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AmeriHealth Insurance Coverage for Rehab

Close up view of doctor touching patient hand while explaining the AmeriHealth drug rehab insurance coverage

Published: September 6, 2023

AmeriHealth, formerly AmeriHealth New Jersey, is mainly available to New Jersey, Delaware, Southeastern Pennsylvania, and New York residents. The company was formed in the mid-1990s.

Outside of these northeastern states, coverage under AmeriHealth is available through AmeriHealth Caritas, which has Medicare, Medicaid, long-term care, and behavioral health and pharmacy plans for 13 states plus D.C.

If you want to know more about AmeriHealth insurance coverage for substance abuse treatment, including its availability in your state and whether your preferred treatment facility is a network provider, keep reading.

Does AmeriHealth Insurance Cover Drug Rehab?

AmeriHealth does cover drug rehab. However, there are a number of things that determine what is covered under your policy.

Factors like these can affect drug rehab coverage by AmeriHealth:

  • Plan type
  • Plan level
  • Patient location
  • Patient age
  • Patient smoker status

What Types of Addiction Treatment Does AmeriHealth Cover?

Because AmeriHealth offers several different plan types and levels, it’s important to check with your individual policy to know if treatment plans for your addiction will be covered.

While the company does cover addiction treatment, the amount of coverage and approved providers will vary by plan. AmeriHealth’s website has a Care Cost Estimator tool to help you determine the cost of your drug addiction treatment.

Your out-of-pocket costs may include copays for treatment and prescription drugs, meeting your deductible, and any remaining balance once AmeriHealth has paid each provider.

Medical Detox

Medical detoxification can be conducted as an inpatient or outpatient treatment, depending on the type of addiction and level of addiction as well as what is available in your area.

More intensive outpatient programs (IOP) may be part of the treatment plan if you or a loved one is living at home while undergoing detox.

You’ll need to check your plan or speak with AmeriHealth for more information.

Medication-Assisted Treatment

MAT, or medication-assisted treatment, is used to treat some addictions. Taking a prescribed medication can help relieve the severity of some withdrawal symptoms.

Your plan may cover all or part of MAT, but the only way to know for sure is to contact your insurance provider.

Inpatient Rehab

Inpatient rehab can be one of the more expensive options, and your AmeriHealth plan may only cover part of the treatment plan.

Some of the coverage components you’ll need to check include:

  • Percentages
  • Amounts
  • Limits
  • Referral requirements
  • Approved providers

Inpatient treatment may be a full or partial hospitalization program to treat your drug addiction.

Dual Diagnosis Treatment

When your substance use disorder (SUD) coincides with mental health issues, your provider will usually give you a dual diagnosis. Mental health services are covered under the Affordable Care Act’s (ACA) essential health benefits.

Treatment plans for drug and alcohol addiction usually include behavioral health treatment like counseling and support groups. However, when you’ve received a dual diagnosis, the treatment services may vary from standard drug rehab.

You can talk to your network providers and AmeriHealth representatives about what your insurance will pay for this type of care.

Outpatient Treatment Programs

Depending on your level of addiction and the treatment plan for it, you may start or finish your drug rehab with an outpatient treatment program. Among other factors, this type of treatment can be less expensive.

AmeriHealth may pay for outpatient treatment programs, but you’ll need to be sure by contacting them.

Counseling & Behavioral Therapy

AmeriHealth plans will have some type of coverage for counseling and behavioral therapy as part of treatment for drug and alcohol addiction, both of which are part of most rehab programs.

If your plan is through an employer, they may also offer a set number of counseling sessions for free each year.

Continuing Care

Once you’ve completed a rehab program, you will still need to seek treatment services for your addiction. These may include individual or group therapy, support group meetings, and residential treatment through a sober living community.

Your AmeriHealth plan may cover a portion of these treatment services, so be sure you know what is covered and your out-of-pocket expenses.

Factors That Affect AmeriHealth Coverage for Drug Rehab

The first factor that affects AmeriHealth coverage for drug rehab is location. If you’re looking for coverage at a facility outside of New Jersey, Delaware, or Southeastern Pennsylvania, it’s likely that it won’t be covered by AmeriHealth. It may be covered under AmeriHealth Caritas.

If you have the right plan, you may be eligible for treatment in New York through a partnership with GHI/Emblem of New York.

Does AmeriHealth Cover Out-of-Network Rehab Programs?

Yes, AmeriHealth may cover out-of-network rehab programs, but it’s important to check your specific plan.

It’s also important to know that even if a program or provider is in-network, they may work with an out-of-network provider for some parts of treatment. You should verify each provider in a drug rehab program before moving forward with a program.

AmeriHealth offers five different networks you can choose from for your coverage.

These five networks are:

  • National Access
  • Regional Preferred
  • Regional Preferred with NY Access
  • Local Value
  • Value Plus Access

Types of AmeriHealth Healthcare Plans

Coverage through AmeriHealth in the U.S. is geographically restricted based on your insurance plan.

You may have one of the following types of plans:

  • Exclusive Provider Organization (EPO)
  • Health Maintenance Organization (HMO)
  • Preferred Provider Organization (PPO)
  • Point-of-Service (POS)

According to its website, some of AmeriHealth’s plans can be paired with an HSA. It also designates which plans are unavailable on the Marketplace and must be purchased specifically through AmeriHealth.

Additionally, its POS plan allows covered individuals to choose their provider without a referral.

AmeriHealth’s healthcare plan choices include:

  • Local Value EPO
  • Local Value HMO
  • AmeriHealth Advantage
  • AmeriHealth Hospital Advantage
  • Regional Preferred EPO/PPO Network
  • Regional Preferred HMO/POS Network

Types of Addiction Covered by AmeriHealth Insurance

Following the passing of the Affordable Care Act (ACA), insurance companies are required to cover any treatment for substance use disorder (SUD) as they would treatment for any other surgery or chronic, mental, and behavioral conditions.

However, that does not guarantee that your treatment center or provider will be covered. You must check with AmeriHealth about that.

Your plan may only cover certain parts of it or only a percentage of it. If you’ve not met your deductible, you may have to do so before AmeriHealth will pay your provider for treatment services.

AmeriHealth covers treatment for addiction to the following substances:

Where to Find Rehab Centers That Accept AmeriHealth Near You

If you have an AmeriHealth insurance plan, you can log into your account on their website to find covered network providers in your area.

You can also call the number for AmeriHealth and ask one of their representatives.

Finally, you can search for drug rehab centers in your state or nearby states by viewing our lists of rehab facilities by state.

Find Drug & Alcohol Rehab Programs Covered by AmeriHealth

Realizing that you need help to treat your addiction is a big step in recovery and healing, and dealing with the complexities of insurance coverage can be a hassle.

To find drug and alcohol rehab programs covered by AmeriHealth in your area, you can call our helpline today for fast, expert assistance.

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