As you begin considering addiction treatment, you may feel overwhelmed by all the choices you need to make. Some of the choices you will need to make include where you will go to treatment, how long your program will be, and how you will pay for your treatment. Although determining how you will pay for treatment can feel daunting, finding the right insurance can help you. Most people who receive addiction treatment pay through private insurance, through Medicare, or through Medicaid. Those in Arizona might be covered by Ambetter insurance. We want to help you learn about all of your financing options. If you live in Arizona and you have questions about whether your Ambetter insurance will cover your addiction treatment, please call us today at 623-335-0909.
Ambetter by Healthnet Insurance has several options for their customers. For example, Arizona plans include Ambetter Essential Care, Ambetter Balanced Care, and Ambetter Secure Care. Each of these plans provide unique services to their clients.
Ambetter Essential Care
First, Ambetter Essential Care provides services for essential healthcare needs. Usually, this plan provides lower monthly premiums. However, this usually means there are higher out-of-pocket costs, coinsurances, and deductibles. Further, if you need a lot of care, this may not be a very effective plan for you. Additionally, the Ambetter Essential Care plan might cover substance abuse treatment. However, copays, deductibles, or coinsurance might still apply.
Ambetter Balanced Care
Second, Ambetter Balanced Care is another plan offered to Arizona residents. This plan works well for people who want the most balance between the price of their monthly premiums and out-of-pocket costs. This is especially true if clients are eligible for financial assistance. Like the Ambetter Essential Care, this plan may also cover addiction treatment. However, deductibles, copays, and/or coinsurance may still apply.
Ambetter Secure Care
Third and finally, the Ambetter Secure Care plan works well for those who expect several doctor’s visits every year. Although the plan’s monthly premium payments are often higher, their out-of-pocket payments are usually lower. Further, this plan might cover substance abuse treatment. But copays, deductibles, and/or coinsurance may still apply.
Medicare and Medicaid in Arizona
In 2010, the Affordable Care Act made health care much more accessible for people in the US. The Affordable Care Act expanded Medicaid, meaning that thousands more Americans can receive the insurance coverage they need. Further, Medicare helps elderly people receive insurance at a lower cost than they would be able to find at a private insurance. Both Medicare and Medicaid can make addiction treatment within reach of people who need it. In Arizona, there are 401 addiction treatment centers. Of these treatment centers, 285 accept Medicaid and 202 accept Medicare.
Information on Medicare
Medicare is a federally-funded insurance program that serves the following individuals:
- Those who are 65 or older
- Some younger people who have disabilities
- People who have End-Stage Renal Disease (ESRD)
To explain, ESRD is a kidney disease that causes permanent kidney failure. Further, Medicare’s services come in four distinct parts. Here are the four parts:
- Hospital Insurance, Medicare Part A
- Medical Insurance, Medicare Part B
- Medicare Advantage, or all-in-one coverage, Medicare Part C
- Prescription drug coverage, Medicare Part D
Medicare helps elderly people access hospital care, physician visits, and prescription drugs. Through Medicare, their copays, deductibles, and out-of-pocket expenses are often lower than they would be through private insurance.
Coverage of Inpatient, Outpatient, and Residential Addiction Treatment
Medicare does not offer specific benefit categories for addiction treatment. However, Medicare covers addiction treatment when providers deem the services necessary and reasonable. Medicare, therefore, could potentially cover the following types of treatment: inpatient, outpatient, and residential treatment.
Information on Medicaid
Additionally, more than 65 million Americans are enrolled in Medicaid. Primarily, Medicaid serves those who are economically disadvantaged. Additionally, people with disabilities, pregnant women, children, and adults with a low socioeconomic background can all receive coverage from Medicaid. Through Medicaid, people can receive care who would not otherwise have the means to do so. States administer Medicaid, and the program is funded by states and the federal government.
Medicaid and Addiction Treatment
Millions of people in the US receive healthcare through Medicaid. Primarily, Medicaid serves economically disadvantaged people. People with disabilities, pregnant women, children, and adults can all receive coverage from Medicaid. Through Medicaid, people can receive care who would not otherwise have the means to do so. States administer Medicaid, and the program is funded by states and the federal government.
Additionally, Arizona’s Medicaid program is called Arizona Health Care Cost Containment System (AHCCCS). AHCCCS covers addiction treatment for adults who experience alcohol or drug dependency. Further, like Medicare, Medicaid’s coverage potentially includes outpatient and residential services, along with other treatments.
Addiction Treatment is Within Your Reach
Ultimately, there is an addiction treatment program that is right for you, and we can help you find it. Not only will you find the treatment that has the right treatment style for you, but you will also find a program that has the right payment options for you. Whether you have Ambetter insurance, Medicare, or Medicaid, you can find the best addiction treatment program for yourself.
One final element to understand when considering the differences in insurance plans is the difference between HMO plans and PPO plans. To begin, HMO stands for Health Maintenance Organization. HMOs have a network of hospitals, medical centers, and primary care physicians. If you have an HMO, you will need to stay within your network in order to receive treatment. Further, you can expect to have lower costs both for monthly premiums and out of pocket. Finally, if you need to see a specialist, you will have to first see your primary care physician and get a referral.
Second, PPO stands for Preferred Provider Organization. In a PPO plan, you still have a network of physicians and healthcare centers. However, you don’t need to stay within your network. If you do leave your network, however, you will have to pay a fee. For the flexibility of being able to see whichever doctor you choose, PPOs often have higher monthly rates and out-of-pocket prices. Finally, unlike HMOs, if you need to see a specialist, you will not need a referral from a primary care physician. If you have any questions about HMO plans, PPO plans, or Ambetter insurance and its ability to cover your addiction treatment, please call us at 623-335-0909.