the severity of the addiction, and it sometimes includes the use of pharmacotherapy to ease unpleasant, dangerous, and sometimes even life-threatening symptoms of withdrawal.16 As a medically necessary part of substance abuse treatment, detox, including the use of FDA-approved drugs, must be covered by all healthcare plans, including Ambetter’s.17

Does Ambetter Cover Mental Health Therapies?

Mental health disorders frequently co-occur with substance abuse disorders and that’s why getting treatment for alcohol or drug abuse includes dual diagnosis evaluation by a team of addiction and mental health specialists. Best practice guidelines for effective substance abuse treatment require simultaneous treatment of all present conditions. It’s often quite difficult to determine whether one’s substance abuse issues developed because of underlying mental health issues or if drug and/or alcohol use triggered the development of a certain mental health disorder.16
In any case, both (or several) conditions must be addressed simultaneously to achieve lasting sobriety and reduce the risk of relapse. All medically necessary treatment is covered by Ambetter health insurance plans, and all diagnosed conditions are treated concurrently in psychotherapy and counseling sessions. Mental health and behavioral therapy are an indispensable part of substance abuse treatment and are therefore covered by all healthcare plans if determined to be medically necessary.17

1. Ambetter.(2021). About Us.
2. Ambetter.(2021). Find Ambetter coverage in your state.
3. Ambetter.(2021). About our plans.
4. National Institute on Drug Abuse. (2019). Treatment Approaches for Drug Addiction DrugFacts.
5. National Institute on Drug Abuse. (2018). Comorbidity: Substance Use Disorders and Other Mental Illnesses.
6. gov. (n.d.). Mental health & substance abuse coverage.
7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition) Principles of Effective Treatment.
8. Ambetter.(2021). Your Better Health Center.
9. The Office of National Drug Control Policy. Substance Abuse and the Affordable Care Act.
10. Substance Abuse and Mental Health Services Administration. (2021). Buprenorphine.
11. Ambetter. Contact Us.
12. National Academy of Sciences. (2004). New Treatments for Addiction: Behavioral, Ethical, Legal, and Social Questions. 3 Treatment, Financing, and Costs. Washington (DC): National Academies Press (US).
13. Ambetter. (2022). Your Better Health Center.
14. Ambetter. (2018). Clinical Policy: Medical Necessity Criteria.
15. FindTreatment.gov. (2019). Paying for Treatment: Understanding the Cost of Treatment.
16. Substance Abuse and Mental Health Services Administration. (2015). TIP 45: Detoxification and Substance Abuse Treatment.
17. U.S. Department of Health & Human Services. (2022). About the Affordable Care Act.