Ambetter for Therapy

Ambetter is a health insurance company that offers plans across nearly half of the country. They connect their members with numerous 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 you’ll receive for therapy depends on your specific plan. It’s important to understand the exact details of your health insurance coverage so you aren’t on the hook for any surprise costs.

How to Check if My Ambetter Plan Covers Therapy

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

Ambetter considers therapy for mental health treatment as a specialty service. When looking at the Schedule of Benefits document, find the line that refers to “Mental Health and Substance Use Disorder Benefits.” The document should provide you two options — working with an in-network or out-of-network provider. Here, you can see how much therapy will cost you.

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 Ambetter?

Because there are different tiers of Ambetter plans, how much you pay for each therapy session you attend depends on your plan. Your Schedule of Benefits should outline coverage with an in-network therapist. In general, you can expect to pay a $20 to $30 copay after the deductible for each therapy session with an in-network therapist. 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. This is the percentage of the session fee that you’re required to pay, which can be around $100.

You might also need pre-authorization to use your Ambetter plan to cover therapy costs — this determines if these services are “medically necessary.” Without prior authorization, you may have to pay the entirety of the session fee out of pocket.

Ambetter also encourages its members to utilize in-network therapists. If you receive services from an out-of-network mental health provider, you may be responsible for the entire bill.

Do I Need a Doctor Referral to Start Therapy?

No, you do not need a referral from your primary care physician (PCP) to see an in-network therapist. However, you may need pre-authorization to receive coverage for mental health services, like therapy.

This process involves your mental health provider submitting your diagnosis and treatment plan to Ambetter's behavioral health utilization management staff, who will either approve or deny the cost of the therapy.

A mental health provider who is in-network with Ambetter can help you through this process.

FAQs About Types of Therapy Covered With Ambetter

Navigating therapy and your Ambetter plan coverage can be challenging. Here are some frequently asked questions to help guide you as you search for the right therapist for your mental and emotional health.

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. That means you could receive therapy from a psychologist, psychiatrist, licensed professional counselor, social worker, or nurse practitioner — just to name a few. However, they must:

Be licensed to provide therapy in the state where you live.
Use evidence-based treatment methods backed by clinical research.
Provide treatments deemed medically necessary for your specific mental or emotional health issues.

That means your Ambetter insurance should cover some of the most widely used therapy methods, including:

If your therapist uses a blended approach or combines multiple modalities tailored to your treatment, that does not impact your coverage — as long as care is based on your needs and mental health goals.

Does Ambetter Cover Online or Telehealth 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.

What Types of Mental Health Conditions Does Ambetter Cover?

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

Ambetter recognizes that treatment for mental health conditions is just as medically necessary to your overall health as a physical ailment. That's why many plans provide coverage for the following mental health conditions and more:

What Types of Therapy Does Ambetter NOT Cover?

Ambetter does not cover therapy services provided by practitioners who are not professionally qualified and licensed. One example includes life coaches, as Ambetter and many other health insurance companies do not recognize this profession.

Ambetter also does not cover therapies that are not backed by evidence-based research. This includes:

Reiki healing
Acupuncture
Nutritional therapy
And other mental health treatments outside of conventional therapies

Does Ambetter Cover Couples Therapy?

No, Ambetter does not cover couples therapy. Many health insurance plans do not provide this as a benefit, as relationship issues are not typically classified as medical conditions.

Numerous people find it immensely helpful to work with a couples therapist to heal or grow their relationship with their partner. So, if you still want to engage in couples therapy, it is possible to find ways to use your insurance coverage for treatment.

Why Let Zencare Help You Find an Ambetter In-Network Therapist?

Whether you're struggling with anxiety or feeling more sad or hopeless than usual, you deserve quality treatment. Talking to an in-network therapist should be covered by your Ambetter insurance plan — so why not use these benefits to help you feel better?

Zencare can help you find a safe and supportive therapist within your insurance network. Whether you prefer the convenience of virtual therapy or you'd like someone you can meet with face-to-face, we've got you covered. There are many reasons to utilize our personalized therapist matching services, including:

Simplified searching: To find the right therapist without feeling overwhelmed.
Vetted professionals: Helping you locate a licensed and qualified therapist for high-quality care.
Personal connection: Video introductions help you connect even before your first session
Streamlined services: Easily book your initial consultation online.

Start Your Search for an In-Network Ambetter Therapist

Zencare is here to help you find a vetted therapist who works with your Ambetter insurance plan. Take our matching quiz or select your state to find an in-network therapist near you: