Get Help Today. (800) 516-4357

Ambetter Insurance for Drug and Alcohol Rehab

Do you struggle with a drug and alcohol addiction? Are you ready to seek out treatment? If so, then you probably want to learn about how the right insurance can cover your treatment.

Struggling with Addiction? Get Help Now
drug and alcohol

Did you know that, according to the NIH, 10 percent of American adults have a drug use disorder that affects them at a certain point in their lives? However, out of the people who are struggling with addiction, only around 11 percent of them are receiving treatment.

At Boca Recovery Center, we are now in-network with Ambetter Insurance for drug and alcohol rehab. This means that, if you have Ambetter insurance, you’ll be covered for much of what we offer at our recovery center.

If you’re considering getting Ambetter Insurance, then you might have questions such as:

  • “What plans are available with Ambetter insurance?”
  • “What are the Ambetter benefits I would get with this insurance company?”
  • “When it comes to Ambetter, is rehab covered?”

To answer all these questions, we’ve put together this article. That way, you can learn if you can use Ambetter Insurance to pay for your treatment at Boca Recover Center. Read on to learn more.

Ambetter Insurance Plans

When it comes to what is covered with Ambetter drug rehab or Ambetter alcohol rehab, it depends on your insurance plan. However, when it comes to all plans, it’s important to know that Ambetter Insurance is a marketplace policy offered by the Affordable Care Act (ACA).

Because of this, this insurer is required by law to cover addiction services and mental health treatments.

That said, the exact coverage will vary, depending on both what state you live in and what plan you have. Let’s review these three different plans now.


The Bronze tier of Ambetter Insurance is the cheapest and most simple of these plans. Its official name is Ambetter Essential Care. It has the lowest monthly premium, which means that the amount you pay each month to continue your coverage will be lower.

However, additional services and emergency costs will be higher with this plan than with the others covered here.


The silver tier of Ambetter insurance is the middle-level of coverage. Its official name is Ambetter Balanced Care. It has a more expensive monthly premium than the Bronze package, which means that you’ll pay more per month.

However, more will be covered by the insurance company, such as medical bills and treatments.


The gold tier of Ambetter insurance provides the highest amount of coverage. Its official name is Ambetter Secure Care. It has the most expensive monthly premium out of all the plans, but it gives you the most options for drug and alcohol rehab.

You will have to pay less if you end up in an emergency room, for example. Additionally, your out-of-pocket health costs will be lowest with this plan.

Choosing the Right Plan

It may be tempting to choose the Bronze plan because it’s the cheapest available. However, you should think seriously about this decision, since you may end up having to pay more if you end up in an emergency situation.

We recommend that you take into consideration your full health, in addition to your addiction. That way, you don’t have to pay a large amount of money later on.

What if you’ve ended up in the emergency room before because of your addiction, or it has created additional health problems you’re dealing with? If that’s the case, then you might want to choose the Gold package for peace of mind.

State Coverage

You should also keep in mind that these Ambetter Insurance plans are only available in specific US states. These states include:

With Ambetter Insurance, you can have some of your costs covered when you come to Boca Recovery Center.

  • Washington
  • Texas
  • Tennessee
  • South Carolina
  • Pennsylvania
  • Ohio
  • North Carolina
  • New Mexico
  • New Hampshire
  • Missouri
  • Kansas
  • Indiana
  • Illinois
  • Georgia
  • Florida
  • Arkansas
  • Arizona

Now that we’ve covered the basics of the plans available through Ambetter Insurance, we’ll review what’s covered by these plans.

Essential Services Covered By All Plans

Even though coverage varies with every Ambetter Insurance Plan (depending on your state of residency), there are essential services that are covered by all plans at all levels. These include:

  • substance abuse and mental health services
  • hospitalization
  • ambulatory or outpatient services
  • emergency services
  • pediatric services

Additionally, these include preventative and wellness services, therapeutic services (such as devices and physical therapy), laboratory services, and prescription drugs.

Now that we’ve reviewed what essential services are covered, we’ll go into these and other services in detail.

Drug and Alcohol Inpatient Rehab

If you want to go to an inpatient rehab center—for example, Boca Recovery Center—then you will be covered by Ambetter Insurance. This is because both mental health and substance abuse health coverage are covered by this insurance policy. However, out-of-pocket costs can vary significantly, depending on your plan and what state you are a resident of.

For example, if you have the Silver Plan, you will still have to pay a deductible. The out-of-pocket maximum can be as high as $8,500—which means that you might have to pay that much.

However, there aren’t any copayments, and the co-insurance rate is 40%.

If you’re prescribed medication while you’re at inpatient rehab, Ambetter Insurance will also cover some of this cost. This depends on the type of brand and whether it’s generic or branded.

The cost would range anywhere between you paying a $20 copay and a co-insurance rate of 50%.

Note that you only get coverage with Ambetter Insurance if the inpatient rehab you’re going to is part of the Ambetter Insurance network.

