Amerigroup Health Insurance

Amerigroup was founded in 1994 and offers Medicare and Medicaid plans in several states across the country. They are owned by Elevance Health. In 2024 Amerigroup began to rebrand as Wellpoint.

The company offers Medicare plans in seven states. They also have Medicaid plans in D.C. and Georgia. Wellpoint also has Medicaid plans in six other states including Maryland and New Jersey.

Does Amerigroup Cover Addiction Treatment?

Yes, both Medicaid and Medicare plans are required to cover drug rehab and addiction treatment as part of their health insurance plans. Your coverage can include a range of services designed to support your journey to recovery from substance use disorders.

However every insurance plan is going to have different coverage limits and requirements so be sure to review your coverage details before you begin a treatment plan. In most cases Medicare and Medicaid will require you to use specific medical providers and treatment centers that are approved by the respective program.

It’s also important to have a treatment plan created by your doctor so you understand what is medically necessary for you. Your insurance plan might require preauthorization before you begin rehab and the treatment plan will provide proof of the care you need.

Types of Amerigroup Plans

Americare offers a variety of health insurance plans. The company works hard to tailor its plans and policies to meet the needs of a diverse population primarily through government sponsored health coverage programs.

Each type of plan is designed to meet specific needs with varying levels of coverage and benefits. You must review the details of your plan to see how it fits with your healthcare needs. The following are the main types of plans offered by Amerigroup.

Amerigroup offers multiple Medicare plans. For those with Original Medicare you can get a Medicare Part D prescription drug plan and Medicare supplement plans that help you pay out of pocket costs. The prescription drug coverage may include medication assisted treatment (MAT).

They also offer Medicare Advantage plans which replace Original Medicare while also offering additional benefits such as vision and hearing care. However these plans also have a specific provider network and may not offer coverage outside the network. Some Advantage plans also require referrals for specialist care such as addiction treatment and you may need preauthorization as well.

Amerigroup also offers Special Needs Plans that are specialized for individuals with diseases or certain characteristics. For example a Medicare Special Needs Plan may cover individuals with a specific chronic illness or with dual eligibility for Medicare and Medicaid. For dual eligibility Amerigroup’s plans coordinate benefits between the two programs and provide comprehensive coverage.

Medicaid is a state and federally sponsored health plan that usually covers low income individuals and families. To qualify you must meet specific eligibility criteria that typically include your financial status and state residency. Amerigroup provides Medicaid managed care plans that offer comprehensive health services.

They cover a wide range of options, including hospital care, preventive services, and behavioral health services. Behavioral health services can include treatment for mental health conditions and substance use disorders.

Amerigroup also offers plans under the Children’s Health Insurance Program (CHIP) to provide coverage for children in families that earn too much for Medicaid but cannot afford private insurance.

What Inpatient Addiction Treatment Does Amerigroup Cover?

Health insurance focuses on medically necessary treatment. That’s why it’s so important to have a treatment plan created by a healthcare professional to ensure you get the help you need.

Your doctor will likely use a test created by the American Society of Addiction Medicine to assess what level of treatment is necessary. This test covers factors like biomedical complications and acute withdrawal or intoxication dangers along with your readiness to change, former relapses or continued usage of mood altering substances, and your recovery environment.

Inpatient medical detox is ideal for those who use substances that may have a dangerous detoxification process. During medical detox there are medical professionals to make sure you stay safe and as comfortable as possible. Handling detox or withdrawal on your own can be dangerous and even terrifying in some situations.

With inpatient treatment you also have access to a support system and freedom from triggers or bad influences back home. If your doctor determines if you qualify for inpatient treatment it’s important that you are committed to overcoming the addiction and that any underlying medical conditions are treated to keep you safe and help you reach long term recovery. With inpatient care you have fast access to medical providers whenever needed and a buffer between you and the outside world.

What Outpatient Rehab Does Amerigroup Cover?

Amerigroup may cover multiple kinds of outpatient addiction treatment depending on your needs.

A partial hospitalization plan (PHP) is a full time program but you don’t live at the facility. You have treatment 6 to 8 hours a day five days a week. These programs can last up to 12 weeks. A PHP is the most intensive and structured type of outpatient care.

An intensive outpatient program (IOP) is also structured but has more flexibility because you only meet for part of the day. It’s common to meet for three hours at a time and you may be able to choose morning or afternoon care so that you can manage work or school alongside treatment.

A standard outpatient treatment plan may only meet for one or two hours per week. During this stage you may also have access to aftercare resources such as help with housing and support for work or school goals.

Outpatient treatment generally allows you to maintain any commitments you have in your life and it’s less expensive. Treatment is often customized to match your schedule. The downside is that you must manage both outside life and treatment at the same time with no buffer.

Does Amerigroup Cover Methadone & Suboxone (MAT)?

MAT is used to help with alcohol and opioid addiction and can be a valuable tool when used correctly and supervised by a physician. Experts combine medication with counseling to give you a higher rate of success. MAT has been proven to increase treatment retention and survival rates.

Methadone is used to help those with an opioid addiction. As a long acting full opioid antagonist it reduces cravings by blocking the effect of the opioid. Suboxone is also used to treat opioid addiction. It’s a combination of two chemicals that block the high of opioids while also blocking the brain’s opioid receptors.

MAT can help you stay stable during treatment so you can establish long term sobriety. Eventually you’ll be able to wean off the medication support and live a truly substance free life.

Does Amerigroup Cover Other Mental Healthcare?

Amerigroup offers Medicaid and Medicare plans which both cover additional mental healthcare treatment. If you struggle with anxiety or depression or other concerns you can get help through therapy and crisis support among other treatment.

Addiction often pairs with other mental illnesses which can make recovery difficult. In order to reach recovery it’s important to get treatment with both mental health and addiction at the same time. Fortunately this type of integrated treatment is available from many providers.

Can I Travel Out of State For Treatment With Amerigroup?

Every plan is unique and benefits can differ. If you have Orignal Medicare along with an Amerigroup prescription or supplement plan you can see any Medicare approved provider around the country.

If you have a Medicare Advantage plan you will probably need to stay within the plan’s provider network. That means you probably need to stay in your local area. Even if your plan covers out of network care, your copayments and deductibles are much higher. To maximize your coverage it’s best to stay in network if you can.

If you have a Medicaid plan through Amerigroup you must choose treatment from a provider within your state that accepts Medicaid — so you would not be able to get treatment out of state.

How Long Will Amerigroup Cover Rehab?

Your insurance plan may have specific limits and requirements for coverage. You’ll want to get your full plan details before you start treatment so you know what is covered and for how long.

Inpatient programs can last anywhere from 30 days to 90 days. After inpatient care is done you may also participate in outpatient programs. The medically recommended length of your treatment depends on how severe the addiction is and what your doctor feels is most beneficial to you.

Because treatment programs are specialized for the individual it’s impossible to know how long your recommended treatment will be until you’ve been assessed. Treatment is not a race and is not something to be completed quickly but rather a way to integrate positive behaviors into your life to replace your addiction.

Those who stay the course and complete the entire program will most have the highest chance of long term recovery. It’s important to embrace the entire process and understand that while you may not see the end right at the beginning your provider has your best interests in mind when designing a treatment program.