Ambetter Alcohol And Drug Rehab Insurance Coverage

Ambetter Insurance offers affordable healthcare coverage in 18 states, including substance abuse services and a variety of other Essential Health Benefits. Alcohol and drug treatment programs which may be covered by Ambetter insurance plans can include inpatient treatment, outpatient treatment, and detox programs.

Ambetter insurance provides insurance plans to fit individual health needs and budgets. The insurance carrier’s comprehensive health plans offer a number of Essential Health Benefits, including substance abuse services.

Ambetter insurance company offers several tiers of coverage. Each tier includes substance abuse treatment services, covering a portion of medications, inpatient treatment, outpatient treatment, and more.

Because Ambetter is a premier health insurance provider, it may be accepted through a number of alcohol and drug rehab centers.

However, it’s important to know which addiction treatment services are covered, how to use your Ambetter insurance policy to pay for addiction treatment, what your out-of-pocket drug rehab costs will be, and more.

Ambetter Insurance Coverage For Massachusetts Drug and Alcohol Rehab

All Ambetter insurance plans cover behavioral health services. Coverage remains the same across the three tiers of Ambetter Insurance plans. The only difference amongst the tiers is the cost of the monthly premium and the amount paid out of pocket.

The three tiers of Ambetter coverage include:

  • Ambetter Secure Care (Gold)
  • Ambetter Balanced Care (Silver)
  • Ambetter Essential Care (Bronze)

Ambetter Gold plans are characterized by higher premiums and limited out-of-pocket costs, while Bronze plans feature lower premiums and higher out-of-pocket costs.

You may need to meet a deductible before Ambetter insurance will begin paying drug rehab costs.

Using Ambetter Insurance To Pay For Addiction Treatment

Health insurance can greatly reduce how much you pay out-of-pocket for addiction treatment services. Using your Ambetter insurance plan can make your out-of-pocket costs for drug and alcohol treatment drastically more affordable.

However, it’s important to note that your treatment cost can vary based on your insurance deductible, prescribed medications, and a number of other factors.

Do I Have To Stay In-Network To Use My Ambetter Insurance For Massachusetts Drug Rehab?

Your Ambetter insurance plan will likely cover costs of in-network treatment. The Affordable Care Act (ACA) requires private insurance carriers like Ambetter to provide coverage for substance abuse treatment. Although, a number of exceptions to the rule can apply.

The Ambetter Insurance company is a marketplace plan provider, offering solely Exclusive Provider Organization (EPO) and HMO plans.

The type of plan purchased will determine which treatment providers will accept your insurance coverage for drug rehab and other substance abuse treatment services. Full or partial costs are more likely to be covered when choosing an in-network healthcare provider.

Generally, an insurance carrier will cover between 40 and 90 percent of drug and alcohol treatment costs.

Out-Of-Pocket Costs For Drug Rehab

A number of out-of-pocket costs for drug rehab can be incurred, including:

  • copayments
  • deductibles
  • medications
  • other treatment costs not covered by your Ambetter Insurance plan

It’s important to know your deductible amount, and how much remains to fulfill it, before contacting your chosen Massachusetts drug rehab center. An unfulfilled deductible means you’ll likely have to pay for some treatment before insurance coverage begins.

Your copayment may be high depending on the Ambetter insurance plan tier you choose. There are several additional options available to cover high copayment expenses. Many rehab centers offer payment plan options, including sliding fee scales and scholarships to individuals and families to cover substance abuse treatment costs.

How Do I Find A Massachusetts Rehab Center That Accepts Ambetter Insurance?

Ambetter is widely accepted across 18 states. Before considering your treatment options, it’s important to know what Ambetter covers for drug and alcohol treatment.

Understanding what is covered by your insurance plan will help you create a treatment plan without unexpected expenses.

Does Ambetter Insurance Cover Inpatient Rehab?

Ambetter generally covers inpatient rehab services. Addiction treatment coverage remains the same across all Ambetter policies, but premium and copayment amounts vary based on the tier chosen.

Inpatient drug rehab services take place in a controlled environment. Residential treatment programs typically begin with detoxification, a medically-supervised treatment used to help the recovering individual through withdrawals.

