PA Health & Wellness (Ambetter) Insurance Coverage for Rehab
PA Health & Wellness (Ambetter) Covered Alcohol and Drug Rehab Centers in Pennsylvania
Pennsylvania residents looking for drug and alcohol rehab centers that accept PA Health & Wellness (Ambetter) can benefit from its Community HealthChoices program.1For participants It is available for Pennsylvania residents aged 21 or older who have both Medicare and Medicaid.1For participants
The program focuses on helping Pennsylvanians receive long-term support by coordinating long-term healthcare coverage to improve the quality of the healthcare experience.1 Currently, PA Health & Wellness (Ambetter) provides long-term behavioral health services and can assist members in finding providers, local resources, planning appointments, and scheduling transportation services.2For participants
When seeking treatment for substance abuse, it’s essential to understand your insurance coverage for services such as inpatient and outpatient rehab. Learning about the expenses you will be responsible for and what will be covered by your PA Health & Wellness (Ambetter) policy can help you plan ahead.2 It can also help prevent unexpected expenses that can hinder your sobriety once you leave treatment.
The best way to start is by calling the number on the back of the insurance card. A customer service representative can answer frequently asked questions. They can explain the details of your policy and explain the types of services covered by your plan.
In addition, rehab centers can also verify insurance coverage. Call us at to speak with an admissions navigator and verify your insurance coverage over the phone.
Currently, there are at least 8 in-network providers offering substance abuse and rehabilitation services in the Pennsylvania area.4
What Is PA Health & Wellness (Ambetter)?
PA Health & Wellness (Ambetter) provides quality Medicaid and health insurance plans to Pennsylvania residents.1
Established to provide high-quality healthcare services in the Pennsylvania area, PA Health & Wellness offers local, regional, and community-based resources.5 A subsidiary of Centene Corporation (Centene) promotes coordinated and compassionate care.6 Centene is a multinational healthcare enterprise providing government-sponsored programs.6
PA Health & Wellness focuses on local healthcare options with additional benefits such as dedicated support, ongoing education, informative reports, and minimal referral requirements.6
Roughly 33% of counties in Pennsylvania have coverage through PA Health & Wellness (Ambetter).7 Counties with coverage include:7
- Bradford.
- Bucks.
- Carbon.
- Chester.
- Columbia.
- Delaware.
- Lackawanna.
- Lancaster.
- Lehigh.
- Luzerne.
- Monroe.
- Montgomery.
- Northhampton.
- Philadelphia.
- Schuylkill.
- Sullivan.
- Susquehanna.
- Wayne.
- Wyoming.
What Substance Addiction Does PA Health & Wellness (Ambetter) Cover?
Your insurance plan may cover behavioral health services, including treating addiction to various substances, such as:8
- Alcohol.
- Marijuana.
- Heroin.
- Opioids.
- Methamphetamines.
- Prescription drugs.
Call the number on the back of the insurance card to learn more about the addiction treatments covered by your policy. You can also call our Helpline Information number at to speak with an admissions navigator. They’ll help verify your insurance coverage and answer any questions you might have about treatment.
What Does PA Health & Wellness (Ambetter) Insurance Cover in Addiction Treatment?
All the health plans offered on PA Health & Wellness (Ambetter) include specific items or services, also known as essential health benefits (EHBs).3 Policyholders are covered by essential medical care and wellness services, including mental health and substance abuse care.3Our health plans
There are various types of addiction treatment available. The kind of treatment you receive depends on your specific needs. Before choosing a treatment program, an addiction specialist may recommend the best course of treatment based on the types of substances abused and how long you have been using them.
Common types of addiction treatment that may be covered by the PA Health & Wellness (Ambetter) plan include:8
- Inpatient detoxification treatments. Medication-assisted detox is the process of withdrawing from drugs or alcohol. Usually, this is the first step in addiction treatment and involves using prescription medications under medical supervision to minimize the effects of withdrawal symptoms to help patients comfortably detox from substances.
- Inpatient/residential treatment programs. Inpatient rehab requires people to live at the facility. Throughout treatment, patients receive individual and group therapy to help them learn about the root of addiction and start implementing healthy coping mechanisms that support long-lasting recovery and sobriety.
- Partial hospitalization programs (PHP). PHPs have a similar structure to inpatient rehab programs, but patients are allowed to live at home or in sober living facilities throughout treatment. Patients are expected to attend the facility at least 5 times a week for approximately 4–6 hours per day.
- Outpatient Treatment. Outpatient rehab is a more flexible type of program. Patients can live at home or in a sober living facility while attending treatment. They are expected to visit the treatment center for approximately 10–12 hours per week.
