Ambetter Drug Rehab Coverage

Does Ambetter Insurance Cover Drug Rehab?

Ambetter is a health insurance provider that offers coverage through the Health Insurance Marketplace created by the Affordable Care Act. They operate in multiple states, providing a range of health insurance plans, including those that cover addiction treatment services.

Ambetter does cover drug and alcohol rehab under their “Essential Health Benefits” that all members have access to. However, like most insurance providers, Ambetter’s specific types of addiction treatment coverage (and the prior authorizations needed) will vary from state to state. As a result, the specifics of your coverage may vary depending on your plan and your state. Detailed information can be found on each state’s specific Ambetter Health website.

Ambetter Substance Abuse Treatment Coverage Details

Ambetter’s Essential Health Benefits cover both mental health and substance abuse treatment services. Deductibles and copayment amounts for covered mental health and substance use disorder benefits are treated in the same manner as physical health services and can be found in your plan’s Summary of Benefits.

According to their member handbook,

“Ambetter follows the Mental Health Parity and Addiction Equity Act (MHPAEA). We make sure that requirements for behavioral health are the same and not more restrictive than your medical benefits.”

Ambetter plans do not require a referral from your Primary Care Physician (PCP) to start substance abuse treatment, but some treatment may require prior authorization.

Inpatient Rehab With Ambetter Insurance

Ambetter Health plans include coverage of inpatient or residential addiction treatment in Florida. Inpatient rehab is best for those suffering from severe addiction and who are in need of a structured program facilitated in a home-like environment. The following inpatient services are covered under your Ambetter insurance:

• Inpatient Psychiatric Hospitalization
• Inpatient detox
• Residential treatment
• Observation
• Crisis Stabilization
• Electroconvulsive Therapy (ECT)

Outpatient Rehab Coverage With Ambetter

Outpatient rehab services are also included in your Ambetter insurance coverage. Outpatient rehab is best for people who have already completed a higher level of care or who have mild addictions that do not require treatment in a residential facility.

Ambetter plans cover the following outpatient rehab services in Florida:

• Partial Hospitalization Program (PHP)
• Intensive Outpatient Program (IOP)
• Outpatient detoxification programs
• Evaluation and assessment
• Individual and group therapy
• Medication Assisted Treatment
• Medication management services (MAT)
• Psychological and Neuropsychological testing
• Electroconvulsive Therapy (ECT)
• Transcranial Magnetic Stimulation (TMS)

Covered outpatient rehab services include psychotherapy and counseling. Ambetter also offers round-the-clock 24-hour phone or video access for non-emergency behavioral health issues.