Drug & Alcohol Rehab Covered by Ambetter Insurance

Ambetter is a health insurer that serves approximately 2 million members across the United States. Ambetter plans are available through the Health Insurance Marketplace or the equivalent state exchange.¹

But can Ambetter plans be used to cover addiction treatment? Continue reading to find out.

Does Ambetter Cover Addiction Treatment?

Yes. Since the Affordable Care Act (ACA) was enacted, all insurance policies purchased through the Health Insurance Marketplace are required to cover mental health and substance use treatment just like they do with other health services. ² It is also illegal to refuse coverage for these conditions on the basis of labeling them a “pre-existing condition.”³

Ambetter offers plans in 3 tiers:⁴

• Bronze. These plans have low premiums, but higher out-of-pocket costs should you need treatment.
• Silver. These mid-tier plans have higher monthly premiums, but costs are lower for most health services.
• Gold. These plans have high monthly premiums, but minimal out-of-pocket costs when you need health services.

All of these plans cover addiction treatment, though the level of coverage depends on the plan.⁴ In many cases, coverage will only be provided at a facility that is within the Ambetter network (such as Greenhouse Treatment Center). You can find out whether your insurance policy covers addiction treatment at Greenhouse within minutes by using the

Types of Addiction Treatment Covered by Ambetter

Addiction is a treatable chronic disease. However, treatment is a highly individualized process and everything from the setting that treatment is provided in, to the length of treatment, to the specific combination of medications and therapies can impact the efficacy of treatment for an individual.⁵

The types of treatment that may be covered by Ambetter at Greenhouse Treatment Center include:

• Medical detox.
• Residential treatment.
• Inpatient care.
• Outpatient programs such as partial hospitalization (day treatment) or intensive outpatient treatment.

How Much Does Substance Abuse Treatment Cost with Ambetter Insurance?

The cost of addiction treatment with Ambetter insurance will likely vary depending on the policy, treatment facility, form of treatment, etc. Reviewing your Summary of Benefits and Coverage packet for your specific insurance policy will help you get a better idea of your total costs. Understanding the following terms will also be helpful:

• Deductible. This is the amount you’ll have to pay per year (excluding monthly premiums) before insurance begins covering treatment costs.⁶
• Co-payment. This is a dollar amount you’ll have to pay out of pocket for certain services, such as a doctor visit or to fill a prescription. With some insurance policies, you might be charged a co-pay for each visit to an outpatient clinic. ⁷
• Co-insurance rate. This is a percentage of the costs you’ll have to pay for treatment, while your insurer covers the rest. For example, with some plans you may be charged a co-insurance rate instead of co-payments for visiting an outpatient clinic or staying in an inpatient facility. If the co-insurance rate was 20%, you’d be charged this amount while your insurer covered the remaining 80% of costs (after you met the deductible).⁸
• Out-of-pocket maximum. This is the total amount you can be charged in a year for health services (except for monthly premiums). Once you’ve paid this amount, your insurer will begin covering 100% of the remaining costs.⁹

Call an admissions navigator at for an estimate of the cost of treatment and more information about the care provided at Greenhouse Treatment Center.

Even with insurance, cost can be a barrier for some people who need addiction treatment. If that is the case, it may be helpful to review some other payment options to help cover the cost of treatment.

Using Ambetter Health Insurance to Pay for Rehab

The most important aspect of using Ambetter to pay for your rehabilitation is finding a facility that is within your plan’s network.

You can see whether your specific plan covers care at Greenhouse Treatment Center by using the online verification of benefits tool. You’ll need some basic personal information such as:

• Your email address.
• The name of the insurance carrier (in this case, Ambetter).
• Your insurance member number.

Our verification form is confidential and HIPAA-compliant, so you don’t have to worry about the security of your information. Once you’ve established your coverage for treatment, you’ll likely then have to obtain pre-authorization for treatment from a representative. Greenhouse admissions navigators can communicate with Ambetter and handle this process for you before you start treatment.

Benefits of Using Ambetter Insurance to Cover Rehab

Using Ambetter health insurance to cover health services makes costs much more reasonable, potentially removing any cost-related barriers to treatment.

All Texas Ambetter health plans provide coverage for essential health services, including:⁴

• Mental health care.
• Substance use treatment.
• Treatment medications.
• Therapy services.

Substance Use Stats in Texas

• In a single-day count in 2019, 35,995 people in Texas were enrolled in a substance use treatment program.¹⁰
• In 2019, 5.9% of Texans over 12 years old suffered from substance use disorders in the previous year.¹⁰
• In 2018, 1,402 people died of a fatal opioid overdose in Texas.¹¹
• An estimated 11,579 Texans over 12 years old were perceived to be at great risk due to drinking 5 or more beverages once or twice per week between 2018 and 2019.¹²

If you or a loved one is struggling with addiction, it’s not too late to get help. Please reach out to an admissions navigator at .