Ambetter Health Insurance for Addiction Treatment

Ambetter by Sunshine Health is available to patients in Florida looking for affordable monthly payments and a range of services. Ambetter is insured by the Celtic Insurance Company and owned by Centene Corporation, a Fortune 500 company with 30 years of experience in the managed care industry.

Read on to learn more about what an insurance company like Ambetter may cover when it comes to addiction and mental health services.

Addiction Treatment Options with Ambetter

Ambetter insurance plans include three tiers of health insurance coverage—bronze, silver, and gold—that vary in monthly premiums and out-of-pocket costs. Any of these plans should cover some level of substance abuse care.

To start, you will most likely need to be assessed by a mental health professional to determine the level of care you may need to treat your substance abuse or addiction. There are several factors that contribute to determining what kind of treatment you may need, such as:1

  • If withdrawal symptoms may present and need medical supervision.
  • General physical health, including any complications that may need to be monitored during recovery.
  • Overall psychological health.
  • Whether or not a patient is ready for recovery and wants to make a change.
  • Potential for continued use, relapse, or other continued problems.

An insurance company like Ambetter might cover such services as:

  • Detox services.
  • Inpatient or residential care. With this approach to treatment, you would live at the treatment center during your care. You can expect to participate in therapy, offered in both individual and group settings, 12-Step style meetings, and other group activities to build comradery and provide a safe, comfortable outlet during treatment.
  • Partial hospitalization. In this instance, you would not live at the facility where you are getting treatment. Instead, you would meet several times a week for a similar treatment regime to residential care but return home in the evenings.
  • Intensive outpatient. This approach is geared more towards people who can manage their recovery in a less restrictive environment. Expect to participate in group therapy, but still potentially have the ability to go to work or school.
  • Outpatient treatment varies in its intensity and can occur at a range of frequencies, although typically less often than intensive outpatient.

What Will My Treatment Cost?

Every person’s treatment needs are different, and so too will be the cost of treatment. Ambetter plans may cover the following services, which are common parts of substance use disorder treatment:

  • Assessment.
  • Detox.
  • Medications.
  • Therapy.
  • The overall cost of an inpatient/residential stay.

The limits of coverage and types of coverage depend on which Ambetter plan you have.

The cost of treatment will depend on many factors, not the least of which will be what your Ambetter insurance covers and what you have to pay for up front. This includes monthly premiums, copays, deductibles, and potential out-of-network costs.

Authorization for Services

Depending on your insurance plan, you might need to get authorization prior to attending a treatment program. This is why an assessment by a mental health professional is so important—he or she can advocate for the treatment you may need. Insurance companies like Ambetter will then determine whether a service, treatment plan, equipment, or medication is medically necessary. However, know that preauthorization does not guarantee that insurance will cover the service.2

We know that trying to determine how your insurance works with a specific treatment plan can be complicated. Your best resources will be contacting Ambetter directly, or working with an insurance specialist at the facility you’re interested in attending.

At Recovery First, we have knowledgeable and compassionate Admissions Navigators standing by ready to answer your questions about treatment and insurance, and we accept Ambetter insurance plans. Just give us a call at to learn more.

You can also verify your insurance benefits below.