- Intensive outpatient programs (IOP). IOPs are more intensive than the typical outpatient programs. While patients are still allowed to live at home or in a sober living facility, they must attend treatment at least 4–6 days a week for approximately 3–4 hours each day.
Does PA Health & Wellness (Ambetter) Cover Mental Health & Co-Occurring Disorder Treatment?
Yes, PA Health & Wellness (Ambetter) provides mental health and co-occurring disorder treatment coverage.8 The level of coverage will vary depending on the specific plan you have.
For co-occurring disorder treatments, your plan may cover the following services:8
- Residential treatment for mental health and substance abuse.
- Outpatient evaluation and assessment for mental health and substance use.
- Integrated care management for behavioral health and substance use.
Expenses for these services are covered when medically necessary and may be subject to authorization. Still, the Affordable Care Act (ACA) lists substance use disorders as one of the 10 essential benefits.9 Therefore, anyone with private insurance should receive at least partial coverage for addiction treatment services. In addition, the Mental Health Parity and Addiction Equity Act (MHPAEA) requires health insurance providers to include benefits for mental health treatments in the same way coverage is provided for medical care.10 Both co-occurring disorder treatment and stand-alone drug rehab programs fall under this mandate.
Nearly half of individuals with a substance use disorder have a co-occurring mental health condition, such as depression, anxiety, or post-traumatic stress disorder (PTSD).11 In addiction treatment, this is referred to as a “dual diagnosis.”11
It’s recommended to treat substance use and mental health disorders together rather than separately.11 Many facilities provide comprehensive treatment that incorporates behavioral therapies for treating individuals with a dual diagnosis.11 Furthermore, research suggests supplementing behavioral therapies with medications to help lessen the symptoms of mental health disorders may help support long-lasting recovery.11
As a PA Health & Wellness (Ambetter) member, you can rest assured that your insurance plan will at the very least provide partial coverage for any co-occurring disorders, including a dual diagnosis involving mental health and addiction.8
How Long Does PA Health & Wellness (Ambetter) Cover Inpatient Alcohol and Drug Rehab Programs?
According to the National Institute on Drug Abuse, remaining in treatment for at least 3 months will significantly provide the best outcomes.12 Your PA Health & Wellness (Ambetter) insurance coverage depends on your insurance. Check your Schedule of Benefits file to plan. It’s important to understand these details before entering a rehab program.8
To learn more about how long your PA Health Wellness (Ambetter) policy will provide coverage, call the number on the back of your insurance card to learn about out-of-pocket expenses you may incur.
Another option is to call our helpline for information at to verify your insurance information and understand the coverage schedule.
What If My PA Health & Wellness Program (Ambetter) Policy Does Not Cover an Inpatient Drug Rehab Program?
Depending on your plan, your PA Health & Wellness Program (Ambetter) insurance may not cover all inpatient drug rehab program costs.8 Starting addiction treatment soon is more important than your out-of-pocket expenses and should not be the reason for avoiding treatment altogether.
Many rehab facilities offer payment plans and financing options to help you afford treatment without insurance. Some government programs also provide grants and scholarships for those who demonstrate financial need.
There are financing options available to achieve long-lasting sobriety.
PA Health & Wellness (Ambetter) In-Network vs. Out-of-Network Inpatient Rehab Centers
A provider network is a list of doctors, healthcare providers, hospitals, and facilities that a plan contracts to provide medical care to its members.13 These providers are called in-network providers because they often have agreements to offer discounted rates for their services.13 A provider that isn’t contracted by that plan is called an out-of-network provider.13
When looking at the different treatment facilities in Pennsylvania, it’s best to choose facilities that are in-network with PA Health & Wellness (Ambetter). In-network providers have an agreement with PA Health & Wellness (Ambetter) to provide treatment services at a discounted rate.13
For the network year 2022, there are at least 8 in-network providers offering substance abuse and rehabilitation services in Pennsylvania.4
Before agreeing on a program, call the rehab center you’re considering to ensure they’re in-network with PA Health & Wellness (Ambetter). For a complete list of in-network facilities, you can call the number on the back of your insurance card.
How Can I Check My PA Health & Wellness (Ambetter) Coverage for Inpatient Drug Rehab Centers in Pennsylvania?
Checking your insurance coverage is easy. You can call the number on the back of your insurance card to learn more about your benefits. Or, to learn more about specific coverage regarding inpatient drug rehab centers in Pennsylvania, contact American Addiction Centers at to speak with an admissions navigator.
Finding the right addiction treatment facility can be an overwhelming experience. American Addiction Centers has leading treatment centers in Pennsylvania to help you receive the treatment you need close to home. Our quality rehab programs provide evidence-based and individualized care for those ready to seek treatment. Use our Find Treatment Centers tool to search for a rehab facility in Pennsylvania that accepts PA Health & Wellness (Ambetter).