Do Drug and Alcohol Addiction Recovery Centers Take Ambetter Insurance?

Choosing a health insurance plan with Ambetter is easy as they offer three plan tiers: Bronze, Silver, and Gold. All plans provide comprehensive coverage, including mental health and substance abuse services. Keep reading to learn more about Ambetter’s rehab coverage.

Who is Ambetter?

Ambetter is a health insurance brand operated by Centene Corporation, one of the largest managed healthcare companies in the United States. Centene Corporation is a Fortune 500 company specializing in health solutions and has been in the Managed Care sector for over 30 years with a diverse and varied portfolio.1
ambetter logo
With over 2 million members nationwide, Ambetter offers a wide range of HMO (Health Maintenance Organization), PPO (Preferred Provider Organization), and EPO (Exclusive Provider Organization) plans and healthcare services. These are offered through the Affordable Care Act (ACA) marketplace, which provides coverage for individuals and families without access to employer-sponsored or government-provided health insurance. 2 The plans follow ACA guidelines and provide essential health benefits as the law requires.3 These benefits include the following:
  • Emergency Care
  • Outpatient or Ambulatory Care
  • Preventive & Wellness Care
  • Maternity & Newborn Care
  • Pediatric Care
  • Mental Health & Substance Abuse Care
  • Laboratory Services
  • Prescription Drugs
  • Therapy Services
  • Hospitalization
Your services and healthcare benefits may vary based on your state and plan. Ambetter customizes its offerings to comply with each state's insurance marketplace regulations and requirements. Below is a brief overview of Ambetter’s Bronze, Silver, and Gold health plans:
  • Bronze - Ambetter Essential Care: These plans cover your basic healthcare needs. Typically, you’ll have lower monthly premiums but higher out-of-pocket expenses. This plan may be a good option if you don’t visit the doctor frequently or require minimal medication.
  • Silver – Ambetter Balanced Care: Out of all the available plans, this one provides the most value and balance between monthly premiums and out-of-pocket expenses, especially if you’re eligible for financial assistance.
  • Gold – Ambetter Secure Care: This plan offers comprehensive healthcare coverage and guarantees peace of mind. Although your monthly payments will increase, you'll benefit from lower out-of-pocket expenses.
As of 2023, Ambetter expanded its plans for some select counties and states. The Ambetter Select Plans provide a cost-effective monthly premium and a provider network of carefully chosen healthcare professionals and hospitals. This ensures you have access to providers with a proven track record of high-quality healthcare outcomes. Ambetter Value Plans offer affordable healthcare options with a list of specific providers and hospitals. Referrals are required for specialist visits. In addition, the Ambetter Virtual Access plans offer a complete virtual primary care service. Members are assigned a Teladoc or Babylon Primary Care Physician (PCP), depending on their state. The PCP provides unlimited $0 visits and can order labs and imaging, write prescriptions, and make referrals for on-site care when necessary.4

Check Your Ambetter Insurance for Addiction Treatment

You can check your Ambetter insurance coverage levels for drug or alcohol addiction rehab by calling us on 866-461-3339 or by using the form below.

Our admissions coordinators will interact directly with your insurance provider on your behalf, removing from your shoulders the burden of figuring out if your insurance will pay for your addiction treatment.

What is Superior HealthPlan?

Superior HealthPlan and Ambetter Health are both subsidiaries of Centene Corporation, a managed healthcare company. They serve different markets and offer different types of health insurance coverage. Superior HealthPlan mainly serves Texas, providing government-funded coverage. Ambetter Health operates nationally, offering health insurance plans through the ACA marketplace.

Superior HealthPlan was founded in 1999 as a managed care organization (MCO) in Texas, providing health insurance coverage and services to eligible individuals and families. Since its founding, Superior HealthPlan has been focused on serving various government programs, such as Medicaid, CHIP (Children's Health Insurance Program), and the STAR+PLUS program,5 which is a Medicaid-managed care program for individuals who are elderly, disabled, or have long-term health needs.

Superior HealthPlan offers its members comprehensive healthcare services, including access to a network of healthcare providers, hospitals, and specialists. Their coverage includes doctor visits, preventive care services, hospitalization, prescription drug coverage, behavioral health services, and more. The specific services and benefits may vary depending on the program and eligibility.6

What is Ambetter Rehab Addiction Recovery Insurance Coverage?

