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Aetna Insurance Coverage for Rehab

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Two adults discussing an insurance coverage for addiction treatment

If you are considering seeking treatment for a substance use disorder, understanding the benefits that your Aetna insurance plan offers can help you make important choices regarding your treatment. Here we will explore the different types of alcohol and drug rehab centers that Aetna insurance plans often cover as well as how you can get the most out of your Aetna coverage when seeking the addiction care you need and deserve.

Does Aetna Provide Coverage for Drug and Alcohol Rehabilitation?

How someone will pay for drug and alcohol addiction treatment is often a common factor associated with making the decision to seek rehab. Many people believe that alcohol and drug rehab is expensive and even unaffordable. While it certainly may be costly to attend a substance addiction program, there are a number of resources available to assist individuals who would benefit from treatment. One of these resources is insurance, and Aetna is a well-known insurance company that offers coverage for addiction programs throughout the nation.

Aetna currently provides coverage for more than 20 million people throughout the United States as well as 500,000 individuals in other countries worldwide. This insurance provider offers several different types of plans and coverage options to best suit the needs of all individuals. And, because of the Mental Health Parity and Addiction Equity Act of 2008, Aetna and all other insurance companies are required to offer equal coverage for mental health services as what is offered for other medical services. Because most addiction treatment services are classified as mental health services, this means that many Aetna plans provide some level of coverage for substance abuse and addiction programs.

Different Types of Insurance Plans Offered by Aetna

Aetna offers a number of different insurance plans to best cater to every customer. While Aetna’s plans vary from state to state, the following are a few of the company’s most commonly offered healthcare plans:

  • Aetna HMO: A Health Maintenance Organization (HMO) plan is one that requires Aetna customers to first receive a referral from their primary care physician (PCP) before they see a specialist or another type of doctor. Aetna HMO plans may only offer coverage for medical providers in Aetna’s network and that have been referred through a PCP.
  • Aetna Select: This healthcare plan is similar to Aetna’s HMO plan and requires PCP referrals for customers to be eligible to receive medical service coverage.
  • Aetna Managed Choice: This plan is considered one of Aetna’s “Network Option Plans” in that it may provide some coverage for medical providers outside of Aetna’s network. This plan also requires a primary care physician referral for patients to seek treatment from other types of medical providers such as addiction counselors or to attend a rehab program.
  • Aetna Open Choice PPO: The Aetna Preferred Provider Organization (PPO) plan provides the most flexibility out of all plans mentioned in this section. This healthcare plan does not require a customer to have a primary care physician or to receive referrals from their PCP before coverage will be provided. This plan may also offer coverage for medical providers outside of the Aetna healthcare network.

It’s important to note that these plans are just a few of the many that are offered by Aetna and may vary greatly depending on the geographical location. Please speak with an Aetna insurance representative to find out the specific details of your healthcare plan.

What You Need to Know About In-Network versus Out-of-Network Aetna Coverage

Understanding in-network versus out-of-network coverage is an important component to making decisions regarding where and what kind of drug rehab center you seek. As with many other insurance companies, Aetna offers both healthcare plans that cover out-of-network services and those that do not cover them. This means that, depending on your plan, if you seek treatment at a medical facility that is not within Aetna’s network, you may not be eligible to receive coverage through your insurance plan.

A medical facility or drug and alcohol rehab program that is in Aetna’s network is one that works directly with the insurance company to come to an agreement regarding the payment requirements for Aetna customers. In-network medical services are typically more affordable than out-of-network services because of this agreement. For example, you may only be required to pay a $35 copay to see an in-network doctor, whereas at an out-of-network medical center you may be held responsible to pay for the full cost of the doctor’s visit out-of-pocket.

Knowing whether your Aetna plan covers out-of-network medical services can play an important role in deciding where you will seek drug and alcohol addiction treatment. For example, if an inpatient rehab center does not accept Aetna insurance, you may have to pay 100 percent of the costs out-of-pocket. However, if you choose to go to a treatment facility that does accept Aetna insurance, you will likely be able to save a significant amount of money depending on the type of plan you have.

Will Aetna Insurance Cover a Medically – Supervised Detox Program?

Attending a medically-supervised detox program is often the first step for people seeking intensive treatment for alcohol or drug addiction. A detox program is where a person can safely and effectively withdraw from substances under the care and supervision of medically trained staff. Most Aetna healthcare plans offer some level of coverage for medically-supervised detox programs.

It’s important to note that your Aetna insurance plan may require you to receive prior authorization before it will provide coverage for a detox program. Prior authorization is when a patient is recommended by a medical professional for a particular service or the service is deemed medically necessary for the patient’s wellbeing. Paperwork may need to be filled out and submitted to Aetna to complete the prior authorization process and receive approval for treatment.

Will My Aetna Insurance Plan Cover Inpatient Drug Rehab?

Inpatient rehab for drug and alcohol addiction is one of the most intensive forms of treatment as well as one of the most successful in many cases. Inpatient treatment requires patients to reside at a residential treatment facility for several weeks and even months. At the facility, patients will undergo intensive daily treatment aimed at helping them get and stay sober in the long-term. Patients remain under professional supervision 24 hours a day and maybe regularly drug tested to ensure sobriety throughout the extent of inpatient treatment.

