You may be wondering, ‘what are some rehabs that accept Ambetter insurance?’, ‘does Ambetter cover therapy?’, or ‘does Ambetter cover mental health treatment?’ Read below to find out more about Ambetter counseling and rehab coverage for inpatient and outpatient treatment.
Yes, Ambetter health plans cover inpatient drug and alcohol rehab treatment, though the level of coverage provided will vary depending on the plan chosen. Inpatient drug and alcohol rehabilitation requires preauthorization through Ambetter before undergoing treatment.8
Taking the standard cost share version of the 2019 Balanced Care plan for individuals that are 250% above the poverty level as an example, here’s a brief summary of coverage for inpatient care at a network provider facility:8
- Deductible of $6,500 (if it has not already been met).
- No coinsurance rate.
- No copayment.
If someone with this plan were to opt for a drug rehab center outside the Ambetter-approved network, Ambetter would cover none of the costs.8
NOTE: Prescription medication (sometimes a necessary part of rehabilitation treatment) will likely incur additional charges. In this particular plan, the charges would be between a $20 copayment (deductible would not apply) to a 20% coinsurance rate when using a network provider. Out-of-pocket costs largely depend on the brand of drugs (generic, preferred brand or non-preferred brand).8
Using a provider outside of the Ambetter network for prescription drugs would incur a 50% coinsurance cost.8
If Ambetter pre-authorizes you for coverage of these services with this plan, the maximum amount you can be charged is $6,800 for network-provided services and $1,300 for out-of-network services.
Does Ambetter Insurance Cover Outpatient Rehab?
Ambetter health benefits also extend to outpatient rehabilitation services. Outpatient drug and alcohol rehabilitation requires pre-authorization through Ambetter before you undergo treatment.8 Using the same example plan used in the section above, costs for outpatient drug and alcohol rehab services at a network provider facility would look like this:8
- The deductible of $6,500 (if it has not already been met).
- No coinsurance rate.
- A $30 copayment each doctor visit (deductible does not apply).
Using a non-network provider for outpatient services would result in having no Ambetter drug and alcohol rehab coverage.
Prescription medication may be required during and after outpatient treatment. In this particular plan, charges for prescription drugs range between a $20 copayment (deductible would not apply) to a 20% coinsurance rate when using a network provider. The out-of-pocket cost incurred from prescription medicine largely depends on the brand of drugs prescribed (generic, preferred brand, or non-preferred brand).8
Using a provider outside of the Ambetter network for prescription drugs incurs a 50% coinsurance cost.8
If Ambetter pre-authorizes you for coverage of outpatient services or you require prescription medication, the maximum amount you’ll be charged is $6,800 for network-provided services and $1,300 for out-of-network services according to this plan.8
Ambetter Insurance Mental Health Coverage
Ambetter Insurance mental health coverage also extends to other mental health problems besides substance abuse. In the summary of coverage, mental health services and substance use treatments are categorized together. The cost breakdown for inpatient or outpatient mental health treatment is the same as that of substance abuse treatment.
