Ambetter Rehab Coverage
Ambetter is a health insurance provider that serves 26 states. This company offers extensive coverage for mental health services, including addiction treatment programs. If you’re looking for a drug or alcohol rehab near you that accepts Ambetter, there are many options.
The health plans provided by Ambetter have varying levels of coverage, along with different deductibles and co-pays, but here’s what you need to know about Ambetter insurance benefits and some crucial advice on figuring out what you’re entitled to.
Does Ambetter Insurance Cover Alcohol Rehab?
Ambetter insurance plans all offer at least some coverage for inpatient and outpatient alcohol rehab. Prior authorization is required before receiving treatment services, so it’s essential to provide your insurance information to the rehab center before enrolling in a program.
Does Ambetter Insurance Cover Substance Abuse Treatment?
All Ambetter plans offer coverage for drug rehab, including hospitalization, inpatient residential treatment, and outpatient services. Many plans have no coverage limits or caps on how many days you can spend in these programs.
However, you may need to choose a treatment center that’s an in-network provider to receive full coverage under a PPO plan. EPO plans also require you to select a treatment facility that’s in-network.
Does Ambetter Cover Mental Health Treatment?
Ambetter covers some of the costs of mental health care providers, but the exact amount will depend on your plan. There are generally no coverage limits if you’re receiving inpatient or outpatient care related to a mental health diagnosis. However, there are certain services that may not be covered, such as alternative therapies.
Ambetter Inpatient Coverage
Taking a look at the standard version of the 2023 Expanded Bronze PPO plan from Ambetter’s services in Florida, you’ll see that the in-network deductible is $7,500 for an individual, and the non-network deductible is $13,500 for an individual. That means you must pay all your deductible before this plan begins to pay.
- Inpatient coverage for substance abuse treatment programs has no limits.
- Inpatient rehabilitation and habilitation services are limited to 21 days per year, but this does not apply when they are being provided due to a mental health or substance abuse disorder diagnosis.
- For mental health and substance abuse treatment, in-network inpatient treatment requires a 20% co-pay, and non-network inpatient treatment requires a 50% co-pay. The same goes for inpatient rehabilitation and habilitation services.
If you’re worried about costs, plan details like the out-of-pocket maximum can keep your care affordable. For this plan, the yearly in-network out-of-pocket limit is $8,000 for an individual, and the non-network out-of-pocket limit is $25,000 for an individual. This is the maximum you’ll pay in a year for covered services, including your deductible but excluding your premiums.
Ambetter Outpatient Coverage
Ambetter plans often provide equal coverage for inpatient and outpatient services. For instance, the same Expanded Bronze PPO plan from above has the same deductibles and out-of-pocket limits for outpatient care. It also offers the same co-pays for inpatient and outpatient treatment.
It’s also worth noting that:
- Outpatient coverage for substance abuse treatment programs has no limits.
- Outpatient rehabilitation and habilitation therapy are limited to a combined 35 visits per year, but this does not apply when they are being provided due to a mental health or substance abuse disorder diagnosis.
- For mental health and substance abuse treatment, in-network outpatient treatment requires a 20% co-pay, and non-network inpatient treatment requires a 50% co-pay. The same goes for inpatient rehabilitation and habilitation services.
Like other types of health insurance coverage, Ambetter also places restrictions on certain types of services. For instance, while acupuncture is sometimes used as an alternative treatment for addiction recovery, Ambetter offers no coverage for this service at all, meaning you would have to pay out of pocket.
Rehabs That Accept Ambetter Insurance Near You
Zinnia Health has locations throughout the country that accept Ambetter health insurance plans.
If you have Ambetter insurance coverage, consider contacting your nearest Zinnia Health facility to learn more about your benefits and out-of-pocket costs.
Check out our Miami location, which is proudly in-network with Ambetter insurance:
How to Check Your Ambetter Coverage
You can check your Ambetter insurance coverage by calling the phone number on the back of your insurance card. You can also dial the Ambetter Member Services helpline at (844) 518-9505. If you have an online account, the Member Portal also shows you your monthly premiums, deductibles, and information about your payments and coverage.
- To see what your Ambetter plan covers, take a look at your insurance card. Your card should have your plan name on the front and a phone number on the back. If you give your plan name or member ID to the helpline, they can explain your benefits.
- If you don’t have an insurance card, try logging in to the insurance company’s website. If you do not have online access, you can enroll in this service for free. The website will show your latest payment information and benefits.
- If you aren’t yet an Ambetter member or you aren’t sure if your plan is still active, the best thing to do is call the helpline. They can provide insurance verification and discuss your health benefits if you have an active plan.
- When checking coverage, ask if you have benefits for out-of-network providers. PPO plans will, but EPO plans will not. Also ask about your annual deductible and how much more you have to pay before Ambetter will cover the cost of treatment.
If you have specific treatment providers in mind for your substance abuse treatment, they can contact your insurance carrier on your behalf. Simply provide them with your member ID and other information, and the treatment center can call and get specific details about the types of treatment covered and how much you’ll need to pay.
Types of Ambetter Plans that Cover Addiction Treatment
All Ambetter plans offer some coverage for substance use disorders. This has been a requirement since 2010 when the Affordable Care Act (ACA) named mental health and substance abuse treatment as an “essential benefit.” This means all plans must offer some coverage for these services.
Ambetter Essential Care, which is the lowest cost plan provided by the company, will offer less coverage than Ambetter Secure Care, which is a higher tier. Essential Care comes with lower premiums and a higher deductible, while Secure Care has higher premiums but a lower deductible.
If you aren’t sure what type of plan you have, the best thing to do is contact Ambetter to get more information about your specific plan type. If you purchased Ambetter through the federal health insurance exchange, marketplace plans have been standardized to cover anywhere from 60% to 90% of your addiction treatment costs.
Frequently Asked Questions
What Length of Stay Will Ambetter Cover?
There are no coverage limits for most Ambetter health insurance plans if your treatment is associated with a mental health or addiction disorder. For instance, outpatient services are capped at 35 days a year under Ambetter, but if it’s related to your addiction treatment, they will cover as many days as your healthcare provider deems necessary.
How to Pay for Costs Ambetter Doesn’t Cover?
Out-of-pocket costs, such as your deductible, monthly premiums, co-pays, and any services not covered by Ambetter, can be paid using a variety of means. Many treatment providers offer payment plans so that you can pay for out-of-pocket expenses over time. A grant may also be available to cover some or all of these costs. State-run rehab programs may offer care free of charge, regardless of your insurance coverage.
What to Do if Ambetter Doesn’t Cover Rehab?
In the rare event that Ambetter completely denies you rehab treatment for drug or alcohol addiction, you do have other options. You can look for financed treatment plans that break the costs down into monthly payments, or you can opt for a non-profit facility for free care. Hospitals also provide addiction treatment regardless of your ability to pay.
Do Rehab Facilities Need to Be In-Network?
If you have an EPO plan from Ambetter, your treatment facility will have to be in-network to receive coverage. If you have a PPO plan, you can go to a non-network facility, but you will pay more out-of-pocket.