Ambetter Health Insurance for Addiction Treatment

Ambetter Insurance is a private insurance company that provides health plans to about 2 million people through the Health Insurance Marketplace. Ambetter plans are available in 25 states, including Florida.¹

If you’re a Floridian with an Ambetter Insurance plan and are looking for care to treat a substance use disorder, you’re probably wondering whether insurance will cover the cost of rehab at a quality treatment center in Florida.

This page will answer some of your general questions regarding using Ambetter Insurance for addiction treatment.

Does Ambetter Cover Substance Abuse Treatment?

Yes, Ambetter does offer coverage for substance abuse treatment. The Affordable Care Act (ACA) mandates that plans purchased through the Health Insurance Marketplace provide coverage for mental health, behavioral health, and addiction care in both inpatient and outpatient settings.

Although coverage is federally mandated, the exact coverage details will vary depending on which Ambetter plan you selected.

Recovery First Treatment Center accepts many major insurers, including Ambetter. This means that as an Ambetter member, you may be able to use insurance to pay for addiction treatment at Recovery First in Hollywood, FL.

Use the to verify whether your insurance is accepted at Recovery First.

Which Types of Rehab Does Ambetter Cover?

Coverage across all Ambetter plans may vary. Although the ACA mandates that your plan provides coverage for mental and behavioral health services, the extent of your coverage will depend on the plan you have and where you seek treatment.

Recovery First offers the following levels of care at our Hollywood, Florida facility:

• Medical detox
• Inpatient rehab, or intensive rehabilitation
• Residential rehab
• Partial hospitalization program (“day treatment”)
• Intensive outpatient program

Prior to starting treatment, staff will perform an evaluation to assess your physical and mental health. They will then help you outline your path to recovery, which extends well beyond formal treatment.

How Much Does Addiction Treatment Cost with Ambetter Coverage?

There are many variables that will determine just how much addiction treatment will cost with your Florida Ambetter insurance plan.

Each plan has a summary of benefits and coverage (SBC) packet that should help you better understand your treatment costs. Here are some terms you should understand:

• Deductible: This is the annual amount you’re responsible for paying out of pocket before the health insurance begins covering certain health services.²
• Copay: This is a dollar amount you may owe for certain treatments. For example, a plan may require you to pay a fee at each therapy session.³
• Coinsurance percentage: Some services require you to pay a percentage of costs instead of a fixed dollar amount. For example, if you have a 30% coinsurance rate for a certain treatment, Ambetter would cover the remaining 70% of costs of that treatment.⁴
• Out-of-pocket limit: This is the total amount of costs you can be charged for covered health treatments. After your limit is reached, Ambetter will cover 100% of the remaining costs of qualifying health services for the plan year.⁵

Call the number on the back of your insurance card to talk to a representative about your specific health plan benefits and the out-of-pocket costs of substance use treatment. You may also call to get more detailed information on treatment and coverage at Recovery First.

If your plan doesn’t cover all or part of your treatment costs, don’t worry. There may still be options available to you that will help you cover the cost of rehab.

Using Ambetter Insurance to Pay for Rehab in Florida

To use Ambetter insurance for addiction treatment, it’s important to first find a facility that is within the Ambetter care network. Treatment at out-of-network centers typically results in either no coverage at all or much higher out-of-pocket costs.⁶

You may need to obtain a referral or prior authorization from Ambetter or your primary care physician (PCP) before you start treatment.^7,8 Admissions navigators at Recovery First can assist you with this process.

To get started, take the first step and fill out the verification of benefits form below. This form will help you quickly identify your benefits and coverage, and tell you whether your Florida Ambetter Insurance plan will be accepted at Recovery First Treatment Center. If you’d rather talk to a person and obtained more detailed information, please call .