Most if not all Aetna healthcare plans offer some level of coverage for inpatient addiction rehabilitation centers. However, the level of coverage provided can vary significantly depending on the location and type of insurance plan a person has. Many plans will provide more coverage when treatment is pre-authorized, and some plans may not offer any coverage if prior authorization is not first provided. Preferred provider organization (PPO) plans typically offer higher levels of coverage for inpatient drug and alcohol addiction treatment; however, exact coverage levels will vary. You should speak with an Aetna representative before attending an inpatient treatment program to ensure you fully understand your coverage options and what you will be expected to pay for rehab.

You should consider inpatient addiction treatment if you fall under one or more of the following categories:

  • You are addicted to more than one substance
  • You have been diagnosed with both a mental health condition and a substance use disorder (known as co-occurring disorders)
  • You cannot stop using drugs or alcohol without regular supervision
  • You are physically addicted to drugs and/or alcohol and experience intense withdrawal symptoms when not taking substances
  • You do not have a reliable method of transportation to get to an outpatient program daily or weekly
  • You live in an environment where drugs and/or alcohol is regularly abused
  • You do not have a good support system

If you are unsure if inpatient addiction treatment is the best option for you, speak with a medical professional to determine what kind of program you would most benefit from.

Will My Aetna Insurance Plan Cover Outpatient Drug and Alcohol Rehab Program?

Outpatient addiction treatment is a less intensive option for individuals who are unable or not recommended to attend an inpatient program. There are several different types of outpatient drug and alcohol addiction programs, including intensive outpatient programs (IOP), partial hospitalization programs (PHP) and standard outpatient treatment. Each type of outpatient program ranges in intensity, so you should work with a medical professional to determine which form is best for your unique condition.

Most Aetna healthcare plans will provide some level of coverage for outpatient rehab. This type of addiction treatment typically requires copays or coinsurance payments per visit, but exact payment obligations will vary depending on the Aetna plan and outpatient program. Some insurance plans will obligate customers to receive prior authorization before coverage will be provided for outpatient addiction treatment.

You should consider seeking outpatient rehabilitation for a substance use disorder if you:

  • Cannot take time off from work for an extended period of time to attend an inpatient program
  • Have a more mild substance use disorder
  • Have a home environment that is free from drug or alcohol abuse
  • Have a reliable support system
  • Are able to attend an outpatient program daily or several times a week

Are Any Other Drug and Alcohol Addiction Services Covered Under Aetna Insurance?

There are a number of additional addiction treatment services available both as part of inpatient or outpatient programs as well as offered separately. Most Aetna healthcare plans will provide partial or full coverage for addiction services that have been deemed medically necessary for the patient. However, each plan will vary on whether coverage is offered as well as the level of coverage offered for each treatment service.

Frequently covered addiction services include:

  • Therapy: Many addiction treatment programs incorporate various types of therapy into their approaches to recovery. Common forms of therapy used in addiction treatment include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), motivational interviewing and rational emotive behavior therapy. Additionally, individual, group and family counseling are also frequently used in the treatment of drug and alcohol addiction. While various therapies are used in outpatient and inpatient programs, they can also be sought on their own. For example, an individual may choose to see an addiction therapist who uses cognitive behavioral therapy several times a week before choosing to enter an inpatient program. Most Aetna plans offer coverage for addiction-based therapies.
  • Medication-assisted treatment (MAT): Medication-assisted treatment is a common addiction service used in the treatment of alcohol and opioid use disorders. Most Aetna plans will provide some level of coverage for MAT. Common drugs used in a MAT program include Vivitrol (naltrexone), Suboxone (buprenorphine), Disulfiram, Acamprosate and methadone.
  • Other medications: It is not uncommon for individuals in a treatment program for addiction to be prescribed medication to help decrease withdrawal symptoms as well as address co-occurring disorders. For example, someone struggling with a substance use disorder as well as an anxiety disorder will likely be prescribed an anxiety-reducing medication. Aetna healthcare plans typically cover medications prescribed during the course of drug and alcohol addiction treatment.
  • Recovery housing: Once a person has completed an inpatient treatment program, they may choose to continue their recovery in a sober living program. This type of program offers a safe and drug-free environment where a person can live for a period of time following addiction treatment. Some Aetna plans may offer coverage for recovery housing; however, many will not.

Questions to Ask When Learning about Your Addiction Services Coverage with Aetna

It is always recommended that you get in touch with an Aetna insurance representative before deciding on a treatment program to ensure you fully understand your coverage options. When speaking with a representative, be sure to ask the following questions:

  • Will my Aetna healthcare plan cover inpatient treatment? If so, how many days in treatment will my insurance plan cover?
  • Will my Aetna insurance plan provide coverage for outpatient addiction programs? If so, what type of outpatient treatment is covered (IOP, PHP, etc.)?
  • Does my Aetna plan require prior authorization for any drug and alcohol addiction treatment services?
  • What am I required to pay out-of-pocket for each type of treatment program?
  • What additional addiction services are covered by my plan? What addiction services are not covered under my Aetna insurance?

How to Find and Choose an Addiction Rehab Facility that Accepts Your Aetna Insurance Plan

Aetna insurance provides coverage for a number of different forms of addiction treatment at several medical facilities throughout the nation. Understanding your coverage options and the treatment facilities that are in your insurance plan’s network are important aspects of seeking treatment for a substance use disorder. To learn more about the coverage offered by your Aetna plan and the treatment centers that accept your insurance, contact our treatment team today.