Does Ambetter Cover Addiction Treatment Therapy?
Since the treatment of substance use disorders is considered to be essential care under the Affordable Care Act, everyone who has an Ambetter healthcare insurance plan can expect some degree of coverage for these services.9,10 The specifics of your coverage depend on your plan. You can check the details of your coverage, deductible, and co-pay by getting in touch with Ambetter.10
Does Ambetter Insurance Cover Medication-Assisted Treatment?
Yes, Ambetter plans cover a wide range of mental health and substance use services, which may include coverage for medication-assisted treatment (MAT).9 This type of treatment combines medication with behavioral therapies to aid recovery. Depending on the specifics of their plans, members can expect a varying degree of coverage.9
Does Ambetter Insurance Cover Suboxone Treatment?
If suboxone (buprenorphine) is prescribed by a certified rehab facility and as a part of a tailored, medically necessary treatment plan, your Ambetter plan will likely cover it at least in part.10
Does Ambetter Insurance Cover Sober Living?
Depending on the details of your Ambetter plan, sober living may be covered. You can contact Ambetter to confirm that your coverage meets your needs for transitional housing.11
What Should I Do if Ambetter Won’t Cover the Total Cost of Rehab?
Even if Ambetter doesn’t cover the entire cost of treatment, this should not deter you from seeking support as there may still be other available options. Many rehab centers provide payment plans that can help patients cover their treatment expenses.12 For example, they may offer sliding scale payment or another form of financial aid.12
What Should I Do if My Ambetter Insurance Doesn’t Cover the Full Cost of Treatment?
Ambetter may cover all or part of your rehab costs, depending on the specific plan you have and the level of coverage it provides. If your policy does not cover the full cost of your individually tailored recovery program, you may have to pay additional costs yourself.14
If this turns out to be the case, you should look into potential financial aid options, or subsidies, that usually depend on your income and household size. Substance abuse facilities generally offer various payment plan options, like installments or sliding scale fees. The best way to get accurate information about what your options are is to contact your chosen substance abuse treatment facility and ask about available payment arrangements.15
Does Ambetter Insurance Cover Drug and Alcohol Detox?
All marketplace healthcare plans, including Ambetter’s, are required to comply with Affordable Care Act provisions. This means that they must provide coverage for behavioral health services as one of the essential health benefits and this includes substance abuse disorders.1 SUD treatment, whether the substance of abuse is alcohol or various types of illicit or prescription drugs, usually starts with medically monitored detoxification.16
Detoxification can last for a few days, up to a week, depending on the severity of the addiction, and it sometimes includes the use of pharmacotherapy to ease unpleasant, dangerous, and sometimes even life-threatening symptoms of withdrawal.16 As a medically necessary part of substance abuse treatment, detox, including the use of FDA-approved drugs, must be covered by all healthcare plans, including Ambetter’s.17
Does Ambetter Cover Mental Health Therapies?
Mental health disorders frequently co-occur with substance abuse disorders and that’s why getting treatment for alcohol or drug abuse includes dual diagnosis evaluation by a team of addiction and mental health specialists. Best practice guidelines for effective substance abuse treatment require simultaneous treatment of all present conditions. It’s often quite difficult to determine whether one’s substance abuse issues developed because of underlying mental health issues or if drug and/or alcohol use triggered the development of a certain mental health disorder.16
In any case, both (or several) conditions must be addressed simultaneously to achieve lasting sobriety and reduce the risk of relapse. All medically necessary treatment is covered by Ambetter health insurance plans, and all diagnosed conditions are treated concurrently in psychotherapy and counseling sessions. Mental health and behavioral therapy are an indispensable part of substance abuse treatment and are therefore covered by all healthcare plans if determined to be medically necessary.17