AmeriHealth Insurance for Drug & Alcohol Rehab

AmeriHealth was established in 1994 and originally offered employer plans in certain parts of Pennsylvania. They expanded and today cover all of New Jersey and parts of Pennsylvania with individual and family plans along with employer plans and Medicare options.

AmeriHealth Caritas is also part of the AmeriHealth family of companies. AmeriHealth Caritas began in 1983 and now offers Medicaid plans in 13 states and D.C. along with individual and family plans in four states.

Together the family of companies serves over 5 million members.

Does AmeriHealth Cover Drug and Alcohol Rehab?

Most AmeriHealth plans will cover at least some addiction treatment in accordance with the 2010 Affordable Care Act (ACA). However, the amount each plan carries and the requirements to ensure coverage applies will vary from plan to plan. That means it’s important to check the details of your insurance before you commit to rehab.

Also all insurance plans will focus on covering medically necessary care. Working with your doctor to get a treatment plan based on your needs will help you get coverage for the addiction treatment that’s appropriate for your situation.

What Are AmeriHealth Plans?

AmeriHealth offers multiple plans through their family of companies. This includes individual and family plans along with Medicare options and Medicaid.

You can get individual and family plans through your employer or in the Insurance Marketplace in New Jersey or Delaware or Florida. There are also Marketplace options in North and South Carolina. If you get your insurance through the Marketplace your plan is likely to be a Health Maintenance Organization (HMO) or Exclusive Provider Organization (EPO) plan. With an HMO you will have a doctor who serves as your primary care physician (PCP). Your PCP will give you referrals to specialists within the provider network and help with any needed prior authorizations. An EPO doesn’t require you to get a referral to see a specialist like an addiction counselor or therapist. Both HMOs and EPOs only cover in network providers unless there’s an emergency or need for urgent care.

AmeriHealth offers Medicare Advantage plans in New Jersey as well. Medicare Advantage is a full replacement plan for Original Medicare. It covers the same things as Original Medicare but often has additional benefits. The AmeriHealth Advantage plan includes routine dental and vision care along with hearing coverage and virtual medical care. AmeriHealth’s Advantage plan is a Preferred Provider Organization (PPO) which means you can see out of network providers although you’ll pay quite a bit more out of pocket. You can also see in network specialists without a referral.

AmeriHealth Caritas offers Medicaid plans and Dual Eligible Medicare Medicaid plans in a variety of states. Medicaid coverage is determined by the state but you will have access to a wide variety of care which includes addiction treatment. You will need to choose medical providers that accept your state’s Medicaid plan.

What Inpatient Addiction Treatment Does AmeriHealth Cover?

Most AmeriHealth plans cover inpatient care as required by the Affordable Care Act. Since insurance focuses on medically necessary treatments getting a treatment plan from your doctor is essential.

For example, the ASAM assessment evaluates the patient’s needs and obstacles along with resources and support system. This information helps decide the right level of addiction care whether that’s inpatient treatment or some level of outpatient rehab.

Inpatient care usually begins with medical detox and is followed by a stay of about 3 to 4 weeks in a care center. This is typically the most intensive level of rehabilitation available.

What Outpatient Rehab Does AmeriHealth Cover?

Outpatient rehab care is a form of addiction treatment that allows patients to continue living at home while attending rehab for multiple hours a week at treatment facility.

These are the three main types of outpatient care:

Partial Hospitalization Program (PHP)
Intensive Outpatient (IOP)
General Outpatient

PHP is the most intense type of outpatient care and is also known as day treatment because you’re in rehab all day although you go home in the evenings. IOP is next and requires around 9 hours of treatment each week divided across three days. You can often choose morning or evening sessions to better accommodate your work or school schedule.

General outpatient is the least intensive and meets once or twice a week. The biggest difference between all forms of outpatient and inpatient care is that you can continue living at home during outpatient rehab.

Does AmeriHealth Cover Methadone & Suboxone (MAT)?

Medication assisted treatment (MAT) is often an essential part of addiction recovery. Many AmeriHealth plans cover MAT under behavioral health services.

MAT is commonly used during detox to manage withdrawal symptoms which helps you stay safe and as comfortable as possible during the process. It can also be used as an ongoing treatment of opioid and alcohol use disorders.

Methadone is a long acting full opioid agonist that works on the same receptors as opioids but doesn’t produce a high. Suboxone works similarly to methadone — acting on the same receptors — but it isn’t as strong.

MAT helps you manage cravings and avoid relapse during treatment while you’re learning new skills and mindsets. As you get stronger in recovery you can wean off the medication support and live a fully substance free life.

Does AmeriHealth Cover Other Mental Healthcare?

Most plans provide some level of coverage for mental health treatment thanks to the ACA. However it’s always a good idea to check your specific plan to confirm what’s covered. Mental health treatment may include counseling and crisis support along with and care for co occurring disorders.

When someone is diagnosed with both addiction and another mental health issue it’s called a co occurring disorder. This is common in addiction treatment and should be addressed simultaneously to support successful long term recovery.

Can I Travel Out of State For Treatment With AmeriHealth?

It depends on your exact AmeriHealth plan and whether you can travel out of state. Many plans require that patients stay in a defined provider network unless they need emergency care.

Some plans include coverage for care outside the network but you’ll pay far more for copayments and deductibles. For example the Medicare PPO plan available in New Jersey offers out of network care but it’s much more expensive.

In general staying within your state and your provider network is better to maximize your insurance coverage and reduce costs.

How to Verify Coverage With AmeriHealth

If you need to verify your coverage with AmeriHealth you can either call their customer service number or log into your online member account. This will give you coverage information and help you find in network providers.

Another option is to ask the treatment center you’re considering if they accept your specific plan. Make sure you verify coverage using your exact plan name and not just “AmeriHealth” since they offer a range of plans with varying levels of coverage.