Does Ambetter Cover Inpatient Rehabilitation Treatment?
Inpatient rehabilitation 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 Program lengths vary; you may choose a 28- or 30-day rehab program or a more long-term 60-day or 90-day inpatient program.
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
Opting for treatment outside the Ambetter network may result in no coverage.
Does Ambetter Cover Outpatient Rehabilitation Treatment?
Ambetter insurance also covers outpatient rehabilitation for drug and alcohol treatment 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
- Drug counseling.
- Mutual support groups.
- Legal, vocational and social support.
Opting for treatment outside the Ambetter network may result in no coverage. Learn more about inpatient vs. outpatient treatment.
Does Ambetter 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 Cover Drug and Alcohol Rehabilitation Treatment?
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) for free at to check your benefits at AAC facilities.
Does Ambetter 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 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 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