Ambetter for Therapy

Ambetter is a health insurance company that offers plans across nearly half of the country. They offer services including dental and vision insurance, a pharmacy program, care management, and health insurance plans that provide coverage for therapy.

Does Ambetter cover therapy?

Yes, Ambetter plans offer coverage for mental health services, including sessions with a therapist. Because Ambetter plans provide coverage for therapy, they can be an excellent way to improve your mental health without breaking your budget.

There are different tiers of Ambetter plans, including Bronze, Silver, and Gold. The amount of coverage that you’ll receive for therapy depends on your specific plan. It’s important to understand the exact details of your plan so you aren’t on the hook for any surprise costs.

How do I check if my Ambetter plan covers therapy?

To check if your Ambetter plan covers therapy, find your plan’s Summary of Benefits document. The Summary of Benefits document tells you how much coverage your plan provides by service type. If you have an online Ambetter account, see if you can find this document there. Otherwise, if you receive Ambetter as an employee benefit, ask your HR team if they can provide you with this document.

When looking at the Summary of Benefits document, find the line called “If you have mental health, behavioral health, or substance abuse needs.” Then look under “Mental/behavioral health outpatient services,” where you'll have two options: working with an in-network or out-of-network provider. Here you can see how much it will cost you for therapy.

You can also try calling Ambetter to speak with a customer service representative so you can ask them about your copay or for coinsurance rates.

How much does therapy cost with my Ambetter plan?

Because there are different tiers of Ambetter plans, how much you pay for each therapy session you attend depends on your plan. You can expect to pay a $20-30 copay for each therapy session with an in-network therapist. This means that you’ll need to pay this amount to your therapist each session on your own — and Ambetter will pay the rest of the session fee.

In some cases, you might also be responsible for a 40% coinsurance with an in-network therapist. A coinsurance is the percentage of the session fee that you’re required to pay, which can be around $100.

Ambetter plans do not provide therapy coverage for out-of-network therapy. You might also need to get pre authorization to use your Ambetter plan to cover therapy costs — and if you don’t, then you may have to pay the entirety of the session fee out-of-pocket.

What types of mental health conditions does Ambetter cover?

Ambetter plans provide coverage for treatment of a wide range of mental health conditions and life situations. To access this coverage and on occasion to get pre authorization to use your benefits, you may need to receive a specific diagnosis from your therapist. Health insurance plans require a diagnosis so they can track your progress to ensure their benefits are being appropriately used.

Ambetter plans provide coverage for the following mental health conditions and more:

What types of therapy does Ambetter cover?

Ambetter covers many types of therapy as long as they’re provided by a credentialed mental health professional who is in-network with Ambetter. Your therapist could be a psychologist, psychiatrist, social worker, licensed professional counselor, or nurse practitioner — just to name a few professions, and they must be licensed to provide therapy in your state. They must also use evidence-based therapy modalities in your sessions, therapy modalities that have clinical research backing its efficacy.

Some commonly used evidence-based therapy modalities include:

Your therapist might also use a blended or integrated approach, which means that they combine multiple modalities to provide tailored, individualized care based on your needs and mental health goals.

What types of therapy does Ambetter NOT cover?

Ambetter does not cover therapy services provided by practitioners who are not professionally qualified and licensed. This excludes many practitioners who are life coaches, as this profession is not recognized by Ambetter and many other health insurance companies. They also do not cover types of therapy that lack clinical rigor, including reiki healing, acupuncture, nutritional therapy, and more.

Does Ambetter cover online therapy?

Yes, Ambetter plans cover online therapy. One of Ambetter’s benefits for its members is access to Ambetter Telehealth, a 24-hour platform that provides members with access to care through an online connection. You’ll pay the same copay or coinsurance rates if you see your therapist online as you would if you met with them at their office.

Does Ambetter cover couples therapy?

No, Ambetter does not cover couples therapy — many health insurance plans do not provide this as a benefit, as it’s difficult to track a diagnosis when there is more than one person involved.

If you still want to engage in couples therapy, you have other options. Many people find it immensely helpful to work with a couples therapist to heal or grow their relationship with their partner or partners.

Do I need to see my primary doctor before starting therapy?

Yes, you will need to see your primary care doctor before starting therapy because Ambetter plans are HMOs. This is because you need a referral and because you may need pre authorization before your mental health benefits activate.

However, you can get this referral easily through Ambetter Telehealth, especially because this service is available to you around the clock. Once you have a referral, you’re ready to search for the perfect therapist for you.