CVS Health Insurance Coverage for Rehab

CVS Health is an insurance provider that supplies health insurance to millions of Americans through Aetna. In addition to coverage for many other health services, many people use their CVS Health plan to access addiction treatment.

If you or your loved one is a CVS Health policyholder, you may be seeking out information about addiction rehab coverage under your plan.

Scroll on to learn all you need to know about CVS Health coverage including coverage levels, what to expect in treatment, and more.

Answer: Yes, CVS Health does cover alcohol and drug addiction treatment. However, this coverage comes with limitations that are important to understand.

Currently, substance abuse treatment is listed as one of the 10 essential health benefits under the Affordable Care Act (ACA) passed in 2010. As a result, all healthcare plans, including those from CVS, are required to cover addiction care services at least in part.

In addition, CVS Health is only available in the following states:

• Arizona (Banner Aetna)
• California
• Delaware
• Florida
• Georgia
• Illinois
• Missouri
• North Carolina
• New Jersey
• Nevada
• Texas
• Virginia

Answer: There are several effective addiction treatment options covered by CVS Health. Coverage will vary between options.

Keep reading to learn a little bit about some common addiction treatment options and how much coverage you may be eligible for.

Medical Detox

Many CVS Health plans cover medical detoxification. You will likely be responsible for coinsurance at a set percentage for this service.

Medical detox is typically offered at the beginning of a treatment program, inpatient or outpatient, and is a treatment service that helps your body detox from any addictive substances.

Trying to detox on your own can be very dangerous, which is why medical detoxification is such an important offering.

Detoxing is made safe through the care of your providers as they monitor your vitals, help manage withdrawal symptoms and cravings, and administer any necessary medications or additional treatments.

Medication-Assisted Treatment

Medication-assisted treatment is another treatment service most CVS Health insurance plans cover.

If you receive this service in an inpatient setting you’ll likely have to pay coinsurance, whereas outpatient settings will require a copay per visit.

MAT is a unique rehab treatment that uses U.S. Food and Drug Administration (FDA)-approved medications such as Suboxone, methadone, or buprenorphine to treat addiction.

It’s typically used in opioid addiction and alcohol addiction and works by reducing cravings and the risk of relapse down the road.

MAT is used in combination with other treatment options to ensure a comprehensive approach, and is often continued for an extended period of time.

Inpatient Rehab

CVS Health plans do cover inpatient treatment programs to an extent. In most cases, you’ll be responsible for coinsurance.

Inpatient rehab is the most regimented treatment option when it comes to substance abuse rehab. It requires individuals to live in a care facility throughout their treatment program in order to provide round-the-clock care.

During inpatient rehab, you can expect to have a regular schedule with several treatment services. This treatment option is where many people start their recovery journey.

Dual Diagnosis Treatment

Dual diagnosis treatment is another treatment option many CVS Health plans will help cover. Much like with inpatient rehab, your out-of-pocket expense will likely include coinsurance.

Many people who have substance use disorder (SUD) also have mental health disorders such as post-traumatic stress disorder (PTSD), anxiety, bipolar disorder, or depression. These mental illnesses can exacerbate addiction or even be the root of it.

Dual diagnosis treatment is a rehab approach that addresses both physical wellness and behavioral health simultaneously.

In other words, your mental health issues and addiction will be treated together. This typically involves counseling and therapy as well as other mental health services.

Outpatient Treatment Programs

Many CVS Health plans also cover outpatient rehab. Outpatient office visits are not subject to your deductible, but are subject to a copay per visit. Other outpatient services are subject to coinsurance.

Outpatient treatment is a less intensive treatment option than inpatient treatment, making it a great option for people who have completed an inpatient program or have less severe addictions.

It also does not require you to live in a care center, so it’s great for people who cannot leave home for extended periods of time.

During an outpatient program, you’ll travel to a rehab center several days a week and stay for treatment for several hours. There are also variations of outpatient treatment such as partial hospitalization programs (PHPs) and intensive outpatient programs (IOPs).

Counseling & Behavioral Therapy

When it comes to counseling and behavioral therapy, coverage through your CVS Health insurance plan will depend on the treatment modality.

Inpatient counseling and therapy will typically leave you responsible for coinsurance whereas outpatient counseling and therapy may require a copay per visit.

Counseling is a common treatment option that allows participants to share their thoughts, goals, and successes concerning addiction and recovery. It is offered in individual and group settings.

Behavioral therapy is a kind of talk therapy specifically designed to reframe behavioral patterns and thought processes that contribute to addiction or mental health issues.

There are several kinds of behavioral therapy, but some common ones include cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT).

Continuing Care

Sometimes called aftercare, continuing care is unique when it comes to coverage through CVS Health. This is because aftercare differs greatly from person to person.

As you reach the completion of your treatment program, you and your care team will devise an aftercare strategy based on your individual needs. Because this will include different services for each individual, coverage also differs.

For example, some aftercare services like 12-step groups or group therapy are free and will not require coverage.

On the other hand, some options like behavioral therapy or MAT have a cost, and are likely eligible for coverage. Finally, some services like sober housing are not usually eligible for coverage.

are several factors taken into consideration when determining coverage levels.

Factors that may affect your coverage through CVS Health include:

• Your plan: First and foremost, the type of plan you have with CVS Health will affect your coverage. This is because different plans offer different coverage levels, even within the same health insurance company.
• Your location: Where you live can also affect your coverage levels. This is because states have access to different healthcare plans as well as different regulations surrounding health insurance and coverage.
• Type of treatment: Some people may need a particular type of treatment, which can affect coverage levels. This is because services are eligible for different levels of coverage.

Answer: No, CVS Health does not cover out-of-network addiction treatment providers. That being said, you’ll need to stick to programs at facilities in your network to ensure you receive coverage.

If you choose to see an out-of-network provider, keep in mind your out-of-pocket cost will be the total cost of your treatment.

While there are other payment options like payment plans or sliding scale payments, your lowest out-of-pocket cost will always be with in-network providers.

Read on to learn some of our tips and tricks for finding treatment centers in your network later on.

CVS Health offers a wide range of commercial, individual and family, Medicare, and Medicaid plans through Aetna health insurance.

Plan options may include:

Commercial plans:

• Bronze plans
• Silver plans
• Gold plans
• Health savings account (HSA) plans

Aetna CVS Health ACA Marketplace plans:

• Bronze plans
• Silver plans
• Gold plans

Aetna Medicare Advantage plans

Aetna Better Health plans

CVS Health covers almost all kinds of substance addiction as coverage is not dependent on addiction type.

Some common addiction types that are covered include:

• Meth
• Alcohol
• Heroin
• Cocaine
• Opioids
• Benzodiazepines
• Prescription drugs

Other types of addiction may be covered, but it’s best to check with CVS Health directly to be sure.

There are several great ways to find treatment facilities that accept your CVS Health insurance plan. We’ve listed a few below.

1. Take advantage of your member portal on the CVS Health website. In your portal, you’ll see a “Find a doctor” tool. Here, you can search for substance abuse treatment to find rehab facilities close by that accept your insurance plan.
2. Talk to your healthcare provider. If you’re seeing a primary care physician for your addiction, don’t be afraid to ask them for referrals. They should be able to provide a few recommendations for treatment centers in your network.
3. Check out our list of addiction treatment centers by state. Each list contains some of the top reliable and accredited facilities in your state alongside relevant insurance

Accessing addiction treatment can be much easier with financial assistance through health insurance. CVS Health covers a range of addiction treatments and types.

If you or your loved one is in need of additional guidance with insurance coverage and substance abuse treatment, give our helpline a call today.