Does AmeriHealth Insurance Cover Alcohol and Drug Rehab?
If you are seeking help for a drug or alcohol addiction and AmeriHealth is your insurance provider, at least part of your addiction treatment should be covered by your AmeriHealth plan. The Affordable Care Act (ACA) states that treatment for substance use disorders (SUDs) is an essential health benefit, and all insurance providers must provide some coverage for treatment, including rehab.1 Exactly how much of your treatment will be covered by insurance depends on the particular AmeriHealth plan you have, the program you attend, and the specific services you receive.
Rehab centers can check your coverage over the phone when you call and speak with an admissions navigator. Or you can call the number on the back of your insurance card to speak with a customer service representative who can provide more information about what your insurance plan covers in regards to drug and alcohol addiction treatments and rehab.
This article provides information about AmeriHealth coverage for addiction treatment, what types of treatments are available, and how to get your insurance plan to cover the costs of rehab.
Check AmeriHealth Insurance Coverage for Addiction Treatment
As an AmeriHealth member, at least some of the costs of your addiction treatment will be covered by your insurance plan.2 AmeriHealth’s behavioral health services include drug and alcohol services and mental health services. In some cases, you may choose your own provider for any behavioral health services, but your primary care physician may also request your access to these services.2
To learn more about what your AmeriHealth insurance plan covers for addiction treatment, call the number on the back of your insurance card to ask for details about what is covered. Or call us at to speak with an admissions navigator, who will verify your insurance for you while you are on the phone and help you get started on the admissions process.
Alternatively, you can complete the form below with your contact and insurance information. We’ll email you within minutes with details of what your insurance plan covers for addiction treatment.
What Is AmeriHealth?
Founded in 1983 in Philadelphia, AmeriHealth is now one of the largest Medicaid-managed care organizations in the United States.3 AmeriHealth serves over 5 million members in 12 states and the District of Columbia.3 Their managed healthcare plans include Medicare, Medicaid, behavioral health, long-term services and supports, and pharmacy benefit management services.3 AmeriHealth prides themselves on treating the whole person rather than just the issue, and its philosophy is “to help people get care, stay well, and build healthy communities.”3
PerformCare is AmeriHealth’s behavioral health care organization.4 Founded in 1995, PerformCare helps health plans and customers provide comprehensive behavioral health management strategies to help people get the care they need when they need it.4
What Will AmeriHealth Insurance Cover?
AmeriHealth plans will cover at least some of the costs of most addiction treatments. The types of treatments vary in intensity, frequency, and duration, and the treatment you access depends on your specific needs. Types of addiction treatment that may be covered by AmeriHealth include:5
- Medical detox. Under 24/7 medical supervision, medical detox helps you safely and comfortably withdraw from drugs and alcohol. You may be prescribed medication to help reduce withdrawal symptoms.
- Inpatient or residential rehab. This type of treatment involves living at the treatment facility for a certain number of days/weeks/months. You will be in a supportive environment where you will access counseling (individual and group) to help support your recovery both in the present and long term.
- Partial hospitalization program (PHP). PHP programs allow you to live at home while accessing treatment at a facility during daytime hours. PHP is often referred to as “day treatment.”
- Intensive outpatient program (IOP). In an IOP program, you will attend treatment approximately three evenings per week. You can live at home and attend to work and family responsibilities during the day.
- Outpatient rehab. Outpatient programs vary — some require you to attend treatment in the daytime hours, others hold evening hours. You will receive individual and group therapy in an outpatient program, and some programs may allow you to attend work and/or school during daytime hours. These programs are best for individuals who have social supports at home and are in a safe environment that does not threaten their sobriety and recovery.
Does AmeriHealth Insurance Cover Mental Health Care?
Yes, AmeriHealth does provide coverage for mental health care. Under the Affordable Care Act (ACA), insurance providers are required to provide coverage for mental health care and treatment.1 Both co-occurring disorder treatment and stand-alone drug and alcohol rehab fall under this mandate.1
Both mental health services and drug and alcohol services fall under the umbrella of “behavioral health” for AmeriHealth members.6 These services are available to members through their behavioral health managed care organization, which is based on the county in which a person lives.