Ambetter rehab coverage provides services for substance abuse treatment. While each member’s substance abuse coverage needs and resources will vary, some of the services that your Ambetter policy may cover include detoxification, medication-assisted treatment (MAT), inpatient care and outpatient care, aftercare, support groups, and health and wellness programs. Your healthcare insurance may cover part or all of your recovery treatment plan. If you or a loved one is contemplating starting a rehab journey, take a free assessment today to see if you are a candidate for recovery.  You can also read more about our rehabilitation admissions process here.

Does Ambetter Rehab Insurance Cover Drug and Alcohol Addiction Recovery?

“Does Ambetter cover rehab?” This is a common question. Ambetter Health covers substance abuse treatment for drug and alcohol addiction. However, the extent of coverage varies depending on several factors, such as your location and insurance plan type. Understanding your plan and being aware of your coverage options is crucial to ensure a successful recovery journey.

Call 866-461-3339 to learn more about your coverage levels for drug and alcohol addiction recovery with your Ambetter Health policy. We can verify insurance benefits and answer any questions or concerns you may have.

Does Ambetter Rehab Insurance Cover Mental Health Rehab?

Yes. Mental health and substance abuse services are considered essential health benefits under Ambetter Health’s plans.7 Mental health benefits may include therapy, counseling, hospitalization, and more. Your coverage levels may vary according to many factors, including the type of services needed.8

Many insurance plans impose limitations and exclusions, including only covering medically necessary services and requiring prior authorization to approve certain services. It’s highly advisable to familiarize yourself with the specifics of your insurance policy. Call 866-461-3339 - We can review your insurance details with you.

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Inpatient and Outpatient Addiction Recovery Centers That Take Ambetter Rehab Insurance

At Virtue Recovery Center, we offer personalized inpatient and outpatient treatment for substance abuse to help our clients achieve long-term sobriety. We prioritize individualized care and use modern, evidence-based methods to address drug and alcohol addiction, recognizing that each person's situation is unique. We also tailor our approach to meet your specific needs.

We can provide the highest quality care you or your loved one needs beginning with a remote, free assessment. Call 866-461-3339 to learn more about the rehab admissions process and get started on your recovery journey today.

You may also read more about our accredited treatment facilities listed below:

Near Me Facility Locator USA Map

How Much is Rehab with Ambetter Insurance?

On average, the cost of drug rehabilitation per person in the United States is $13,475.9 However, health insurance plans can help pay for these costs.  What you need to pay will vary widely and is influenced by several factors, including your location, particular policy, treatment facility, and the treatment duration. Call 866-461-3339 to receive the details on addiction recovery costs with your Ambetter rehab insurance policy, including any potential out-of-pocket expenses.

How To Check My Ambetter Rehab Insurance Coverage Levels for Addiction Recovery

The easiest way to determine your Ambetter insurance coverage levels for addiction recovery is to call 866-461-3339. Our admissions coordinator is available to assist you in confirming your insurance details and answer any questions regarding addiction treatment and insurance. They are understanding and accommodating in their approach.

Alternatively, you may fill out our online, no-obligation insurance verification form below. You can have peace of mind that all information provided and discussed will remain 100% Confidential.

How To Get Ambetter Rehab Insurance to Pay for Addiction Recovery

These steps are general guidelines, and the specific requirements and processes may vary based on your Ambetter plan and state regulations. However, to maximize the chances of getting Ambetter rehab insurance to pay for addiction recovery services, you can follow these general steps:

  • Understand Your Coverage: To fully grasp the coverage and benefits of addiction recovery services offered by your Ambetter insurance plan, it is crucial to review your policy carefully. Take note of important details, such as in-network providers, deductibles, copayments, and any limitations or exclusions that may be applicable. You can also call us at 866-461-3339 – we can help with this step.
  • Verify In-Network Providers: Before choosing an addiction recovery treatment facility or provider, checking if they are in-network with Ambetter is essential. In-network providers have negotiated rates with the insurance company, which typically leads to lower out-of-pocket costs.
  • Obtain Prior Authorization: Ambetter may require prior authorization. This means you must get approval from Ambetter before beginning treatment. If you don't obtain prior authorization, your coverage may be denied.
  • Medical Necessity Documentation: To ensure that addiction recovery services are necessary for your medical needs, it's important to work closely with your healthcare provider. You may need to provide evidence and documentation to support the specific treatment or level of care required.
  • Follow Treatment Plan: To ensure proper coverage, it is necessary to follow the treatment plan advised by your healthcare provider. This involves attending therapy and group sessions, taking prescribed medications, and adhering to any other recommended interventions. Failure to comply with the treatment plan may impact coverage.
  • Submit Claims Promptly: Submitting all claims promptly and accurately is important. We recommend keeping copies of all relevant documentation, including bills, receipts, and treatment records, in case you need to appeal a denied claim.
  • Seek Assistance: If you face difficulties or require assistance with insurance procedures, you can seek help from Ambetter's customer service or a healthcare advocate who can offer guidance and support.

