Addiction Treatment Covered by Ambetter Health Insurance

Ambetter is a national health insurance provider operating in the state of Mississippi and surrounding areas of the South. Since 2014, it has specialized in providing insurance plans on the Health Insurance Marketplace and serves over 2 million members.1

Read on to learn about how Ambetter can help cover the costs of addiction treatment, and what to expect when using health insurance to pay for rehab.

Does Ambetter Cover Substance Abuse Treatment?

Because Ambetter specializes in Health Insurance Marketplace plans, substance abuse treatment should be covered in some capacity. That’s because the Affordable Care Act (ACA) defines mental health and substance use disorder services as one of 10 essential health benefits each Marketplace plan is required to offer.2

While the ACA mandates coverage for addiction, it doesn’t determine the level of coverage. Your specific benefits will vary depending on what plan you have.

Oxford Treatment Center in Etta, Mississippi is approved by Ambetter as an in-network provider, which means treatment at our facility should be covered.

We’ll make sure of that by verifying your coverage through our . In just a few minutes, you can get a better sense of what may be covered and potential out-of-pocket costs.

How to Use Ambetter Insurance to Pay for Rehab

Most Ambetter insurance plans will need a referral from your primary care provider before approving coverage for addiction treatment. Schedule an appointment with your doctor first, to discuss your substance use and the ideal course of treatment.

Most plans also require you to remain in their network. Ambetter has negotiated discounts with select providers throughout the Mississippi area, so it prefers that you use these providers, unless you need emergency care. That said, some plans may let you coordinate your own specialty care with any facility or medical professional you choose.

To know for sure, your best bet is to call the number on the back of your insurance card and ask for help.

Oxford’s trained admissions navigators are also here to assist you every step of the way. We are available 24/7 at to make sure you don’t have to navigate the complicated insurance process alone.

Which Types of Addiction Treatment are Covered by Ambetter?

Ambetter doesn’t go into specifics about what types of mental and behavioral health services it covers. However, at a minimum, each Ambetter plan includes:6

This aligns with the levels of care available at Oxford Treatment Center. Depending on your plan, Ambetter drug rehab coverage may include:

  • Medical detox, where patients wean off drugs or alcohol in a setting supervised by medical professionals.
  • Residential treatment, where patients live at our facility and receive daily therapy to combat addiction.
  • Partial hospitalization program, where patients attend full days of treatment but continue to live at home.
  • Intensive outpatient program, where patients receive treatment in the mornings or evenings, so they still have time for work or family commitments.
  • Standard outpatient, where patients meet with a therapist daily or weekly depending on their needs.

How Much Does Rehab Cost with Ambetter Insurance?

The cost of rehab varies greatly from person to person depending on their specific needs and exact plan. Some factors that may impact treatment include:

  • Type. As an example, residential treatment is more expensive than outpatient treatment because living expenses are added into the cost.
  • Deductible. A deductible is the amount that must be paid before coverage kicks in. If you have a high deductible, you’ll pay more upfront until Ambetter starts to cover the bills.
  • Coinsurance. Coinsurance is the percentage split with Ambetter when paying the bill. For instance, if you have 20% coinsurance, you’ll pay 20% of the bill, and Ambetter will pay 80%.

Even with great insurance, you may still have a few out-of-pocket costs. That’s why Oxford offers a number of payment options to make treatment as affordable as possible.

Why Use Ambetter Insurance to Pay for Rehab?

Ambetter is a great choice for people in Mississippi because it partners directly with Magnolia Health, a Mississippi-based healthcare provider. This means you’ll have access to a wide range of addiction specialists and other medical providers without having to travel.

Ambetter provides a searchable database, so you can find in-network care nearby, whether you live in Jackson or Oxford.

You may also be eligible to join the My Health Pays program, which offers cash rewards for completing wellness activities like healthy eating, exercising, and visiting your primary care doctor.7 These financial incentives can be a bonus as you work to improve your physical, mental, and emotional health during recovery.

Addiction statistics in the South underscore the importance of getting quality, research-based treatment. In Mississippi, 310 people died from overdose deaths in 2018, and 173 of those deaths were linked to opioids.8 In the South as a whole, about 2.7% of the population has an illicit drug use disorder and 4.5% has an alcohol use disorder.9

Want to learn more about substance abuse in the South? Check out our local addiction guide for additional info.

It’s important to note that, while your situation may feel hopeless, you or your loved one can find hope and healing through proper treatment. The first step is to fill out the form below, so we can answer your questions, talk you through your insurance benefits, and start you on the path to recovery.