Using Ambetter Insurance Benefits for Addiction Treatment

Getting insurance to cover substance abuse treatment is always a point of contention. A rehab program can help you overcome your dependence on a substance. Some insurance providers don’t believe that they don’t have the obligation to pay treatment centers for certain treatment practices. Others require a particular type of treatment center before they consider covering the procedure.

Most insurance companies will cover a rehab center rendering medical advice to a patient to help with their recovery. Yet, these companies prefer a specific rehab center that falls within their network. Private insurance companies usually don’t cover out-of-pocket costs either.

Verify Your Insurance Coverage Free


What rehabs accept Ambetter insurance? Will they cover all of your treatment, or just part of it? How would you pay for the rest?

In this guide, we look at the rehabs that accept Ambetter insurance coverage for drug and alcohol addiction treatment.

Keep reading to find out about going to rehab with Ambetter, and how Resurgence Tennessee can form a top option for your recovery!

The Importance of Health Insurance Providers in the United States

Importance of Health Insurance Providers in the United States

Insurance companies are an important part of the healthcare system in America because they help people who cannot afford to pay for essential health benefits and medical treatment, or get access to it. The importance of insurance companies in the United States cannot be overstated.

They are responsible for covering about 60% of all medical bills in the country. This is especially true when it comes to paying for emergency room visits and other types of care that you might need after hours or on weekends, when your primary care doctor isn’t available.

A health insurance provider can also help you manage any chronic illnesses and help you manage general health so that you’re less likely to end up needing expensive treatments or procedures later on down the line.

These companies usually have a preferred rehab center they want their clients to go to for treatment. The rehab center they choose is typically well-outfitted and conforms to a rigorous standard for admittance. However, some insurance companies don’t expect their clients to go to any specific rehab center for treatment. Recovering persons can choose a rehab center of their choice to attend, with the insurance company covering the cost.

When it comes to seeking addiction treatment for substance abuse, knowing what kind of insurance coverage you can rely on makes a huge difference in how secure you feel taking the next step forward into recovery.

What is the Ambetter Insurance Company?

Over 2 million Americans have access to health insurance thanks to Ambetter, one of the premier health insurance providers. Ambetter provides marketplace insurance plans as part of the Affordable Care Act (ACA). The ACA is a law that requires most Americans to have health insurance coverage.

Also, as per the ACA, mental health services, mental health treatment and addiction treatment are now all protected, to some degree or another, depending on your insurance policy’s specific limitations, as well as terms and conditions.

The ACA has basically ensured that virtually all insurance companies offer coverage for mental health services such as behavioral health treatment and drug and alcohol rehab centers.

24 Hour Addiction Treatment Hotline


Another interesting fact about this company to note is that Ambetter health insurance plans are only available for purchase on the ACA marketplace. Their policies are thus, not available in all the states. The following states allow you to make use of Ambetter insurance benefits: Arizona, Arkansas, Florida, Georgia, Illinois, Indiana, Kansas, Michigan, Mississippi, Missouri, New Hampshire, New Mexico, North Carolina, Ohio, Pennsylvania, South Carolina, Tennessee, Texas and Washington.

What is Health Insurance Coverage for Rehab?

Health insurance coverage is the set of benefits, rights and privileges provided by an insurer to a policyholder. When you have health coverage, you are paying for a portion of your medical bills when you receive care from a doctor or hospital.

Your insurance policy may cover some services in full, while other services (like prescription drugs or group therapy sessions) may be partially covered by your plan. This means that even though you paid a certain amount toward your doctor visit, there may be some costs that are not covered by your plan.

What Does Ambetter Health Insurance Typically Cover?

Prescription drug coverage

Ambetter health plans cover a wide range of costs to the client. However, they differ by state and plan type. Ambetter coverage offers comprehensive coverage with many benefits. Some Ambetter health benefits for both inpatient and outpatient care include:

  • Doctor visits
  • Prescription drug coverage
  • Emergency room visits
  • Mental health services
  • Dental services
  • Chiropractic care
  • Vision care

Are Addiction Treatment Services Covered by Ambetter Insurance Plans?

Addiction treatment is covered by most, but not all Ambetter health insurance plans. It’s important to note that addiction treatment can’t be used as a substitute for medical or surgical care. The Affordable Care Act (ACA) requires most private health coverage plans to cover substance use disorder treatment at the same level as physical health issues. This includes coverage for mental health services like counseling, therapy and behavioral therapy.

