Seeking Therapy with Ambetter in Illinois: What You Should Know

At CARE Counseling, we understand that navigating health insurance can feel intimidating—especially when you’re already taking the important step of seeking mental health support. If you have an Ambetter Health Insurance plan (offered through the Illinois Health Insurance Marketplace), this guide will help you understand your benefits, what to check before your first session, and how to get started on your path to wellness.

Does Ambetter Cover Therapy?

Yes. Under the Affordable Care Act, mental and behavioral health care is considered an Essential Health Benefit. This means that almost all Ambetter plans—including Bronze, Silver, and Gold tiers—provide coverage for treatment that supports emotional wellbeing.

At CARE Counseling, our research-backed services are often covered by Ambetter, including:

• Individual outpatient therapy

• Telehealth and virtual therapy sessions

• Diagnostic assessments

• Treatment for anxiety, depression, and trauma

How Your Ambetter Mental Health Coverage Works

Insurance benefits can vary based on your specific plan and state. Here are the four key components to understand before your first appointment:

1. The Value of In-Network Providers

To maximize your coverage and reduce out-of-pocket costs, it’s essential to work with a therapist who is in-network with Ambetter of Illinois. When you see an in-network provider at CARE Counseling, you typically only pay your predetermined copay or coinsurance rather than the full session fee.

2. Understanding Your "Metal Level"

Your plan level dictates how you and Ambetter share the costs of your therapy:

Plan Level Monthly Premium Out-of-Pocket Costs Bronze Lowest Higher deductible and copays Silver Moderate Balanced cost-sharing (Best Value) Gold Highest Lowest out-of-pocket expenses

3. Referrals and Prior Authorizations

While most Ambetter plans do not require a referral from a primary care doctor to start therapy, some specialized services may require prior authorization to confirm "medical necessity." Our administrative team can help you navigate these requirements.

4. Copays and Deductibles

Your financial responsibility depends on your plan's details. Once your annual deductible is met, Ambetter will cover a significant portion of the session cost, and you will be responsible for a small copay (often between $20 and $50).

Frequently Asked Questions (FAQ)

Q: Is CARE Counseling in-network with Ambetter of Illinois? A: Yes, we are a participating provider with Ambetter. We recommend providing your member ID to our intake team for a specific benefit verification to ensure your particular plan is covered.

Q: Does Ambetter cover virtual (telehealth) therapy? A: Yes. Ambetter provides robust coverage for telehealth sessions, often at the same cost-sharing rate as in-person visits, allowing you to access care from the comfort of your home.

Q: What is a "Summary of Benefits" and where do I find it? A: This is a document that outlines what your plan covers. You can find your "Schedule of Benefits" by logging into your Ambetter Member Portal or by calling the number on the back of your insurance card.

Q: Can I use "My Health Pays®" rewards for therapy? A: Yes! In 2026, Ambetter members can earn up to $500 in rewards for healthy activities. These rewards can often be used to help pay for healthcare-related costs like copays and deductibles.

How CARE Counseling Supports You

Navigating insurance shouldn't be a barrier to healing. At CARE Counseling, our administrative team acts as your advocate by:

• Verifying your Ambetter benefits before your first visit.

• Explaining your exact costs so there are no surprises.

• Matching you with a clinician who fits both your clinical needs and your insurance network.

Take the Next Step

Seeking therapy is a positive investment in your future. With the right information and support, you can access meaningful care with clarity and confidence.

Ready to explore therapy with Ambetter coverage? Visit carecounseling.healthcare today to schedule a consultation or request benefit verification. We’re here to walk with you at every step of your mental health journey.

Building a community to strengthen the community—one session at a time.