Ambetter Drug Rehab Coverage

If you or a dependent is struggling with substance abuse and have an Ambetter health insurance plan, it’s important to know what kind of drug rehab coverage is available. 

Does Ambetter Cover Drug Rehab?

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

Substance Abuse Coverage Details

Ambetter’s Essential Health Benefits cover both mental health and substance abuse 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 referall from your Primary Care Physcian (PCP) to start substance abuse treatment, but some forms of treatment may require a prior authorization.

Inpatient drug rehab treatment services

Ambetter’s mental health services include coverage of inpatient, or residential drug treatment. 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:

  • Inpatient Psychiatric Hospitalization
  • Inpatient detoxification treatment
  • Observation
  • Crisis Stabilization
  • Inpatient Rehabilitation
  • Residential Treatment facility
  • Electroconvulsive Therapy (ECT)

Outpatient drug rehab treatment services

Ambetter plans also cover the following oupatient rehabilitation services:

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

Outpatient covered services include psychotherapy and counseling, and Ambetter offers round the clock 24-hour phone or video access for non-emergency behavioral health issues. 

1st Step Behavioral Health Takes Ambetter for Drug & Alcohol Rehab

First Step Behavioral Health in South Florida accepts patients that are covered by Ambetter — nationwide. Our substance abuse treatment providers work with you to curate the right drug rehab program for your recovery. They make sure that every component of your treatment is evaluated against your Explanation of Coverage and Summary of Benefits so that you can feel at ease that your elected services are covered. 

Contact us online, or give us a call or text at (866) 971-5531 to get your recovery journey started. 

Reviewed for Medical & Clinical Accuracy by Brittany Polansky, MSW, LCSW

Brittany has been working in behavioral health since 2012 and is the Assistant Clinical Director at our facility. She is an LCSW and holds a master’s degree in social work. She has great experience with chemical dependency and co-occurring mental health diagnoses as well as various therapeutic techniques. Brittany is passionate about treating all clients with dignity and respect, and providing a safe environment where clients can begin their healing journey in recovery.