That’s why we’re so happy to be part of this network providing Ambetter drug rehab and Ambetter alcohol rehab. With Ambetter Insurance, you can have some of your costs covered when you come to Boca Recovery Center.

Outpatient Rehabilitation

Once you’ve gone to rehab or a recovery center, you want to be sure that you still have the support you need so that you don’t continue to have addiction issues in the future. This is why it’s so important to choose an addiction insurance plan that covers outpatient rehabilitation.

With Ambetter Insurance, you get coverage for outpatient rehabilitation.

Breaking it down, it would look a lot like what we covered above. You would still have to pay a deductible, and the out-of-pocket maximum could be as high as $8,500. The co-insurance rate would be 40%.

However, it is slightly different in that there would be co-payment. This is quite low, however; you would only have to pay $30 every time you went into the doctor’s office.

As for prescription costs, these would also vary as above. The cost would range anywhere between you paying a $20 copay and a co-insurance rate of 50%. Additionally, as above, you wouldn’t have any of this coverage if your outpatient rehabilitation were out of network.

Mental Health Services

One of the best features of Ambetter Insurance is that they also cover mental health services. This is incredibly important since many addiction issues actually stem from underlying mental health issues. Additionally, behavioral services are covered.

When it comes to coverage for mental health services, it’s the same as for outpatient rehabilitation, as outlined above. This is the same whether you have a mental health disorder or a substance use disorder (also known as SUD).

Before you choose a mental health service, check with Ambetter Insurance to make sure that their services are covered.

Medication-Assisted Treatment

Medication-assisted treatment, also known as MAT, is medication provided to you that alleviates withdrawal symptoms when you’re detoxing from the drug or alcohol you’re addicted to.

One example of this is Methadone, which helps the recovery of someone who has struggled with an addiction to heroin or opiates. Whether or not you’re covered for MAT depends on what state you live in, FDA regulations and laws, and the level of your coverage.

To see if medication-assisted treatment is covered with the particular Ambetter Insurance plan you’re considering, you should call to ask.

Sober Living Coverage

Many people who have faced addiction choose a sober living option after they have been to a rehabilitation center. This makes it easier for them to move back into normal life after their struggles with addiction.

Sober living coverage is offered by some of the Ambetter Insurance plans. Give the insurance company a call to find out if the insurance plan you’re considering offers coverage for this living solution.

Alcohol and Drug Detox Coverage

When you’re getting treatment for an addiction, it’s important to be able to get through the alcohol and drug detox stage, which can be both emotionally and physically painful. Choosing a plan that offers this type of coverage is essential.

With Ambetter Insurance, you get alcohol and drug detox coverage. However, there are still some costs you may have to pay. This will vary depending on which plan you choose.

Partial Hospitalization Coverage

If you aren’t able to go to an outpatient or inpatient center, then partial hospitalization is a way to get the treatment you need when struggling with addiction issues. Partial hospitalization is covered by Ambetter Insurance, which is one of its many benefits.

However, you may need to pay for some of the costs of partial hospitalization coverage. Check out the details of each plan available if you think you may need partial hospitalization.

Aftercare Coverage

Many people struggling with addiction issues will want to use aftercare once they have been at a rehabilitation center or received another form of treatment.

Aftercare can include support meetings (such as 12-step groups), therapy, sober living, and outpatient care. There are also other treatments available that will help you move forward after struggling with addiction.

Ambetter Insurance covers some, but not all of these aftercare types. If you know which type of aftercare would work best for you, we recommend getting in touch so you can find out what’s covered with Ambetter drug rehab and Ambetter alcohol rehab.

How to Check Your Benefits

If you’re enrolled with Ambetter Insurance and you’re considering getting addiction-related care, treatments, or medication, then it’s a good idea to check your benefits. This way, you will know exactly what it is and isn’t covered when you’re getting the treatment you need.

There are several ways you can do this. One way is to call up Ambetter Insurance. All you have to do is look at the back of your card, where there will be a number for you to call. Once you get connected to a representative, they can explain to you what your benefits are.

Additionally, if you prefer, you can check your benefits online. They have an online portal that makes this process easy.

If there’s a specific treatment center you’re considering, then you can call and ask if they’re part of the Ambetter Insurance network, too. Contacting Ambetter Insurance will also make it possible for you to ask about the rehab center you have in mind.

Need More Information?

Now that you’ve learned about Ambetter Insurance coverage for drug and alcohol rehab, as well as other coverage they offer, you might need more information.

Maybe you want to determine which plan is best for you. Or maybe you want to learn about the best inpatient rehabilitation centers out there.

Whatever you need, we’re here to help. At Boca Recovery Center, we have all the information available about Ambetter Insurance. Additionally, we can help you with your addiction issues and a place to recover.

To learn more about how we can help you live a clean, sober, and fulfilling life, contact us here.

Updated May 10, 2024
Take The Next Step Now
Call Us Now Check Insurance