Your primary care physician can also help you find treatment. Your PCP, AmeriHealth, and the facility you receive addiction treatment from will work together to help you get the services you need in order to get sober and stay in recovery long-term.
How Long Does AmeriHealth Insurance Cover Rehab?
How long your rehab stay is covered by AmeriHealth insurance depends on both your treatment needs and the specific insurance plan you have. Know that at least part of your treatment costs will be covered by your AmeriHealth plan. While research shows that longer treatment times (3+ months) typically result in better outcomes (e.g., long-term sobriety), the amount of time you spend in rehab will depend on several factors, including the substances you use, how long you’ve been using, and whether or not you have other co-occurring disorders.7, point 5 No matter how long you stay in rehab, know that you have at least partial coverage with your AmeriHealth insurance plan.
Call the number on the back of your insurance card to learn more about how your AmeriHealth insurance coverage will help and determine how long your treatment will be covered. Be sure to ask about your out-of-pocket expenses, such as deductibles and copays that you are responsible for paying on your own.
For assistance, call our helpline at . Our staff at American Addiction Centers can verify your insurance for you, help you understand what treatments are covered by insurance, answer your questions, and help you navigate the admissions process.
What If My AmeriHealth Policy Does Not Cover Rehab?
Depending on the plan you have, your AmeriHealth insurance may not cover all of your rehab expenses. However, it is important not to let finances be a barrier to accessing the treatment that could save your life.
Many rehab facilities offer payment plans, so you can pay back your out-of-pocket costs over time. Other facilities offer scholarships and grants to those who are in financial need. Some states also offer grants to low-income individuals who need financial assistance to access treatment.
Making the choice to attend rehab for drug or alcohol addiction is one of the most important things you can do. There is help available — both in treatment and to help cover the financial costs — so you can focus on what truly matters: your treatment, sobriety, and long-term recovery.
AmeriHealth In Network vs. Out-of-Network Rehab Centers
If a rehab center is in-network with AmeriHealth, it means that facility has an agreement with the insurance provider to offer treatment at a discounted rate to its members. Out-of-network facilities do not have such an agreement, and therefore, the cost of treatment may be significantly more expensive.
Whenever possible, aim to choose a rehab facility that is in-network with AmeriHealth to ensure you receive your full benefits. If you choose an out-of-network facility, you may be responsible for paying the full cost of rehab on your own. While you may be able to discuss financing options (e.g., grants and payment plans) with the rehab facility, it is best to choose an in-network provider.
Many American Addiction Centers facilities are in-network with AmeriHealth. Contact us at to inquire about which facilities are in-network.
AmeriHealth offers a variety of plans to allow members to select the amount of coverage that fits their budget and healthcare needs. Options include:
AmeriHealth plans include:8
- Health maintenance organization (HMO). With an HMO, your primary care physician will provide referrals to specialists who are in-network with AmeriHealth. HMO plans do not provide coverage for out-of-network doctors or treatment facilities.
- HMO (plus). Similar to an HMO, you are able to choose your own doctors or healthcare facilities without a referral. However, they must be in-network with AmeriHealth for coverage to be provided.
- Point-of-service (POS). When you have a POS plan, your primary care physician will coordinate all of your care for you. You can choose an in-network or out-of-network provider with a POS plan.
- POS (plus). Similar to the POS plan, these plans do not require a referral from your PCP to see a specialist. You may access care both in-network and out-of-network.
- Preferred provider organization. This type of plan offers the freedom to choose any doctor or specialist you want to see without a referral. You pay fewer out-of-pocket costs when you see a provider that is in-network, but you can still go out-of-network if you prefer.
- Exclusive provider organization (EPO). EPO plans allow you to see any doctor or get care from a specialist or a facility without a referral, but you must stay in-network in order for insurance coverage to be provided for services you receive.
AmeriHealth does cover Suboxone treatment when it is prescribed by a licensed physician.9 Suboxone can be used to help reduce withdrawal symptoms from opioid addiction and prevent future opioid abuse.