Peach State Health Plan Georgia (Ambetter) provides insurance coverage via the Health Insurance Marketplace to residents of most counties in Georgia. As required by the Affordable Care Act, all plans available on the Health Insurance Marketplace provide coverage for substance abuse services and treatment. The exact coverage provided and details of treatments covered are specific to each patient’s case and plan, but if you have coverage through Peach State Health Plan Georgia (Ambetter), you have at least some form of coverage for drug treatment.¹

Your plan will also determine the kinds of rehab centers or treatment facilities from which you can receive covered care. If you or a loved one are interested in a specific treatment center, representatives from that facility can check your coverage if you provide them with your insurance information over the phone or in person. You can also call the number on the back of your Peach State Health Plan Georgia (Ambetter) insurance information card. A representative from the insurance company will be able to give you more specific information about your plan and coverage.

What Is Peach State Health Plan Georgia (Ambetter)?

Ambetter is a health insurance company that has been working with states and local communities since 2014 to develop insurance coverage plans available through the Health Insurance Marketplace best suited for the community the plan is developed for. Ambetter currently serves more than 2 million members across 26 states.^2-3

Peach State Health Plan Georgia (Ambetter) has plans from Ambetter developed for those living in one of the 149 counties in Georgia. There are 5 types of plans available to those with Peach State Health Plan Georgia (Ambetter):⁴

Ambetter Essential Care: Essential Care plans cover the essentials of policyholders’ healthcare needs. These plans have the lowest monthly premiums. However, you should expect to pay more out of pocket for services that aren’t considered essential.
Ambetter Balanced Care: Named by Ambetter as the “best value” of all its plans, Balanced Care plans provide a balance of costs between your monthly premiums and out-of-pocket payments. While it covers more than just the essentials, expect some out-of-pocket costs for certain non-essential healthcare services.
Ambetter Secure Care: Secure Care plans may have the highest monthly premium payments, but your out-of-pocket costs will remain minimal as these plans cover the most healthcare services of all of the plans.
Ambetter Select Plus Plans: Select Plus Plans offer low monthly premiums while also covering healthcare services provided by the Piedmont Healthcare system. Available in Gold and Silver plan levels, Select Plus Plans are only available to those living in 8 select counties in Georgia.⁵
Ambetter Select Wellstar Plans: Similar to Select Plus Plans, Select Wellstar Plans offer low monthly premium payments but also cover healthcare services provided by the Wellstar Health System. Wellstar Plans are offered in Gold and Silver plan levels and are only available to residents of 5 specific counties in Georgia.⁶

All of these plans provide at least some coverage for substance abuse treatment. There are an estimated 8 rehab centers in Georgia that accept Peach State Health Plan Georgia (Ambetter),⁷ so those covered by any of these policies can receive treatment in their state of residence.

What Substance Addiction Does Peach State Health Plan Georgia (Ambetter) Cover?

Because Peach State Health Plan Georgia (Ambetter) provides coverage for substance abuse treatment, treatment for abuse of many different substances may be covered by your plan. Your plan may provide treatment coverage for commonly abused substances such as alcohol, cocaine, heroin, crystal meth, opioids, marijuana, or prescription drugs. Check with the treatment facility you’re interested in to make sure they are not only covered by your insurance plan but also provide treatment for abuse of the substance you or a loved one are struggling with.

What Does Peach State Health Plan Georgia (Ambetter) Insurance Cover In Addiction Treatment?

There are many types of substance abuse treatment that may be suitable for you or your loved one, and your Peach State Health Plan Georgia (Ambetter) insurance policy may cover some or all of several types of treatment.

Inpatient/residential rehab: Inpatient rehab is a common treatment choice for those struggling with more severe cases of addiction. Patients live full-time at their treatment facility for the duration of their treatment and participate in daily therapeutic activities as well as group and/or individual therapy sessions.
Outpatient rehab/therapy: Outpatient rehab is normally a more affordable form of treatment and usually best suited for those with less severe addictions. Patients attend treatment sessions at their chosen facility at a set frequency and for the duration that their doctor deems appropriate but can continue living at home.
Intensive outpatient programs (IOP): Intensive outpatient programs are a type of outpatient program that provide higher-intensity treatment for those struggling with severe addictions but who don’t have the schedule flexibility needed to attend an inpatient program. IOPs provide treatment comparable to that of an inpatient program while allowing the patient to reside at home.
Partial hospitalization programs (PHP): Partial hospitalization programs are another form of outpatient rehab that take place in a hospital setting. They are similar in intensity to an inpatient program but allow patients to return home after treatment sessions. The differentiating aspect of PHPs is the amount of time required to be spent in treatment. These programs often require around 20 hours and at least 5 days each week spent in treatment.

