Choosing the right addiction treatment program can seem like an overwhelming task. Not only does a person have to find the treatment method that best suits their needs, they also have to figure out how to pay for the help they need.

What some people may not realize is that health insurance plans often include coverage for drug and alcohol rehabilitation programs that can help make recovery affordable. Ambetter insurance offers multiple health insurance plans that include varying levels of coverage for drug and alcohol rehab.

Does Ambetter Insurance Cover Drug And Alcohol Detox?

Inpatient drug and alcohol detox is covered, and the substance abuse treatment coverage limits apply. Depending on which Ambetter plan a person has, they may pay anything from zero to 20 percent in coinsurance for an in-network provider once their deductible is met.

The first step to treating an addiction is helping the body to end any physical dependence on drugs or alcohol. This drug and alcohol detoxification process is often performed under the supervision of medical staff, since many of the side effects of withdrawal can be dangerous.

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While detox is the first step in treatment, it does not address the psychological or behavioral aspects of addiction that drive a person’s use of drugs and alcohol. Patients typically transfer from a detox program to an inpatient rehab program where they’ll learn the relapse-prevention skills necessary for long-term recovery.

Does Ambetter Insurance Cover Inpatient Rehab?

Ambetter insurance covers inpatient rehab at in-network facilities at a variety of levels. For instance, the Ambetter Secure Care 1 (Gold Level) Plan offered in Ohio has an annual deductible of $1,000. Once the insured has paid this amount out of pocket, Ambetter will cover 80 percent of in-network costs. The insured person will then be responsible for paying the remaining 20 percent.

The length of inpatient rehab programs varies from program to program. While Ambetter does not place a set limit on the number of days a person can remain in an inpatient rehabilitation program, the primary care physician may need to establish medical necessity for extended care.

Does Ambetter Insurance Cover Outpatient Rehab?

Ambetter often covers outpatient rehabilitation services in the same manner it covers inpatient therapy. Depending on the plan, patients will be required to meet a deductible. Once any deductible is met, if the plan requires coinsurance then the insured will be responsible for a percentage of the total cost. However, there are some notable differences for certain plans that can make outpatient treatment a more affordable option.

For instance, the Ambetter Silver Balanced Care 4 plan offered in Washington has a deductible of $7,050 for an individual. If someone covered under this plan checks into an inpatient rehab facility, they will pay 20 percent coinsurance once their deductible is met. However, if they participate in an outpatient rehab program, there is a $30 copay per office visit and the deductible does not apply. All other outpatient services are applied to the deductible with no charge once that amount has been met.

People who have only recently become dependent on drugs or alcohol or who need to maintain their work schedule or care for family while attending treatment may opt for outpatient rehab. These programs address addiction in the context of daily life, rather than requiring patients to live in a residential facility.

Does Ambetter Insurance Cover Medication-Assisted Treatment?

Medication-assisted treatment is the use of prescription medications in combination with behavioral therapy and counseling to reinforce sobriety. Suboxone (buprenorphine, naloxone) and Diskets (methadone) are two of the FDA-approved medications used to prevent withdrawal from opioids and deter relapse.

Ambetter classifies both medications as specialty drugs and may offer coverage under the prescription drug portion of their insurance plans. Patients may be responsible for anywhere from $0 to a 50 percent coinsurance for the cost of these medications, depending on where the person lives and the level of coverage their plan offers.

Does Ambetter Insurance Cover Sober Living Houses?

Sober living houses that are supervised by medical or behavioral health professionals or that are accredited as rehabilitation facilities are considered inpatient rehab. As such, they are covered under the inpatient substance abuse treatment section of ambetter insurance plans. Coverage varies from 100 percent of the cost once the deductible is met to 80 percent of the cost once the deductible is met.

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However, sober living houses that are not licensed and accredited or that do not also offer a treatment component in addition to residential facilities are not covered under any Ambetter Insurance plan. Contact Ambetter or the preferred sober living home to learn specific coverage details.

In-Network Vs. Out-of-Network

Locating the right treatment program is often like trying to find a needle in a haystack. With so many therapeutic methods and facility locations available, finding the program that meets a patient’s unique needs and is also in-network can be a moment of relief.

“In-network” means the healthcare facility and its medical professionals have contracted with the insurance company to provide services to insured patients at an agreed-upon price. When someone uses an out-of-network provider, Ambetter insurance does not cover any treatment costs, nor is the insured eligible for a discount.

However, if the preferred provider appears to be out-of-network, the insured should contact that treatment facility or Ambetter to verify. Rehab facilities can perform a personalized verification of benefits and help a potential patient figure out how to pay for the treatment they need.

How To Find Drug And Alcohol Rehab Centers That Accept Ambetter

  • Contact Vertava Health for an immediate verification of benefits. Vertava Health can answer questions about insurance and addiction treatment and perform a no-obligation verification of insurance benefits on your behalf.
  • Contact the insurance provider by using the phone number on the back of the insurance card or by visiting the provider’s website. A representative will be able to match you to an in-network drug and alcohol rehab center.
  • Call the treatment center you or your loved one is interested in. The treatment center’s admissions team can answer questions about covered services.