As with all things related to healthcare insurance coverage, however, it is critical to know the specifics of your particular policy and the facility you’re interested in seeking addiction treatment before coming to any hard conclusions. Healthcare insurance can be a very complex topic to navigate, and you should take care to make sure you understand the parameters of your situation and options before moving forward.

What Factors Affect the Degree Of Coverage You Can Have?

The degree of health coverage you can have will depend on the type of policy you choose. Although some people may be able to get full coverage, others may need to make sacrifices if they want a policy that is affordable. The following factors will affect the degree of coverage you can have:

  • Your age:

If you are in your 20s or 30s and healthy, then it would be easier to get a full-coverage health plan. However, if you are older and have a history of health problems or chronic conditions, then it would be harder to get full coverage plans because these are more expensive for insurers.

  • Your income level:

If you belong to an underprivileged socioeconomic class, then it would also be harder for you to get affordable insurance because these groups usually receive less money from their employers and are thus forced into purchasing more expensive plans than those belonging to higher socioeconomic classes who have access to better options.

  • Any pre-existing conditions:

Whether or not you’re part of a group that’s considered high risk to insure (such as people with pre-existing conditions) can affect what options are readily available to you from an insurance provider.

Common Terms to Consider About Health Insurance

There are several unique terms and concepts related to working with an insurance company that are important for you to know. Being aware of these ideas ahead of time will make you better prepared to understand what you’re looking at when considering Ambetter insurance coverage.

  • Coinsurance: This is the portion of the overall cost that a patient must pay when receiving treatment. For instance, Ambetter would pay the remaining 80% of the treatment’s cost if the coinsurance rate was fixed at 20%.
  • Out-of-pocket cost limit: This is the yearly limit that a consumer may spend. Deductibles, copayments, and coinsurance are all part of it. Once a client reaches this sum, insurance takes care of the remaining balance. This is frequently the total sum due for drug or alcohol addiction treatment, whether it be inpatient, residential, or outpatient.
  • Deductible: The minimum payment a consumer must make in order for Ambetter to start covering costs.

What are the Tiers of Coverage Offered by Ambetter Health Insurance?

Tiers of Coverage Offered by Ambetter

Ambetter Health Insurance offers a number of different plan options. The extent of coverage you get with Ambetter insurance varies between the plans. Ambetter insurance plans have provided their subscribers with three different care levels since 2014.

In some States, these care packages can include extra services to meet each patient’s specific treatment requirements. The treatment programs they cover also vary. Some providers won’t cover certain treatment programs because they don’t consider them worthwhile.

Bronze Package

This is the lowest and typically most basic package offered by Ambetter health insurance. They typically refer to it as their “Essential Care” plans. These insurance plans often cover your basic and necessary medical expenses.

A Bronze Ambetter health plan participant often pays lesser monthly premiums to cover the cost of their total medical care. However, if a person with this insurance plan requires more frequent and ongoing treatment, their out-of-pocket expenses may increase.

Silver Package

Ambetter sees this as the most balanced option they offer. They actually refer to these packages as their “Balanced Care” plans. From most perspectives, the best value for medical services is still offered to members of these Balanced health plans.

Out-of-pocket expenses and monthly premiums are almost exactly balanced in silver plans. As a result, they offer their members much-needed basic health benefits, particularly in cases when they are financially eligible for additional help.

Gold Package

Out of all the insurance company’s tiers, the “Secure” Gold Plan from Ambetter has the highest monthly premiums. However, these increased monthly fees may give members a feeling of greater security.

With this gold plan, it doesn’t matter if you suddenly need to participate in mental health treatment or not due to a medical emergency. Due to their increased monthly payments, you are much less likely to incur significant out-of-pocket expenses for their treatment programs.

Getting Substance Abuse Treatment Covered by Insurance

In general, there is also more access to services and treatments, the greater the monthly premium that you pay to health insurance carriers. A treatment provider may have several different programs, but your insurance may only cover a few. Regardless of the scope of the insurance policy, if a person with Ambetter insurance had a medical emergency, the insurance provider would pay the treatment provider.

All in all, the thing to keep in mind about these various packages is that you have to weigh the policies themselves and what they afford you, as far as treatment centers and a treatment program goes, with what you are able to afford. This is the balancing act that everyone seeking health coverage must keep in mind.

What Types of Addiction Treatment Services are Covered by Ambetter Insurance?

