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Ambetter Insurance Coverage for Opioid Addiction Rehab Programs

On this page, you will learn about Ambetter health insurance coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
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Ambetter Coverage FOR Opioid REHAB PROGRAMS

Provider Overview

Does Ambetter Cover Opioid Rehab?

Entering opioid rehab can be a life-saving step for many individuals who have been struggling with a chronic, relapsing addiction to illicit or prescription opioids. Admission to an inpatient treatment program can be especially effective at preventing overdose which can have a fatal or near-fatal outcome. These programs offer highly structured high-intensity care which begin with medically supervised, medication-assisted detoxification.1

The process of detoxification enables recovering individuals to stabilize and begin rehabilitation. The program often entails treatment of co-occurring mental health disorders. Other programs may not be comprehensive enough in order to address opioid addiction adequately.1 

However, this form of treatment can be expensive and many individuals cannot afford to enter the program without some form of financial support, even if they are ready to seek help.2

Individuals struggling with addiction or who have a loved one in that situation are often also struggling to find treatment-related insurance coverage information. Concerns over the financial aspect of things makes it more difficult to find an appropriate treatment program.3

 

This is why insured treatment-seeking individuals typically look for in-network facilities, that is, treatment centers and programs which are in-network with their health insurance providers, making treatment more affordable.2

Ambetter provides affordable plans for quality health coverage in 26 states. Ambetter insurance coverage will apply to at least a portion of opioid rehab or another form of substance abuse treatment for the insured. The coverage depends on the plan, with some plans providing full, and others partial coverage.5

What Does Ambetter Insurance Cover for Opioid Treatment?

Ambetter coverage for opioid rehab typically includes all the necessary services:4 

  • Screenings, interventions
  • Detox
  • Inpatient
  • Outpatient
  • Behavioral therapies
  • Treatment for co-occurring disorders

Many opioid rehab centers nationwide are in-network with Ambetter and other leading insurance providers.2

What Ambetter Does Not Cover for Opioid Treatment?

Elements of opioid treatment that are not covered by insurance may include:2

  • Non-medical amenities
  • Holistic care services
  • Recreation programs
  • Food delivery
  • Private treatment services
  • Alternative therapies 

How Much Does Opioid Rehab Cost?

When it comes to opioid rehab, there is no one size fits all solution. Rehab cost depends on a variety of factors, starting with the unique situation a treatment-seeking individual is in.1

The contributing factors affecting the cost of opioid rehab may include:2

  • Services offered
  • Intensity of services
  • Duration of treatment
  • Amenities

For many individuals, paying for treatment seems like an insurmountable challenge, but insurance coverage can make treatment at in-network facilities much more affordable.2 

Cost of Inpatient Opioid Rehab

The average cost of inpatient opioid rehab is higher than the cost of outpatient opioid rehab, but these programs are also likely to be more effective than programs implemented in outpatient settings.1

Cost of Outpatient Opioid Rehab

The average cost of outpatient opioid rehab is $100–$500 per session.  Program specifics such as the frequency of sessions depend on the person’s progress.1 An intensive outpatient program with housing, which is considered to be as effective as inpatient rehab, comes with a somewhat higher price tag: $3,500–$5,000 on a weekly basis. 

Cost of Opioid Partial Hospitalization Programs (PHP)

The average cost of opioid PHPs depends on the duration of the program. Unlike detox, these programs provide day care but without actual hospitalization.1 For more information whether your Ambetter insurance coverage will include all the expenses or just a portion, it’s best to contact the Ambetter hotline directly or consult with a specialized treatment provider. 

Cost of Medication-Assisted Treatment (MAT)

MAT gives recovering individuals a safe way to overcome the notorious opioid withdrawal syndrome without relapsing.6 The average cost of MAT depends on the duration and complexity of the patient’s condition.2

Opioid Rehab vs. the Cost of Opioid Addiction

The cost of maintaining addiction to opioids can be high, and not only in the financial sense. Excessive use of opioids can lead to life-threatening or even fatal outcomes. Opioids have a powerful effect on those who use them, both during intoxication and during withdrawal.1

Additionally, it is not necessary to pay for the full cost of opioid rehab out of pocket, as most private rehab centers also accept insurance from all the major providers in the country.2

In the long term, rehab costs considerably less than continuing drug-seeking and use, especially considering factors like the cost of substance abuse, the cost of lost income, and the cost of health problems and complications which arise from excessive drug use.2

Opioid abuse takes a toll on a person’s health and life, and it can even have a life-threatening or fatal effect in the event of an overdose. An overdose can easily happen whether prescription opioid abuse is concerned or abuse of illicit opioids such as heroin and its potentially dangerous additives such as fentanyl.1

What Length of Opioid Rehab Does Ambetter Cover?

Longer treatment times are generally considered to be the most effective, as longer treatment duration often correlates positively with beneficial long-term treatment outcomes. However, each person’s individual needs are a little different and they also change over time.1

Because there are many different types of policies and tiers of coverage, the length of your Ambetter coverage for opioid addiction treatment will depend on your specific plan.2 You can easily look up your plan information on your insurance card or by contacting your insurance company.

