Ambetter Drug & Alcohol Rehab Coverage for Veterans

Ambetter is a health insurance company with over 3 million members nationwide. With various health insurance plans offered on the Marketplace, Veterans with Ambetter insurance may be able to have some or all of their addiction treatment services covered.¹

Read on to learn about using Ambetter and VA benefits for drug and alcohol treatment.

Does Ambetter Cover Drug & Alcohol Treatment for Veterans?

Yes, Ambetter does cover addiction treatment in some capacity. In fact, all Marketplace health insurance plans, as well as Medicaid and Medicare plans, are required by law to cover substance use disorder treatment services as essential health benefits.²

Furthermore, the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008 requires all health insurers (including Ambetter) to offer drug and alcohol addiction treatment benefits at the same level as they do for surgical/medical care.³

Ambetter may cover various levels of addiction treatment, including:

• Medical detox.
• Inpatient rehab.
• Outpatient addiction treatment.
• Partial hospitalization program (PHP).
• Intensive outpatient program (IOP).

Actual coverage for addiction treatment will depend on your exact plan.

Does Having Ambetter Insurance Mean I Can’t Use VA Benefits?

No, having Ambetter insurance doesn’t mean you can’t use VA healthcare. You can use both VA benefits and Ambetter insurance coverage together.⁴ There can be potential benefits to having both VA and Ambetter coverage for addiction treatment. For example:⁴

• Your private insurance may apply your VA health care expenses toward your annual deductible.
• VA copayments may be offset in part or in full by payments made by private insurance providers for non-service-connected care at the VA.

How Do I Use Ambetter Coverage With My VA Benefits?

Using Ambetter coverage with your VA benefits for drug and alcohol treatment is straightforward. Once you have signed up for an Ambetter health plan, the VA will require you to provide them with your health insurance coverage information (including coverage under a spouse’s plan).⁴

By sharing your insurance plan information, it allows the VA to bill your private insurance provider for any care or treatment not related to your military service. It also allows the VA to potentially use your private health insurance provider’s payments for your non-service-connected care toward part or all of your VA copayment.⁴

Additionally, if a Veteran is pre-authorized for care with a community provider, having both VA benefits and Ambetter coverage for addiction treatment may lessen their financial responsibilities.⁵

Do Providers Outside of the VA Accept Ambetter for Addiction Treatment?

Yes, providers outside of the VA accept Ambetter for addiction treatment. Having private insurance such as Ambetter may provide expanded access to medical providers, rehab facilities, and care. Exact coverage for addiction treatment will vary depending on the Ambetter plan you are enrolled in.⁶

VA Community Care & Ambetter Coverage

The VA Community Care Network (CCN) is a program that assists Veterans in accessing timely, high-quality substance use disorder treatment in their local community, outside of a VA medical facility.⁷

It is important to remember that Veterans generally still have the option to receive care from a VA medical facility, even if they are also eligible for community care. To be eligible for community care, Veterans must meet one the following criteria:⁷

• The Veteran lives somewhere that does not have a full-service VA medical facility.
• The service needed is not available at a VA medical facility.
• The “Grandfather” provision applies, and the Veteran is eligible based on the distance qualification under the Veterans Choice Program.
• Community care is in the Veteran’s best medical interest.
• The VA cannot provide care within certain designated access standards.
• Certain quality standards are not met with a VA service line.

Eligibility to receive community care will continue to be dependent on the Veteran’s health care needs and circumstances.⁷

VA-Approved CCPs That Accept Ambetter

All American Addiction Centers rehab facilities are industry-accredited, VA-approved community care providers (CCPs). Depending on your specific plan, the following facilities are in-network with Ambetter:

• Desert Hope Treatment Center in Las Vegas, Nevada.
• Greenhouse Treatment Center in Grand Prairie, Texas.
• Oxford Treatment Center in Etta, Mississippi.
• Recovery First Treatment Center in Hollywood, Florida.
• River Oaks Treatment Center in Riverview, Florida.

Every AAC facility offers a specialized treatment program tailored to the needs of Veterans. For more information on how to find a VA-approved rehab program, call .

FAQs About Addiction Treatment With Ambetter