Ambetter Insurance Coverage - Medical Detoxification.webp

Ambetter rehab coverage and substance abuse treatment coverage varies wildly based on several factors. Firstly, there is your specific policy and what degree of Ambetter rehab coverage is allowed for under your specific policy’s terms. Secondly there is the specific treatment process or plan that you require.

Finally, the treatment provider or treatment facility you’re looking at. All of these things make the process of knowing exactly what’s possible when seeking treatment for substance addiction a bit complex. Nevertheless, let us examine some of the treatment options that make up substance abuse treatment which CAN be accounted for by Ambetter addiction treatment coverage.

Medical Detoxification

Sometimes called detox or detoxification, this process helps your body get rid of certain substances that can cause problems, such as alcohol or drugs with high addictive potential. This is a critical first step in drug and alcohol addiction treatment. In fact, substance abuse treatment without a successful detox stage often simply results in a relapse.

Detoxification in a professional treatment program will often include professional medical supervision, as well as medication assisted treatment, or MAT. This involves the administration of medications designed to temper the unpleasant withdrawal symptoms and adverse consequences commonly associated with depriving the body of a substance once there is an addiction.

Inpatient or Residential Rehab Services

Inpatient treatment is a type of care that involves staying at a facility. It’s also termed residential treatment, since the patient stays at the facility. Inpatient rehab is typically involved in extensive alcohol treatment or cases of debilitating drug abuse. For example, you may need inpatient care if you’re addicted to opioids and need detoxification from painkillers or heroin (detox). Residential treatment is a private and convenient solution to the problem of addiction. It’s one of the most reliable treatment options that patients have.

Inpatient treatment programs offer many benefits, including the opportunity to be removed from the circumstances, stressors and the environment that likely influenced or pushed them towards their destructive habit in the first place. Being removed from that space while in the process of recovering, healing and strengthening habits and abilities can be invaluable. In many cases, once they’ve completed inpatient treatment, clients can go on to live very fulfilling lives.

24 Hour Addiction Rehab Hotline


Outpatient Rehab Programs

Outpatient treatment is offered on a treatment by treatment basis. This means you don’t have to stay at the facility for the duration of the treatment. With Outpatient addiction treatment, you typically only need to be at the treatment center for the periods where you are going to be actively engaged with the treatment process.

Outpatient care may include intensive outpatient programs (IOPs), which are often used for people who have recently completed an inpatient program and need continued support before transitioning back into their homes or communities. Outpatient care is one of the most useful treatment options for individuals that don’t want their alcohol addiction treatment coverage to impact their real-world lives.

Mental Health Care

Mental health care and services are a critical component of both inpatient and outpatient treatment when it comes to substance abuse treatment. High-quality behavioral healthcare is often ultimately the thing that empowers you to understand why the pattern of drug abuse began, what were the underlying factors that caused it, and how you could heal and empower yourself to avoid falling back into the same patterns.

The behavioral health industry has expanded, and this type of care is available in most recovery centers. There are several techniques empowered by the behavioral health industry when it comes to addiction treatment. The most common are Cognitive Behavioral Therapy (CBT) and Dialectical Behavioral Therapy (DBT).

Holistic Therapies

Holistic Therapies

The term “holistic” refers to a whole-person approach to treatment that addresses the physical, emotional and spiritual aspects of an individual’s life. For example, holistic programs may include nutritional counseling, exercise programs, meditation and yoga classes, massage therapy, and other therapies designed to promote overall health. Holistic therapies offer several unique treatment options for clients to deal with mental health issues.

Holistic interventions can help people recover from drug addictions by addressing all of these aspects of their lives at once. An individual may benefit from improving his or her diet or exercise routine in order to feel better emotionally and physically as well as spiritually. A holistic approach also includes developing coping skills so that an individual can deal with stressors in his or her life without turning to drugs or alcohol for relief.

What are Some Ways to Check Your Insurance Coverage?

Consider this your “check coverage disclaimer”! Knowing the specifics of your own policy is a critical step that you should not discount or take for granted. Here we’ll try to give you some things to keep in mind when it comes to knowing as much as possible about your policy and just general things you should keep in mind.

