Ambetter Insurance Coverage for Drug and Alcohol Addiction Rehab

Ambetter Insurance Coverage Levels and Plans

Ambetter insurance plans are offered in 3 main tiers.² Each tier offers different monthly premium amounts and out-of-pocket expenses to align with your health and financial needs.² Within each tier, there are plans for different income levels and varying levels of coverage. The 3 main levels are:²

• Bronze: The bronze tier, or the Ambetter Essential Care package, provides healthcare with a low monthly premium (the amount a customer must pay each month to retain coverage). However, rates for services and emergencies with these plans will generally be higher than the two other levels.
• Silver: The second level, known as the Ambetter Balanced Care package, requires customers to pay higher monthly premiums. In return, Ambetter will pay a higher share of most medical bills.
• Gold: The final tier—Ambetter Secure Care—demands the highest premium, but the coverage provided in cases of emergency or necessary health services exceeds the previous levels.

It’s important to consider these options carefully when deciding on an insurance plan. While it can be tempting to choose a plan with the lowest possible monthly premium, there’s always the possibility this approach will cost more in the long term if an emergency or need for expensive care arises.

Rehab centers that take Ambetter insurance coverage are currently located in 26 states across the nation.³ States may offer different plans, so be sure to contact Ambetter to learn more about Ambetter drug rehab coverage in your area.

To compare pricing and Ambetter insurance coverage, visit Healthcare.gov or the Ambetter website. Visiting Healthcare.gov will allow you to compare Ambetter plans to other health insurance providers.

Does Ambetter Insurance Cover Inpatient Rehab?

Inpatient rehab and other substance use and mental health services are covered by Ambetter insurance.² However, out-of-pocket costs and coverage may vary depending on the specific plan chosen and the customer’s state of residency.^{2, 8}

Inpatient or residential treatment is that in which a person resides at the facility while undergoing treatment for substance misuse. The level of care and services offered will depend on the needs of the individual. Inpatient rehab may include:⁷

• Detox services.
• Therapy.
• Care for co-occurring disorders.
• Medication management or Medication-Assisted-Treatment.
• Mutual support groups.
• Continuing care planning.

Opting for treatment outside the Ambetter network may result in no coverage.

Does Ambetter Insurance Cover Outpatient Rehab?

Ambetter insurance also covers outpatient rehabilitation for drug and alcohol services at varying levels, depending on the plan you choose and the needs of the individual. Outpatient treatment is that in which a person visits a facility on a regular basis to receive treatment services but lives at home. This allows them to still work, go to school and attend to personal needs.⁷ Outpatient services may include:⁷

• Detox.
• Therapy.
• Drug counseling.
• Mutual support groups.
• Legal, vocational and social support.

Opting for treatment outside the Ambetter network may result in no coverage.

Does Ambetter Insurance Cover Mental Health Treatment?

Ambetter insurance coverage includes mental and behavioral health services as they are essential health benefits as listed in the ACA.^{2, 8}

With any mental health, behavioral health or drug and alcohol treatment service, it’s important to gain preauthorization with an Ambetter representative before enrolling in a facility to ensure coverage.

Does Ambetter Insurance Cover Drug and Alcohol Rehab?

All Essential Health Benefits (EHBs) are covered under Ambetter Insurance plans, which includes mental health and substance abuse care.⁸ However, coverage for certain types of treatment and services may vary depending on the plan you have and factors like geographic location. Make sure to speak with an Ambetter Insurance representative to understand which addiction treatment providers are covered under your plan. You can also reach out to American Addiction Centers (AAC) at to check your benefits at AAC facilities.

Does Ambetter Insurance Cover Medication-Assisted Treatment (MAT)?

Ambetter Insurance may cover MAT if it is determined to be medically necessary.² If you aren’t sure what’s covered, be sure to verify coverage before choosing treatment for you or a loved one.

Medication-Assisted Treatment is a longer-term form of treatment that uses a combination of medication and therapy to aid in the recovery from alcohol and drug misuse.⁶ People entering detox and going through acute withdrawal may receive FDA-approved medication to help manage the withdrawal process; however, this is not the same as MAT.

Does Ambetter Insurance Cover Sober Living?

Sober living homes, or recovery housing, may be covered by Ambetter insurance depending on your plan and coverage. Sober living is a type of continuing care that allows people to transition back into a more independent lifestyle after other types of treatment. It can serve as a bridge between inpatient treatment and daily life, reinforcing what was learned during previous treatment.⁷

It may be a form of step-down care after inpatient treatment, or step-up care from less intensive treatment. While less structured than inpatient treatment, sober living still provides a sober environment in which to continue the recovery journey and navigate life free of drugs and/or alcohol.⁷

Checking Your Ambetter Insurance Coverage

To learn information specific to your Ambetter health insurance plan, you can:

• Login to your Ambetter account. If you have not already registered for online services, you may have to create an account.
• Call a customer service representative in your state to ask specific coverage questions.
• Look through the paperwork supplied by Ambetter when you enrolled in the healthcare plan.

If you are considering an American Addiction Centers facility and would like to learn more about how your insurance provider handles coverage, consider reaching out to an admissions navigator, use the “Verify Your Insurance” portal or fill out the form below. Our caring admissions navigators understand what you’re going through and are ready to help you understand treatment options.