Ambetter Insurance Coverage for Rehab
What Is Ambetter Insurance?
Ambetter is a Marketplace insurance plan that offers healthcare for people across the United States. Ambetter insurance is provided through Centene Corporation and has been around since 2014.1 Serving 2 million people, Ambetter insurance health plans are offered across 20 states:1,2
- New Hampshire.
- New Mexico.
- North Carolina.
- South Carolina.
Does Ambetter Cover Alcohol Addiction Treatment?
Per the Affordable Care Act (ACA), Ambetter must cover some form of alcohol treatment.1 The ACA mandates that all Marketplace plans cover essential health benefits, including mental health and substance use services.3,4
The specific amount of coverage you will have through your Ambetter plan for alcohol addiction treatment will vary. You can check your insurance benefits before checking into a rehab facility to find out what your out-of-pocket costs will be. Someone at the rehab treatment center can assist you with the process. You won’t have to do anything except call and have them verify your insurance.
How to Check My Ambetter Insurance Benefits
You can easily check your Ambetter coverage a few different ways:
- Visit the Ambetter website and log in to your account. If you don’t have access to your online account, you may need to register for one. Once you are in your account, you will be able to see information about your benefits.
- Call the customer service number listed on the back of your insurance card.
- Call the rehab center directly. They should be able to verify your insurance benefits while you wait.
Ambetter Insurance Plans
With Ambetter health insurance, you will have one of 3 tiers of coverage:5
- Ambetter Essential Care (Bronze): At the Bronze level, you get basic services and care. This makes your monthly premiums lower, but you could face higher out-of-pocket costs if you need more than basic care.
- Ambetter Balanced Care (Silver): This level offers members a balanced approach. The monthly premiums are moderately priced, as are the out-of-pocket costs.
- Ambetter Secure Care (Gold): The Gold level of service has the highest level of coverage. You’ll pay more for monthly premiums, but out-of-pocket costs will be lower.
Out-of-pocket costs you may be responsible for paying include:
- Deductible payments. This is the total yearly amount you pay for certain services before Ambetter will pay. For example, if your deductible is $2000, you pay the first $2000 in costs and Ambetter covers the rest.10
- Co-pays. This is the amount you pay for each service.11 For example, $10 for prescriptions and $30 for an office visit.
- Out-of-pocket maximum. This is the most you will have to pay for services each year, excluding your premiums. Once you reach this amount for services, your insurance covers the rest.12
Before attending rehab, you may want to ask both Ambetter and the rehab facility about your exact out-of-pocket costs so there are no surprises.
What Types of Treatment Does Ambetter Cover?
When being treated for an alcohol use disorder, you have a range of treatment options to choose from. These options offer different care settings and levels of intensity to best help you recover. Your Ambetter insurance coverage may help pay for some or all these treatments.
Does Ambetter Insurance Cover Inpatient Rehab?
Yes, Ambetter insurance often covers inpatient alcohol rehab. However, your coverage will depend on your specific plan. It’s also dependent on getting treatment with an in-network provider.
An inpatient rehab program is the most intensive setting for alcohol treatment. During inpatient treatment, you live at the treatment center for the length of treatment and get 24/7 care and support. 6
Does Ambetter Insurance Cover Outpatient Rehab?
Ambetter insurance does typically cover outpatient alcohol rehab. But how much they cover will depend on your plan. Outpatient settings that may be covered include:
- Partial hospitalization program (PHP): The most intense form of outpatient care, where you attend therapy and rehab most of the day each day of the week and return home at night.7
- Intensive outpatient program (IOP): IOP programs are less intense than PHP but more intense than standard outpatient treatment.6
- Outpatient treatment program: Most people are familiar with a standard outpatient treatment program. It involves attending treatment session a few times per week.6
Does Ambetter Insurance Cover Alcohol Detox?
In many cases, your Ambetter insurance plan will cover detox. As with other settings, the amount of coverage you’ll have with depend on your exact tier level, your location, and other factors.
Detox involves the body going through the withdrawal phase of stopping a substance, such as alcohol.8 During detox, your care team will keep you as safe and comfortable as possible while you go through this difficult stage of recovery.8
Does Ambetter Insurance Cover MAT?
Depending on your plan, Ambetter insurance may cover medications for addiction treatment (MAT). The three medicines FDA-approved for use in alcohol treatment are acamprosate, disulfiram, and naltrexone. MAT can help reduce cravings and prevent relapse.9
Does Ambetter Insurance Cover Mental Health?
Because Ambetter is a Marketplace plan, it must cover all essential health benefits in some way.4 This includes mental health and substance use services.3 You may want to call Ambetter to see if you’ll need a referral or pre-authorization for these services. Find out this information before you go to treatment to make the process more seamless.
How to Use Ambetter for Alcohol Rehab
You can use your Ambetter insurance to get started on your journey to alcohol rehab. If you don’t know how to get started, talk to your doctor. They can help guide you to the right type of treatment for your recovery needs, as well as give you any necessary referrals or pre-authorizations.
You can also check online for rehab facilities that take Ambetter health insurance. When you find one, they should be able to give you an idea of what your insurance will cover and what your out-of-pocket costs will be. American Addiction Centers (AAC) is in-network with Ambetter. Call us at to learn more about how to use your Ambetter insurance for alcohol rehab at one of our treatment centers.