The type of treatment options covered by your Peach State Health Plan Georgia (Ambetter) insurance will be specific to your plan. However, the most important thing to consider when choosing your treatment method or plan is which one will be best for your type of substance abuse and the severity of your addiction. Getting the right help is imperative.

Does Peach State Health Plan Georgia (Ambetter) Cover Mental Health & Co-Occurring Disorder Treatment?

It is common for those struggling with substance abuse or addiction to also be struggling with a mental health disorder. When both conditions occur in a patient at the same time, it’s called a co-occurring disorder.⁸ The 2020 National Survey on Drug Use and Health found that an estimated 17 million adults in the U.S. struggled with a co-occurring disorder that year.⁹

Because co-occurring disorders are so common in substance abuse patients, the National Institute of Mental Health recommends that substance abuse patients also be evaluated by a medical professional for any possible co-occurring mental health disorders. It’s best to treat both disorders at the same time, and treatment should be tailored to a patient’s specific combination of abused substance and mental health disorder.¹⁰ If you are seeking help for substance abuse disorder, it is important that you also be evaluated for any possible co-occurring disorders so that your doctors and treatment team can make the best treatment plan for you.

Not only does the Affordable Care Act require all Marketplace plans to offer coverage for substance abuse treatment, but it also requires that mental health care and treatment be covered in some way as well. This means that your Peach State Health Plan Georgia (Ambetter) plan covers both co-occurring disorder treatment and standalone drug rehab.¹¹ The types of treatment and length will vary based on your plan, facility, and case, but your plan will provide at least some level of coverage for mental health treatment as well as substance abuse treatment.

How Long Does Peach State Health Plan Georgia (Ambetter) Cover Inpatient Alcohol and Drug Rehab Programs?

When considering a substance abuse rehab program or treatment plan, an important piece is the length of your program or stay in a rehab facility. Positive treatment outcomes are dependent upon the patient staying in rehab for an adequate length of time. For lasting positive outcomes, programs longer than 90 days are best, as those shorter than 90 days have proven to be less effective.¹²

The length of stay a patient needs is highly specific to their case and the severity of their addiction. Because there are many different types of policies and tiers of coverage to each Peach State Health Plan Georgia (Ambetter) plan, the length of time covered by the insurance provider will depend upon your specific plan. For information on the length of stay your plan covers for different types of rehabs, call the number on the back of your insurance information card and a representative from the insurance company can talk you through exactly what your plan covers.

What If My Peach State Health Plan Georgia (Ambetter) Policy Does Not Cover an Inpatient Drug Rehab Program?

If your Peach State Health Plan Georgia (Ambetter) policy doesn’t cover an inpatient drug rehab program, you are not out of options. In addition to outpatient rehab options, you may also have access to financing or scholarship options depending on the inpatient rehab center you’re interested in.

To learn more, you can call the rehab center directly to speak with a representative about what scholarship or financing options might be available to you at that specific facility.

If you or a loved one are facing financing issues but ready to seek help, don’t let these hurdles keep you from finding treatment. It’s critical that treatment is started as soon as possible so that addiction can’t claim any more of your life, time, or relationships. Reach out about your options today so that your treatment can begin as soon as possible.

Peach State Health Plan Georgia (Ambetter) In-Network vs. Out-of-Network Inpatient Drug Rehab Centers

All insurance providers have a network of clinicians and facilities from which they cover treatment for their policyholders. Doctors and facilities within this covered group are considered “in-network” for policyholders. Those that are not within this covered group are considered “out-of-network.” Peach State Health Plan Georgia (Ambetter) has its own group of in-network providers and facilities that policyholders can choose from to receive covered care.

When choosing a drug rehab center or provider, you’ll have fewer out-of-pocket costs if you choose one that is considered in-network with your Peach State Health Plan Georgia (Ambetter) policy. While you can still receive treatment from facilities and providers that are considered out-of-network, you will likely have to pay fully out-of-pocket for the care you receive. Choosing an in-network facility will ensure you can take advantage of the coverage that your insurance plan provides.

To check if a treatment provider is in-network with your insurance plan, you can call the facility or provider directly and provide them with your insurance information over the phone. You can also call the number on the back of your insurance information card and speak to a representative from your insurance company or log in to your Peach State Health Plan Georgia (Ambetter) account at ambetter.pshpgeorgia.com.

What Rehab Centers Take Ambetter Insurance?

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.

How Can I Check My Peach State Health Plan (Ambetter) Coverage for Inpatient Drug Rehab Centers in Georgia?

There are several ways you can check your Peach State Health Plan (Ambetter) policy coverage for drug rehab centers in Georgia. The first is calling the number on the back of your insurance information card and speaking with a representative from the insurance company or logging into your account at ambetter.pshpgeorgia.com. You can explore your coverage as well as facilities near you that might be a good fit with your plan.

Peach State Health Plan Georgia (Ambetter) Rehab Centers in Georgia