Does Ambetter cover rehab?
During these difficult times, having health insurance for you and your family boils down to peace of mind. Ambetter believes that healthcare insurance companies best deliver quality care on a local level. Offered products come from Centene Corporation, a multi-national Fortune 500 company. Ambetter substance abuse coverage is designed to deliver high quality, locally-based healthcare services to its members, with providers benefiting from enhanced collaboration and strategic care coordination programs.
Having coverage means you and your family have access to a wide variety of valuable programs, educational tools, and support. This can help keep you in charge of your health and to lead a healthy fulfilling life. For patients requiring substance abuse rehab, Ambetter’s Essential Benefits provides coverage, including Mental Health and Substance Abuse Care. We can help you find the right Ambetter in-network rehabs for you. Call today with any questions you may have, at 912-214-3867.
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Health Plans that Work for You
Ambetter provides affordable health insurance, with a variety of options, like Ambetter in-network rehabs. Patients get to choose how they want to balance their health costs each month, with high-quality care one can count on.
Coverage options include:
- Ambetter Essential Care – this plan covers your essential healthcare needs. Includes lower monthly premiums but potentially higher out-of-pocket costs, depending on the amount of care needed.
- Ambetter Balanced Care – this plan provides the best value and most balance between your monthly premium and out-of-pocket costs, especially if you’re eligible for financial assistance.
- Ambetter Secure Care – for peace of mind, choose this plan for all your healthcare needs. A higher monthly premium will limit out-of-pocket costs later.
Every Ambetter insurance plan offers all Essential Health Benefits: Emergency services, outpatient or ambulatory services, preventive and wellness services, maternity and newborn care, pediatric services, laboratory services, prescription drugs, therapy services (such as physical therapy) and devices, and hospitalization. Ambetter offers multiple health insurance plans that include various levels of coverage for mental health and substance abuse recovery services. An initial plan in addiction recovery treatment is detoxification, an extremely efficient first step towards recovery is followed by an intensive rehab program.
Detoxification is to start eliminating harmful substances from the body and for coping with the symptoms of withdrawal. Detoxification might involve the slow reduction of the chemical or going ‘cold turkey’ under supervision. Detox must be followed by a treatment program to result in an efficient process. Depending on the Ambetter plan chosen, the client may pay anything from zero to 20% in coinsurance for an in-network provider, once the deductible is met. Detox 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.
Ambetter Covers Inpatient Rehab
Inpatient treatment means the patient stays at a facility for a period of time—usually between three weeks and six months; the length of stay varies from program to program. While staying at the facility, they undergo intensive treatment. Inpatient treatment has a higher success rate than outpatient treatment, but it is also more expensive. Further, inpatient treatment interrupts daily life (patient takes a break from employment, school, family obligations), but remove the distractions from normal life.
Inpatient treatment provides medical and emotional support at all times. Ultimately, inpatient treatment is especially effective for those who have undergone serious addictions. Inpatient treatment combines detox and rehab services in one location – usually at a hospital or clinic. To be eligible for inpatient rehabilitation, a doctor must first diagnose you with a condition that requires the services of an acute inpatient rehabilitation program.
To participate in inpatient rehabilitation, you must:
- Be medically stable.
- Have functional deficits or needs that can be addressed through rehabilitation techniques.
- Be able to tolerate and benefit from three hours of a combination of skilled therapies — physical, occupational, and speech — throughout each day.
- Anticipate making progress toward functional goals within a reasonable time frame.
Ambetter insurance covers inpatient Ambetter in-network rehab facilities at various levels. As an example: Ambetter Secure Care 1 (Gold Level) has an annual deductible of $1,000. Once the insured has paid this amount out-of-pocket, Ambetter will cover 80% of in-network costs, with the insured person responsible for the remaining 20%. Ambetter does not place a set limit on the number of days one can remain in an inpatient program, the primary care physician may need to establish medical necessity for extended care if needed.
Ambetter Covers Outpatient Rehab
Outpatient treatment is part-time, usually between 10 to 12 hours a week, meaning that the recovering user comes to the facility, but they do not stay in the facility. Outpatient treatment usually occurs in health clinics, counselor’s offices, community medical clinics, or in residential programs with outpatient services. Participants in outpatient services commute to daily rehab classes at a facility while still living at home.
People who have only recently become dependent on drugs or alcohol or who need to maintain their work schedule or care for the 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.
Some outpatient factors to consider:
- lower success rate, but a more affordable option
- patient’s daily schedule remains mostly uninterrupted (patient can usually continue working or going to school)
- this option is better suited for mild addictions
- patients still have to deal with daily distractions
- patients do not have access to their support team at the rehab center whenever they go home
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. For instance, the Ambetter Silver Balanced Care 4 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% 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 apply to the deductible with no charge once that amount has been met.
What Other Treatments Does Ambetter Cover?
- MAT is the use of prescription medication in combination with behavioral therapy and counseling to provide a whole-patient approach to the treatment of substance abuse disorders. Medications used in MAT such as Suboxone (buprenorphine, naloxone) have approval by the Food and Drug Administration (FDA). Research shows that a combination of medication and therapy can successfully treat these disorders, and for some people struggling with addiction, MAT can help sustain recovery.
- MAT is also used to prevent or reduce opioid overdose. Ambetter classifies MAT 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% coinsurance for the cost of these medications, depending on where the person lives and the level of coverage their plan offers.
Sober Living Homes
- Group homes offer a sober environment, free of alcohol and drugs for individuals in recovery. They operate like a co-op, where clients pay the costs and maintain the home by contributing to the upkeep through rent and chores. People run the majority of homes privately, most often by groups of sober people who form an informal agreement to have a sober living arrangement. Sober living homes are different than other residential programs, more loosely structured to facilitate employment and other outside obligations.
- Sober living houses supervised by medical or behavioral health professionals or accredited as rehabilitation facilities, fall under the category of inpatient rehab. As such, they are covered under the inpatient substance abuse treatment section of Ambetter insurance plans.
- Coverage varies from 100% of the cost after the deductible, to 80% of the cost after the deductible. However, sober living houses with a license and accreditation or that do not also offer treatment in addition to residential facilities may not have coverage under any Ambetter Insurance plan.
In-Network vs Out-of-Network
The difference between in-network and out-of-network is simple. When a doctor, hospital, or other provider accepts your health insurance plan they fall under in-network (also called participating providers). When you go to a doctor or provider who doesn’t take your plan, they fall under out-of-network. The two main differences between them involve cost and whether your plan helps pay for the care you get from out-of-network providers.
When a provider joins a network, they agree to accept an approved amount for their services. For example, a doctor may charge $150 for a service. If the approved amount is $90, you save $60. Doctors or hospitals not in a network don’t accept the approved amount. You’ll be responsible for paying the difference between the provider’s full charge and your plan’s approved amount. Locating the right treatment program is often difficult. 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 big relief.
Additional Information on Ambetter Rehab Network
When a client 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.
Complete healthcare coverage in Georgia with Ambetter is available in cities throughout the state, including Atlanta, Columbus, Savannah, Decatur, Winder, and many more. If you are looking for a healthcare provider, we can assist you in your search. Additionally, for those searching for Ambetter in-network rehabs and other services, please call today at 912-214-3867. Our compassionate, dedicated staff is standing by to help you on your road to recovery.
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