  • Check your plan’s summary of benefits and coverage (SBC). This document outlines what services are covered under your policy and how much they will cost. The SBC should be available on the insurer’s website. If you have any questions about something in the SBC, ask an ACA or Ambetter representative before signing up for a plan.
  • Read through the fine print in your policy booklet or email confirmation letter to see which services aren’t covered under your plan, who isn’t eligible for certain treatments or services and what other limitations may apply.
  • Keep track of any out-of-pocket expenses during treatment or after receiving medical care from providers not contracted with your insurer — some health insurance companies require patients to pay out-of-pocket costs upfront and then submit receipts for reimbursement later on.
  • Keep in mind a call to Resurgence Tennessee will help you determine coverage and if you are responsible for any out-of-pocket costs, confidentially and without obligation. And asking about coverage never impacts your costs or monthly premiums.

Will Most Rehabs Accept Ambetter Insurance?

A critical question at the heart of this issue is the treatment providers that accept Ambetter insurance. Contact Resurgence Tennessee first to verify your insurance. We offer free insurance verification as part of our dedication to clients.

Specifically, finding out the details of Ambetter insurance coverage for those seeking addiction treatment can be a challenge, but one that we will gladly help with!

It is crucial that you verify your insurance coverage. We identified earlier in this article the States that offer Ambetter insurance coverage. This somewhat narrows down the situation as, if you’re not in one of the states that are covered, then you can be pretty confident that rehab centers won’t accept Ambetter insurance policies.

Insurance for drug addiction can usually be figured out by reaching out to the treatment provider directly as they would, most times, be able to specifically tell you whether or not your policy would be accepted and what sort of substance abuse services and treatment options you would be able to access.

In-Network vs Out-of-Network Facilities

One of the most important factors in choosing a rehabilitation center is whether or not it’s in-network with your insurance company. There are two main types of treatment facilities: in-network and out-of-network. In an in-network facility, the patient’s insurance company has contracted with the facility to provide services at a lower cost than if they were to be provided at an out-of-network facility. The out-of-network facility has not entered into an agreement with the insurance company, so it will usually charge more.

The amount of coverage varies depending on the type of plan and specific provider network in question. In some cases, a plan may cover all or most of the cost of out-of-network care; in others, there may be no coverage at all. It’s important to check with your insurer before making any decisions about out-of-network care so that you’re not surprised by any unexpected bills later on down the road.

FAQs on Rehabs that Accept Ambetter Insurance

What will my out-of-pocket costs be at Ambetter rehab centers?

If you want to receive treatment and professional care, the inpatient drug and alcohol rehab program at Resurgence Tennessee has a lot to offer. And we can let you know within minutes about your costs for attending treatment, both overall and out of pocket (if it applies).

Even in cases of partial coverage, we can help you decide among options and will work with you to make sure you have access to care and can begin a recovery journey with us!

Can I get dual diagnosis treatment using an Ambetter policy?

Yes, dual diagnosis treatment is among the coverage options with Ambetter. If our dual diagnosis program is the right treatment program for you, we can let you know about Ambetter insurance benefits for this track and get you started on a path to recovery in most cases.

Get Started with Addiction Treatment Using Your Ambetter Insurance Plan Today!

Drug and alcohol addiction can be debilitating conditions that steal your life away. This does not need to be the case for you or any of your loved ones! At Resurgence Tennessee, we offer comprehensive drug and alcohol rehab programs.

Our team of medical professionals are all fully qualified and trained, offering a high-quality behavioral healthcare experience. A wide range of treatment options exists at Resurgence TN. Both residential treatments as well as outpatient addiction treatment programs are available as necessary.

We are also an in-network facility with Ambetter! This means that when you seek treatment for drug and alcohol rehab with us, your Ambetter insurance plan is fully accepted, and you will be able to experience the full measure of all essential health benefits that are part of your plan.

Start Your Recovery – Call Now!


At Resurgence Tennessee facilities, you will find a rehab to start your journey of recovery. Our facilities are industry-leading, state-of-the-art, and fully equipped to be as comfortable and peaceful spaces as possible. When you’re with us, we want your energies to be focused entirely on the process of healing and recovery.

The range of services we offer range from time-tested techniques like Cognitive Behavioral Therapy and Dialectical Behavioral Therapy, to EMDR Trauma Treatment, Holistic Techniques, Family Therapy, Life Skill Training, and Dual Diagnosis Treatment.

Find a Rehab and Recovery Community with Resurgence Tennessee

As you can see, at Resurgence Tennessee, we take addiction treatment seriously. Drug and alcohol addiction can feel insurmountable but with the right support, recovery is possible.

Don’t settle for anything less than what you deserve. Today is the time to take back control.

Reach out to us today to speak to one of our welcoming Admissions team and let’s get a customized treatment program started for you now!