How Many Times Will Ambetter Rehab Pay for Addiction Recovery?

The extent of coverage for addiction recovery services under Ambetter plans is subject to variation depending on state regulations, your specific plan, and other factors. The number of times Ambetter will cover the treatment is not fixed but rather determined by factors such as medical necessity, the type of treatment, and individual needs.

Typically, Ambetter plans offer coverage for addiction recovery services based on the medical necessity of the treatment, as determined by healthcare professionals. The specific coverage details, including any restrictions on the number of treatment sessions or duration of coverage, can be found in your plan documents or by contacting Ambetter directly.

Addiction Recovery Treatment and Insurance Statistics

  • Approximately 92% of Ambetter Health members receive a subsidy that lowers their monthly premium.10
  • Ambetter Health has a silver-level plan that most of its members, about 84%, are enrolled in. This plan provides additional savings on out-of-pocket expenses.
  • The average monthly cost of an Ambetter insurance plan for a 30-year-old is $408 on the ACA marketplace. For a 40-year-old, it’s $460 per month, and for a 50-year-old, it's $642 per month.11
  • As of 2021, 8.6% of noninstitutionalized American civilians lacked any type of health insurance.12
  • Although effective treatments are available for common substance use disorders, many American adults suffering from these conditions do not receive treatment.13
  • Before the implementation of the Affordable Care Act (ACA) Medicaid expansion in 2014, individuals with low income who required treatment for substance use disorder did not qualify for Medicaid coverage.14
  • In 2020, approximately 64.5 million non-elderly adults were affected by mental illness and substance use disorders, which is around one-third of the population. These issues are more common among young adults and white people. The lower rates among people of color may be due to underdiagnosis within these communities.15
  • Motivational interviewing that considers cultural influences and social stressors can effectively reduce heavy drinking and the frequency of related negative outcomes among Latinx.16
  • Of the 11,732 individuals with private insurance who had a drug use disorder between 2005 and 2018, and were surveyed about their drug use treatment coverage, 62.4% (6,808) were aware of their insurance coverage for drug use treatment, while 37.6% (4,924) were not.17
  • From 2012-2013 to 2015-2016, the number of adults without health insurance decreased significantly. This was true for both those with substance use disorders (from 27.8% to 18.7%) and those without (from 22.6% to 14.6%). The decrease was mainly due to Medicaid expansion and individually purchased private insurance rather than employer-based private insurance.18

Check Your Ambetter Insurance Coverage With Virtue Recovery Center

If you’re committed to recovery, submit a request to one of our professional admission coordinators today using the form below. Before discussing the next steps, a coordinator will address any inquiries regarding our programs, including interacting directly with Ambetter Rehab on your behalf to check your insurance coverage levels for drug or alcohol addiction rehab.

STEP 1

Using your Health Insurance Card, fill out all of the fields on the confidential form.

STEP 2

A member of our staff will contact your insurer to verify if your policy will cover your treatment

STEP 3

We will contact you promptly with the results of the verification and discuss the next steps

*Insurance Disclaimer: Virtue Recovery Center will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note that this is only a quote of benefits and/or authorization. We cannot guarantee that payment or verification eligibility will be accurate and complete as conveyed by your health insurance provider. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service. Your health insurance company will only pay for services it determines to be “reasonable and necessary.” Virtue Recovery Center will make every effort to have all services preauthorized by your health insurance company. Suppose your health insurance company determines that a particular service is not reasonable and necessary or that a specific service is not covered under your plan. In that case, your insurer will deny payment for that service, and it will become your responsibility.

Your Name*
Who is seeking treatment?*
Name of Patient
MM slash DD slash YYYY
Insurance Company's Name*
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*Insurance Disclaimer: Virtue Recovery Center will attempt to verify your health insurance benefits and/or necessary authorizations on your behalf. Please note, this is only a quote of benefits and/or authorization. We cannot guarantee payment or verification eligibility as conveyed by your health insurance provider will be accurate and complete. Payment of benefits are subject to all terms, conditions, limitations, and exclusions of the member’s contract at time of service. Your health insurance company will only pay for services that it determines to be “reasonable and necessary.” Virtue Recovery Center will make every effort to have all services preauthorized by your health insurance company. If your health insurance company determines that a particular service is not reasonable and necessary, or that a particular service is not covered under your plan, your insurer will deny payment for that service and it will become your responsibility.

