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Ambetter Health Insurance for Drug and Alcohol Addiction Treatment in California



Ambetter health insurance is an Affordable Care Act marketplace policy providing coverage to residents of California. Affordable Care Act health plans like Ambetter must cover mental health and addiction services in California. Ambetter health insurance for drug and alcohol addiction treatment in California includes various options like drug detox, counseling, residential drug rehab, and outpatient services. The extent of coverage and what drug treatment services are covered depends on the policy. Ambetter health insurance offers three tiers of health plans that are Bronze, Silver, and Gold. Bronze tier plans provide health care with a low monthly premium, but rates for services are generally higher. Silver plans require customers to pay higher monthly premiums but cover more healthcare options.

Additionally, Gold plans are the highest premium but cover all necessary healthcare services. The rehabilitation process for treating addiction involves drug detox, residential drug rehab, outpatient treatment, and aftercare support. Drug detox is the first step, and this process is important because it manages withdrawal symptoms and cravings. However, drug detox should not be considered the only approach to treating drug addiction. Following drug detox, the next step in treating drug addiction involves residential or outpatient drug rehab. Residential drug rehab is usually the better option because more services are provided to help the addict. However, no single form of drug rehab is right for every person, and many addicts choose outpatient drug rehab.


How Does Private Health Insurance Cover Drug Rehab in California?

Private health insurance coverage in California covers drug rehabilitation, yet the extent of coverage depends on the plan. The out-of-pocket costs with services vary greatly, depending on the specific plan chosen. Typically, there is a deductible, which means the patient would have to pay before insurance starts to cover drug rehab costs. Also, there is an out-of-pocket maximum with Ambetter health insurance plans. The maximum is the total amount the customer has to pay before health insurance cover 100% of medical costs. Ambetter health insurance does not offer co-payments for residential drug rehab to be paid. However, the co-insurance rate with the plan is 40%, which means after reaching the deductible, the patient must 40% of the fees.

When using health insurance to cover some or all the cost of drug rehab in California, the first step is to contact the health insurance provider. Ambetter health insurance will walk a family through what is covered and provide a list of services. It is also important to contact the different drug rehab centers to determine the process of using health insurance and what services are usually covered. Private health insurance or state health insurance is an excellent option because it is not always possible to afford drug rehab in its entirety. Effective drug rehabilitation must treat more than just drug use, and health insurance provides effective options for families.


What Type of Drug Rehab Does Health Insurance Cover in California?

Ambetter health insurance covers different drug rehab forms. Some of the common addiction services in California covered by Ambetter health insurance include medically supervised detox programs, intervention programs, various forms of therapy, medication-assisted treatment, and support groups. More intensive forms of addiction treatment are also covered, and the extent of coverage depends on the level of health plan. Outpatient and inpatient treatment programs are covered, but the extent of coverage depends on the health insurance plan. It is important for families to find the right type of drug rehab. No single form of drug rehab is right for every person. Health insurance plans provide different options for families to consider.


Family Intervention for Drug Addiction in California

Drug addiction becomes a dangerous problem when an addict cannot get the help they need. Family intervention in California is an excellent option. Family intervention for a drug-addicted family member helps motivate the individual to seek help for their drug or alcohol use. It is challenging to watch a loved one struggle with addiction and convince them to seek help. Someone who battles drug addiction is often in denial about their situation and unwilling to seek drug rehab. In addition, they may not recognize how their drug addiction affects their lives and their family lives. Family intervention is a structured process and presents the drug-addicted family member with an opportunity to attend drug rehab.

The best way to organize a family intervention is to hire a professional interventionist who helps the family plan and prepare the intervention. Family intervention is a carefully planned process that is done with family and friends. During an intervention, family, friends, and the interventionist come together to confront the addict about the consequences of addiction and ask them to accept treatment. The interventionist helps the family provides specific examples of destructive behaviors and their impact on their loved ones. The process also offers prearranged drug rehab plans with clear steps, goals, and guidelines. More importantly, intervention spells out what each person will do if the drug-addicted loved one refuses to accept treatment.


Health Insurance for Drug Rehab and Drug Addiction Trends in California

California has a built-in Affordable Care Act that further expands access to health coverage. The expansion of the act implemented additional subsidies to help more people afford coverage on Covered California. Overall, California’s uninsured rate has fallen from 17% to 7.1%, and the number of uninsured Californians has dropped by 3.7 million. Approximately 12.7 million Californians are covered by Medi-Cal, including 3.7 million adults through the Affordable Care Act expansion. Between 2015 and 2016, around 8.5% of California residents met the criteria for a substance use disorder. Roughly 6.4% of California residents had an alcohol addiction, and around 3.3% struggled with illicit drug addiction. Moreover, 0.6% struggled with an addiction involving pain medication. The rate of substance use disorder in California was approximate twice the overall average among adults aged 18 to 25.



California Health Care Foundation. How Many in Your Area Are Covered by the Affordable Care Act. September 2020.

California Health Care Foundation. Substance Use in California: A Look At Addiction in Treatment. October 2018. https://www.chcf.org/wp-content/uploads/2018/09/SubstanceUseDisorderAlmanac2018.pdf