Does Aetna Insurance Cover Drug and Alcohol Rehab?

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Choosing to get treatment for an addiction is a significant act of courage. However, you may wonder: Does insurance cover drug rehab? The good news is that many insurance companies offer at least some drug and alcohol addiction treatment coverage. It’s important to learn about the plan you are enrolled in, what’s covered, and what copayments or deductibles may apply. Aetna Insurance mental health coverage is available. Let’s take a look at the healthcare benefits you may be entitled to as you begin your journey to recovery.

Please note: While American Addiction Centers (AAC) works hard to provide you with the most updated information on each insurance carriers’ addiction insurance coverage, policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. AAC is not affiliated with or endorsed by Aetna or any of its licensees.


Aetna Coverage Levels and Coverage Plans of Aetna Insurance

Does Aetna cover drug rehab? Different Aetna medical insurance policies will have different levels of healthcare coverage for addiction treatment. While basic addiction treatment coverage is required by the Affordable Care Act, the exact programs covered and the deductibles or copayments that apply will vary based on your policy.1 Aetna has a program called Screening, Brief Intervention and Referral to Treatment (SBIRT) that is used to help treat addiction and reduce the severity of use and trauma that results.2 To participate, a patient has to have an Aetna Insurance health plan and be at least 9 years old.

If you have Medicare through Aetna, your coverage will be different than a traditional health plan. Aetna Medicare Advantage  works alongside your traditional Medicare coverage.3 It helps you access expanded treatment options and may offer lower deductibles and copayments. Depending on your plan, you may have the flexibility to seek out-of-network treatment.

A Medicaid plan managed by Aetna may give you addiction treatment coverage. Aetna offers Medicaid plans in 14 states across the U.S.4 Coverage will vary by state, so you’ll need to call the insurance provider to get specifics about your plan. As an example, in many states, Medicaid will cover a buprenorphine prescription for addiction treatment. The key to using Medicaid for treatment is to find a treatment plan or facility that will accept it. You may need to contact different programs and ask questions before settling on the right facility for your needs.

Does Aetna Insurance Cover Inpatient Treatment?

You may be wondering about Aetna insurance for inpatient treatment. Most Aetna policies cover inpatient drug or alcohol programs. However, the exact amount of coverage you have may vary, so be sure to fully understand the details of your insurance plan. Not all inpatient treatment programs will be covered. You’ll also need to speak with your insurer and the program you’re interested in to find out what deductibles and copayments might apply. The program may have payment assistance if you can’t afford the portion of the cost that you’re responsible for.

Does Aetna Insurance Cover Outpatient Treatment?

Outpatient treatment allows you to receive help for your addiction without living in a center or program facility. You’ll need to choose a program that’s approved and covered by Aetna insurance. The insurance company will want to verify that the plan is effective and uses evidence-based treatment. Aetna insurance for outpatient treatment may require preauthorization before you enroll. Work closely with the insurer so that they are aware of the program you’re choosing and when you’re scheduled to begin.


How Do I Check My Insurance Benefits?

The best way to learn about your specific Aetna insurance therapy coverage is to log in to your online account on the Aetna member website.5 You’ll be able to review your coverage and benefits, print your insurance card, and find out whether a specific doctor is within the insurance network.

Your doctor will be able to help you get the referral you need for proper addiction treatment. A variety of programs are available, and Aetna offers doctors a variety of tools, including criteria from the American Society of Addiction Medicine, to help determine the best course of treatment.6

A treatment deemed medically necessary is much more likely to qualify for Aetna drug rehab coverage. You can contact the program directly and ask if they accept Aetna health benefits. However, your insurer has the final word about what is covered and how much payment is made.


Does My Health Insurance Plan Cover Drug and Alcohol Addiction Treatment?

An Aetna medical coverage policy should provide at least some coverage for addiction treatment. However, the exact programs covered and how much of the payment you’re responsible for will vary.

You’ll want to contact the insurance provider to determine what your financial responsibility will be as you seek treatment. Remember that costs may be different if the treatment center is in-network or out-of-network, so ask about a variety of options. If you’re not sure if a program is covered, contact Aetna, verify your insurance here, or fill out the form below.

Some treatment programs, including outpatient programs, may require a pre-certification to ensure the treatment meets Aetna’s criteria for coverage. Check with the insurance company to see if the program you’re interested in needs pre-certification before you begin.

Addiction treatment is a significant and important step, and the good news is that it’s more accessible today than it has been in the past. To find out the specifics, including copays and deductibles, it’s important to contact the insurer directly. Treatment is the first step on a journey to a long and happy life.


Sources

  1. Aetna Patient Care Programs. LOCAT, ABA, & ASAM guidelines.
  2. Healthcare.gov. Mental health & substance abuse coverage.
  3. Aetna Medicare Solutions. Medicare Advantage plans.
  4. Medicare Advantage, alcoholism, and substance abuse treatment: What you should know.
  5. Aetna. Member login.
  6. Aetna documents for healthcare professionals. Let’s get there: Screening, brief intervention and referral to treatment program.

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You are never too old to improve your health and quality of life!

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