Inpatient treatment services can range greatly in format, approach, and length, and may include therapies, counseling, medications, and more.

Most insurance providers require a clinical evaluation to determine types of treatment the recovering individual needs. This evaluation often determines how much coverage is provided by the insurance carrier.

Is Alcohol And Drug Detox Covered By Ambetter Insurance?

Alcohol and drug detox is one of the first and most important steps to recovery. Detox is typically covered by Ambetter insurance plans. However, the entire cost may not be covered, as the recovering individual may be required to meet a deductible, make copayments, purchase required medications, and more.

Does Ambetter Insurance Cover Outpatient Drug Rehab?

Outpatient drug and alcohol treatment does not require the patient to live at the drug rehab center for the duration of treatment. Many outpatient rehab programs are covered by Ambetter insurance policies.

Coverage provided will vary based on the rehab facility and program chosen. Your Ambetter insurance carrier may require a clinical assessment or physician referral to assess your need for treatment via outpatient drug rehab.

Is Partial Hospitalization Covered Through Ambetter Insurance?

Partial hospitalization treatment can be an effective choice for patients who are unable to enter inpatient addiction treatment programs. Partial hospitalization programs (PHP) may be fully or partially covered by your Ambetter insurance policy.

Is Massachusetts Intensive Outpatient Treatment Covered Through Ambetter Insurance?

Your Ambetter Insurance plan may cover intensive outpatient programs (IOP) if your recovery requires continued medical treatment. Intensive outpatient treatment, also known as day treatment, is a flexible approach to treatment, which allows the patient to fulfill other commitments, such as attending school or working.

Does Ambetter Insurance Cover Medication-Assisted Treatment?

The Ambetter insurance company often covers medication-assisted treatment (MAT). Medication-assisted treatment typically includes medically supervised detox, which is one of the first steps of the addiction treatment process.

Does Ambetter Insurance Cover Methadone?

Methadone maintenance therapy (MMT) is used when a recovering person is addicted to prescription opioids or heroin and experiences withdrawal symptoms when attempting to stop using. Ambetter may cover methadone costs for addicted individuals experiencing opioid use disorders.

Will Massachusetts Ambetter Insurance Cover Suboxone Therapy?

Medication-assisted therapy with Suboxone is commonly used to treat opioid addiction. Ambetter insurance often fully or partially covers Suboxone therapy. Ambetter pharmacy benefits include more information on which prescriptions are deemed essential to long-term recovery plans.

Does Ambetter Insurance Cover Sober Living?

Sober living costs can be covered by Ambetter insurance, depending on whether the sober living home is offered through the rehabilitation center.

Unfortunately, sober living is not considered substance abuse treatment in some parts of the United States, so it’s important to consult your Ambetter Insurance carrier before transitioning into a sober living facility.

Does Ambetter Insurance Cover Aftercare?

Aftercare, also known as continuing care, is the long-term rehabilitation process that takes place when inpatient treatment ends.

Common types of aftercare include outpatient care, sober living, counseling, 12-step group support meetings and more. Some forms of aftercare can be covered by your Ambetter policy, depending on the services provided.

Verifying Your Ambetter Insurance For Addiction Treatment

Verifying your Ambetter insurance coverage is the first step to locating drug and alcohol treatment for you or your loved one.

This is the process in which you discover which treatment options are covered by your Ambetter insurance plan and what your deductible, copayment, and other fees will likely cost. From here, you can begin the search for the ideal Massachusetts addiction treatment center for your needs.

Spring Hill Recovery Center, in Ashby, Massachusetts, is here to help with every step of the process. Our rehab center can help verify your insurance, provide initial drug and alcohol assessments, describe possible treatment options, and more.

Visit or call (888) 743-1696 to learn more about all of the addiction treatment services we offer today.

  1. Substance Abuse and Mental Health Services Administration (SAMHSA)—Recovery and Recovery Support
  2. Ambetter Health Insurance
  3. Ambetter Health Insurance—Plan Options
  4. Substance Abuse and Mental Health Services Administration (SAMHSA)—Medication-Assisted Treatment (MAT)

Written by Spring Hill Recovery Editorial Team

© 2024 Spring Hill Recovery | All Rights Reserved

* This page does not provide medical advice.

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