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Related Rehab and Insurance Resources
Sources and Citations
  1. [1]“Who We Are.” Centene Corporation, www.centene.com/who-we-are.html. Accessed 1 July 2023
  2. [2] “Ambetter – About Us.” Centene Corporation, 2022, https://www.ambetterhealth.com/about-us.html
  3. [3]  “What Is the Affordable Care Act (ACA)? | healthinsurance.org.” healthinsurance.org, 13 Mar. 2023, www.healthinsurance.org/glossary/affordable-care-act.
  4. [4] “About Our Plans.” Ambetter Health, www.ambetterhealth.com/health-plans.html. Accessed 30 June 2023.
  5. [5]“STAR+PLUS.” Texas Health and Human Services. www.hhs.texas.gov/services/health/medicaid-chip/medicaid-chip-members/starplus. Accessed 1 July 2023
  6. [6] Centene Corporation. “About Superior HealthPlan.” Superior Healthplan, www.superiorhealthplan.com/about-us.html. Accessed 1 July 2023.
  7. [7] “Essential Health Benefits.” Ambetter From Coordinated Care, ambetter.coordinatedcarehealth.com/benefits-services/health-benefits.html. Accessed 1 July 2023.
  8. [8] “Important Mental Health and Substance Use Disorder Treatment Information.” Ambetter From Coordinated Care, ambetter.coordinatedcarehealth.com/resources/mental-health-resources.html. Accessed 1 July 202
  9. [9] Stilkind, Joseph. “Average Cost of Drug Rehab [2023]: By Type, State and More.” NCDAS, 1 Jan. 2023, drugabusestatistics.org/cost-of-rehab.
  10. [10] “Health Insurance Marketplace Plans From Ambetter Health.” Centene Corporation, www.centene.com/products-and-services/state-and-national-solutions/marketplace.html. Accessed 1 July 2023.
  11. [11] Kissell, Chris. “Ambetter Health Insurance Review 2023.” Forbes Advisor, 8 June 2023, www.forbes.com/advisor/health-insurance/ambetter-health-insurance-review.
  12. [12] USAFacts. “US Health Statistics and Data Trends: Life Expectancy, Health Insurance, and More.” USAFacts, Jan. 2023, usafacts.org/topics/health.
  13. [13] Grant, Bridget F., Tulshi D. Saha, et al. “Epidemiology ofDSM-5Drug Use Disorder.” JAMA Psychiatry, vol. 73, no. 1, American Medical Association, Jan. 2016, p. 39. https://doi.org/10.1001/jamapsychiatry.2015.2132.
  14. [14] Tolbert, Jennifer, et al. “Key Facts About the Uninsured Population.” Kaiser Family Foundation, 19 Dec. 2022, www.kff.org/uninsured/issue-brief/key-facts-about-the-uninsured-population.
  15. [15] Saunders, Heather, and Rudowitz Robin. “Demographics and Health Insurance Coverage of Nonelderly Adults With Mental Illness and Substance Use Disorders in 2020.” Kaiser Family Foundation, 6 June 2022, www.kff.org/medicaid/issue-brief/demographics-and-health-insurance-coverage-of-nonelderly-adults-with-mental-illness-and-substance-use-disorders-in-2020.
  16. [16] Lee, Christina, et al. “A Randomized Controlled Trial of Motivational Interviewing Tailored for Heavy Drinking Latinxs.” Journal of Consulting and Clinical Psychology, vol. 87, no. 9, American Psychological Association, Sept. 2019, pp. 815–30. https://doi.org/10.1037/ccp0000428.
  17. [17] Mojtabai, Ramin, et al. “Private Health Insurance Coverage of Drug Use Disorder Treatment: 2005–2018.” PLOS ONE, vol. 15, no. 10, Public Library of Science, Oct. 2020, p. e0240298. https://doi.org/10.1371/journal.pone.0240298.
  18. [18] Olfson, Mark, et al. “Effects of the ACA on Health Care Coverage for Adults With Substance Use Disorders.” Psychiatric Services, vol. 72, no. 8, American Psychiatric Association, Aug. 2021, pp. 905–11. https://doi.org/10.1176/appi.ps.202000377.

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