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Published: August 2, 2023
If you or a loved one are seeking treatment for an alcohol or drug addiction, you may be wondering if your insurance company is going to cover the cost of treatment. The types of treatment you consider may change depending on your insurance coverage.
The Affordable Care Act (ACA) is a law that has made health care and insurance available to many people who previously would not have been able to afford it. The ACA also applies to addiction treatment and substance abuse screening as well.
Keep reading to learn about Aetna insurance coverage for substance abuse treatment, including:
Yes, Aetna insurance coverage extends to drug rehab due to the fact that substance abuse treatment generally falls under mental health treatment.
The Mental Health Parity and Addiction Equity Act of 2008 states that insurance providers such as Aetna must provide equal coverage for mental health care that they do for other types of medical care.
The extent of the coverage you receive from Aetna will depend on which of their plans you have signed up for. Each plan has a different level of coverage, which can affect how many out-of-pocket expenses you will be responsible for.
When you or a loved one are considering seeking alcohol and drug abuse treatment, it is helpful to understand your insurance benefits and the type of treatment coverage you have under your insurance policy.
There are many evidence-based treatment programs available, including inpatient and outpatient services. The following drug and alcohol treatment services are at least partially covered by Aetna insurance.
Medical detox is the first step in addiction treatment. Detoxification helps alleviate symptoms of withdrawal for patients who have a substance use disorder.
Most Aetna insurance plans do cover medical detox; however, you may need a doctor to refer you. This is called prior authorization, and it requires a doctor to fill out paperwork that proves the procedure or program is medically necessary.
Medication-assisted treatment is a common method of treatment for alcohol and opioid addiction. There are medications that assist people with addictions as they detox and begin rehab for alcohol or drug abuse.
You will find most Aetna insurance plans will cover at least some of the cost of medication-assisted treatment (MAT). Some of the approved medications for treatment include Vivitrol (naltrexone), Suboxone (buprenorphine), disulfiram, acamprosate, and methadone.
Inpatient rehabilitation, also known as residential treatment, is for patients who need around-the-clock supervision and care for a substance use disorder. It is one of the most successful rehab programs.
Aetna insurance programs will cover at least a partial amount of the total cost of inpatient rehab, though the amount will vary depending on which plan you have, where you live, and other factors. Prior authorization from a doctor can help with the amount of coverage in some cases.
In many cases, people who have a substance use disorder will also have a mental health disorder; this is called a dual diagnosis. Treating the mental health problem is usually a critical step in treating the addiction.
Aetna states they typically cover any medications prescribed for a co-occurring disorder during the course of addiction treatment, such as anxiety and depression medications.
Outpatient treatment programs offer a less-intensive level of care than inpatient treatment and are for people who do not require inpatient treatment or who are unable to attend.
There are many different types of outpatient rehab programs, including:
All Aetna plans cover at least some portion of outpatient care. In many outpatient programs, there are copays or coinsurance fees, and the exact amount you will be responsible for will vary depending on which plan you have signed up for.
Many addiction programs offer various types of counseling and behavioral therapies as part of their treatment curriculum. These therapies include cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), as well as group and family counseling.
Aetna has many plans, such as Aetna HMO, Aetna Select, Aetna Managed Choice, and Aetna Open Choice, that cover addiction-based therapies for individuals who need them.
Once a person has successfully completed an inpatient or outpatient treatment program, they may decide they still need assistance through aftercare programs. This assistance can be found in sober living programs, which help people maintain sobriety in their everyday lives.
Some Aetna insurance does cover sober living programs. However, you will find that most Aetna programs do not cover continuing care programs.
Aetna insurance has multiple policies that provide different amounts of coverage for drug and alcohol addiction treatment. This means that there is likely an Aetna insurance policy that best fits your specific needs.
However, there are factors that can affect your rehab coverage. These can range from your state of residence to prior authorization requirements.
Factors that can affect your Aetna coverage for alcohol and drug rehab include:
Yes, there are Aetna insurance policies that do cover out-of-network rehab programs, primarily in emergency situations.
However, this means that any addiction treatment center that is not part of the approved group of medical providers and treatment centers may charge you more than what Aetna is willing to cover.
Some Aetna insurance plans only cover out-of-network treatment in emergency cases.
When you sign up for healthcare through Aetna Health Insurance, you will find multiple options to choose from. Each plan offers different coverage options to meet each customer’s needs best.
While Aetna does have treatment plans in every state, each state has different laws and regulations for insurance coverage. Be sure to familiarize yourself with your state’s Aetna insurance policies.
There are a few Aetna healthcare plans that are the same across the country, however.
Aetna HMO is a Health Maintenance Organization plan, which means that if you need to see a specialist or any type of doctor outside of your primary care physician (PCP), you will need a referral from your PCP.
Aetna only provides coverage for medical providers in Aetna’s network that have been referred by a PCP.
Aetna Select is an insurance plan that is similar to Aetna HMO. With Aetna Select, if you need medical service coverage, you will need a referral from a primary care physician.
The Aetna Managed Choice plan is one of Aetna’s “network option plans.” This means that it provides some coverage for medical providers who are not in-network.
This plan still requires you to receive a referral from a primary care physician in order to receive care from a different doctor
The Aetna Open Choice PPO is the most flexible option in Aetna health insurance plans. This Preferred Provider Organization plan does not require you to receive a referral from a primary care physician, and it also does not require you to have a primary care physician.
The Aetna Open Choice PPO plan provides coverage from doctors and medical providers outside the network.
These are only a few of the many plans that Aetna has to offer future policyholders. Plans vary by location, because states have different laws for insurance companies. To make sure you are getting the most out of your insurance policy, contact an Aetna insurance agent today.
If you or a loved one are battling substance abuse, you may be unsure what your Aetna policy will cover. Alcohol and drug addiction treatment fall under the category of mental health services, and therefore many addictions are covered because of this.
Some of the addictions covered by Aetna Insurance include:
If you are still unsure whether your addiction is covered, call us today. Our addiction specialists are happy to walk you through your insurance coverage.
Understanding your treatment coverage can help you narrow down your treatment options when you are looking for addiction or behavioral health rehab treatment. One way to see which rehab centers take Aetna insurance is by calling and speaking to an Aetna representative.
Another way to find addiction treatment in your area is by logging into the member’s website for Aetna policyholders. There is a search bar that you can use to find a treatment center in your network.
If your Aetna policy requires you to have a referral to see a specialist, it will require your primary care provider to refer you to an addiction treatment center. You should keep this in mind if you are looking at an out-of-state treatment facility.
If you or a loved one are dealing with a substance use disorder, you may be interested in finding drug or alcohol rehab facilities in your area that Aetna covers. Knowing what your insurance covers can help you make an informed decision about your treatment.
Avoid the confusion of finding an in-network rehab facility on your own. If you are ready to begin your journey to recovery, call our phone number today to speak with experts who can help walk you through your insurance coverage.
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Insurance Coverage for Alcohol and Drug Rehab Programs