Ambetter by Health Net Insurance

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Ambetter by Health Net Insurance

Insurance Plans

The Ambetter by Health Net Insurance offers a few different plans to choose from. Ambetter Essential Care is a plan that covers most of the essential healthcare needs of an individual. With this plan, there are usually lower monthly premiums but higher out-of-pocket costs. Substance abuse treatment may be covered under this plan. However, there may still be copays, deductibles, and/or coinsurance that may apply. The second plan option is the Ambetter Balanced Care plan. This is the best value plan that provides the most balance between monthly premium payments and out-of-pocket costs. Substance abuse may be covered under this plan but the standard copays, deductibles, and/or coinsurance may still apply. Lastly, there is the Ambetter Secure Care plan. All your healthcare needs are met with the Secure Care. Under this plan you can expect higher monthly premium payments, however, the out-of-pocket costs will be lower. Substance abuse treatment may be covered under this plan but copays, deductibles, and/or coinsurance may apply. When choosing an insurance plan it is best to talk with an insurance representative. They can go through each plan and help you figure out which one is best for you and your situation. Always check the website for specifics about substance abuse treatment coverage. 

Insurance plans fall under two categories. There are HMO and PPO plans. Which one is better depends on the individual and their situation. HMO plans tend to have lower monthly premiums while PPO plans have higher monthly premiums. With an HMO plan individuals must seek treatment through the network of providers in order to receive coverage. However, with a PPO plan individuals can seek treatment out of the network and still receive coverage. There are no referrals required. However, in some cases individuals may need to pay providers up front and then get reimbursed after.

Medicaid, on the other hand, is health coverage for Americans who are low-income. Medicaid is administered by the states. Arizona Medicaid covers substance abuse treatment for adults with alcohol or drug dependency issues. Outpatient and residential services are both covered. To check for substance abuse treatment coverage look under the behavioral and mental health sections of insurance company websites. Always check your insurance company’s website to make sure a treatment provider is covered by your plan.

Medicaid and Medicare Coverage

There are many different ways to go about receiving coverage for substance abuse treatment. Prior to treatment, it is important to consider if any other coverage applies to you or a loved one. This includes coverage such as Medicare and Medicaid. Medicare is a federal health insurance program for people 65 and older. Your doctor or medical care provider is the person to go to with any questions about what Medicare covers. However, most major cities will have several treatment centers that accept Medicare. Although there is no specific category of coverage that applies to substance abuse, coverage is available when treatment is reasonable and necessary. The coverage applies to both inpatient and outpatient treatment.