Choosing Between Ambetter Inpatient vs. Outpatient Opioid Rehab Centers

In many cases, inpatient opioid rehab offers a higher intensity of care than treating opioid addiction in an outpatient setting. This structured form of care has a higher success rate than its outpatient counterparts, especially when it comes to long-term inpatient treatment.1

Treatment-seeking individuals undergo an assessment that helps determine the level of care that would best meet their needs.1

Treatment-seeking individuals often choose inpatient over outpatient opioid rehab because these programs have considerable advantages which affect treatment outcomes favorably, including but not limited to:1

  • Quality of care
  • Treatment ecosystem
  • Support group
  • More focused environment
  • Accountability

How to Use Ambetter Insurance for Opioid Rehab?

After checking the coverage provided by Ambetter Insurance, the insured can proceed to take advantage of their Ambetter policy benefits. The process is simple and straightforward:2

  • Consultation with a doctor
  • Finding a suitable rehab program
  • Verifying insurance coverage
  • Working with rehab center to determine coverage

Many private rehab centers are flexible in terms of the payment options they accept in the event a portion of the costs may need to be paid out of pocket.2 Rehab center hotlines can provide information on treatment costs, payment options, and insurance providers in their Ambetter network.

How to Find Opioid Rehabs That Accept Ambetter Insurance

There are two ways to find an appropriate in-network treatment program: to call the Ambetter hotline and inquire about in-network programs and facilities, or to contact a preferred treatment center and ask whether they are in network with Ambetter. Many people first look for the nearest rehab facility, but location is not always an essential factor to consider, especially when it comes to opioid rehab in an inpatient or residential setting.

With locations conveniently scattered across the country, American Addiction Centers can verify the insurance coverage for you or a loved one. AAC helpline representatives are available to respond to callers’ questions, help them develop a better understanding of the treatment process, as well as walk them through the intake procedure.

Prior to admission, treatment-seeking individuals can consult a doctor to receive recommendations regarding the course of treatment and opioid rehab options. In the event a person is diagnosed with a co-occurring disorder, the treatment outcome is likely to be better if the treatment program has the capabilities to address both aspects of the dual diagnosis upon admission.1

A simple, confidential call to a helpline can be the beginning of a positive, lasting change. Heroin rehab hotline support representatives can provide up-to-date information to interested parties. Some treatment centers even have the resources to cater to the specific needs of treatment-seeking individuals, such as offering rehabilitation for couples

Every year, many people go into rehab every year financed through Ambetter, and AAC, which is in the network of this insurance provider, operates the leading treatment centers nationwide. AAC provides recovering individuals with a full continuum of care. 

How to Read Your Insurance Provider Card
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  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
Sources
  1. National Institute on Drug Abuse. (2012). Principles of Drug Addiction Treatment: A Research-Based Guide, Third Edition.
  2. FindGovernment.gov. (2019). Paying for Treatment.
  3. Substance Abuse and Mental Health Services Administration. (2022). Do you have health insurance? 
  4. FindGovernment.gov. (2019). Treatment options
  5. AmbetterHealth. (2022). Ambetter
  6. Substance Abuse and Mental Health Services Administration. (2022). Medication-Assisted Treatment (MAT).
  7. AmbetterHealth. (2022). Becoming Medicare Eligible? Stay with the health plan you trust.

Check Your Policy Coverage

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Frequently asked questions

How Long Is Ambetter-Covered Inpatient Opioid Rehab?
The duration of inpatient opioid rehab depends mainly on the progress a person has made. For many individuals, it’s vital to stay in treatment for an adequate period of time, but also to begin treatment as soon as possible. Some individuals may also benefit from same-day admission, especially if they are in urgent need of care and facing a real risk of relapse and overdose.1
What Is Ambetter-Covered Opioid Rehab Like?
Whether funded through public assistance, paid via insurance or out of pocket, opioid rehab normally takes place in two stages: strictly supervised detoxification and withdrawal which can last up to 10 days, and rehabilitation which can last considerably longer.1
Does Ambetter Cover Luxury Opioid Rehab?
Ambetter may cover a portion of the costs of staying in a luxury opioid rehab facility. Since these rehab facilities are typically more expensive due to the higher standard of care, comfort, and privacy they provide, insurance is not likely to cover the full price of the program. Coverage depends mainly on the individual health care plan.5
Does Insurance-Covered Opioid Rehab Work for Opioid Use Disorder?
Opioid rehab implemented in accordance with the principles of effective treatment can be effective at addressing the needs of individuals battling an opioid use disorder.1
Does Ambetter Cover Opioid Rehab for Women/Mothers?
There are specialized treatment programs which cater to the specific needs of individuals within a certain vulnerable group, and this includes women and mothers. If available through in-network programs, they may be covered by Ambetter insurance plans.5
Does Ambetter Cover Christian Opioid Addiction Rehab?
Ambetter may also cover Christian opioid addiction rehab programs or other faith-based programs, although these programs may also receive funding from other sources, making them available to the uninsured.2
Does Ambetter Cover Executive Opioid Rehab?
Ambetter insurance may cover the costs of rehab partially or in full, depending on the coverage provided by the plan. The plan may cover a portion of the cost of an executive opioid rehab program.5
Does Ambetter Medicare Plans Cover Opioid Rehab?
Ambetter is owned by Centene, which serves Medicaid and Medicare members. Ambetter Medicare plans do provide coverage for opioid rehab programs, although there may also be out-of-pocket costs. The duration and level of care provided, as well as the access to various services and amenities within a treatment program are some of the factors which determine the cost of rehab.7

Guides for other health insurance providers

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