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Aetna Insurance for Addiction Treatment

Founded in 1853 and active in all 50 states, Aetna’s network coverage includes 1.2 million healthcare professionals, almost 700,000 primary care doctors and specialist and over 5,700 hospitals.1The company has over 46 million members in its various health plans, including regular health insurance, dental insurance, and vision insurance.2

As part of the Affordable Care Act (ACA), Aetna provides marketplace insurance plans that cover some or all the costs of drug and alcohol rehab programs. If you have Aetna health insurance and are searching for a drug and alcohol treatment facility that is covered by your plan, American Addiction Centers (AAC) is here to help.

American Addiction Centers (AAC) strives to provide you with the most updated information on each carrier’s addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.


How to Check Your Insurance Benefits?

Before choosing the right rehab treatment center for you, check your Aetna policy benefits to determine which costs will be covered by your insurance company and which will be out-of-pocket for you. Call the number on the back of your insurance card or log in to your account on Aetna’s website to learn more about what your specific policy plan covers.

Knowing exactly what your Aetna plan covers can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Aetna insurance plans and to check what your plan covers, call , click here, or fill out the form below.


Does Aetna Cover Addiction Treatment?

You may be wondering if your Aetna insurance plan covers alcohol and drug addiction treatment. The short answer is yes. Aetna will cover at least some of your addiction treatment. Based on the plan you have, your treatment may be partially or fully covered.

The Affordable Care Act (ACA) requires all insurance companies to provide some type of coverage for alcohol and drug treatment. The ACA requires all health insurance plans to cover behavioral health treatment (e.g., psychotherapy and counseling), mental health inpatient services, and substance use disorder (SUD) treatment.3

The financial responsibility you have for your treatment will depend on the state you live in, the healthcare plan you have, the treatment you need, and if you choose an in-network or out-of-network facility. No matter what treatment facility you choose and what insurance policy you have, you will likely be responsible for paying some out-of-pocket costs.


What Are Aetna’s Coverage Levels and Plans?

Aetna offers open-access plans, copay only plans, and high-deductible plans.4

  • Open-access plans allow you to choose your doctors; they don’t require a referral, and they don’t require a primary care physician.
  • Copay-only plans will guarantee that your costs after paying your deductible are only copays, with primary care physician visits and generic drugs covered before you hit your deductible.
  • High-deductible plans offer preventative care services before the deductible is met, sometimes coverage through a primary care physician before the deductible is met (with copay), and the option of a health savings account. To view your plan’s details, you can log into the member website.

Aetna offers many local plans supported by the national network of providers to better support patients at the community level. For example, at AAC, our facilities frequently provide care for patients of Schaller Anderson Aetna Better Health networks of New York and Ohio.5,6

Aetna, Medicare & Medicaid

Aetna works with federal insurance programs like Medicare and Medicaid to supplement rehab expenses just as they do other healthcare costs.

Aetna Medicare Advantage plans supplement your Medicare Part A and B with additional coverage and, many times, lower deductibles and copayments.9 Medicare Advantage plans are HMOs, HMO-POS plans, or PPOs which can be used for alcohol & drug rehab coverage.

Aetna provides Medicaid plans in 17 states.10 From California to New York, you might be able to access low-cost coverage through this insurer. The specific coverage you’ll receive will vary depending on which state you live in.


What Length of Addiction Treatment Will Aetna Cover?

If you’re not ready to seek treatment because you’re worried about what others might think, you’ll be glad that you have Aetna. Aetna offers members 24/7 support, and it can help you find a doctor or rehab center quickly.

Anything that you say to your representative is kept confidential, and the company will be discreet when it comes to handling your needs. The company’s new plan calls for a combination of private therapy and 12-step programs to treat prescription drug addiction, and the duration of your stay depends on your coverage. Regardless of the length of your stay, you’ll feel safe and protected.

When you call your insurance company, you’ll want to ask the representative some questions about your coverage. Some questions include:

  • Do you cover substance abuse assessment?
  • Do you cover detox services? How many days?
  • Do you cover outpatient rehab?
  • Do you cover inpatient rehab?
  • How many days of rehab do you cover?
  • Which programs in my area accept Aetna?

What Types of Addiction Treatment Does Aetna Cover?

With most Aetna plans covering at least some of the costs of treatment for alcohol addiction or drug addiction, the types of treatment can vary in intensity and frequency. Types of treatment may include:7,8

  • Detox: Medical detox helps you withdraw safely from drugs and alcohol. Under 24/7 medical supervision, staff will work closely with you—and may prescribe medications to help ensure that you withdraw safely and that your symptoms are addressed as needed.
  • Inpatient or residential treatment: With inpatient treatment, you receive treatment and live at the facility. Inpatient treatment typically involves group and/or individual therapy. It is often recommended for individuals with co-occurring mental health issues, limited outside support, home environments that don’t lend themselves to sobriety, and poor treatment outcomes in the past.
  • Partial hospitalization: These programs allow you to live at home throughout treatment and spend your days at the treatment facility. This is sometimes referred to as day treatment.
  • Intensive outpatient programs: These programs typically involve attending treatment programs approximately 3 evenings a week. People in these programs can live at home and go to work during the day.
  • Outpatient treatment: An outpatient facility lets you meet with doctors and therapists, and you can even attend group sessions and recovery meetings before heading back home at the end of the day. With a residential program, you get the chance to focus solely on your recovery without any daily tasks getting in your way or slowing down your progress.

When you decide to get treatment for a drug or alcohol addiction, you will need to decide what type of treatment is best for you.


Do Treatment Centers Need to Be In-Network?

In most cases, you will need to seek treatment at a facility that is in-network with Aetna to receive your full benefits. Even if you choose a treatment facility that is in-network, you may still be responsible for some of the treatment costs.

If you choose a facility that is out-of-network, you may be responsible for all the costs of your addiction treatment. You may be able to discuss financing options such as a payment plan or scholarships offered by the facility.


How to Verify the Coverage of Your Aetna Plan?

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the treatment center, the type of program attended, and specific services received.

Before deciding on a rehab center, check your Aetna policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Aetna’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the center you are considering is in-network with Aetna. Or, call to speak to one of our admissions navigators to have them check your benefits and help you understand what is covered.


What Should I Do if Aetna Won’t Cover the Total Cost of Rehab?

If your Aetna insurance policy does not cover all your rehab expenses, it’s important not to let that stop you from getting treatment. You don’t have to use the insurance when you decide to check into rehab. There are many other ways to finance your treatment and get the help you need. Some ways to pay for rehab include:

  • Payment plans: You pay off rehab in affordable installments.
  • Sliding scale: The rehab decreases your cost to something you can reasonably afford—typically based on your income level.
  • Grants or scholarships: The Substance Abuse and Mental Health Services Administration (SAMHSA), as well as individual rehabs, offer grants and scholarships to pay for people who can’t afford treatment.
  • Purchase affordable insurance on the Healthcare Marketplace.
  • Open a healthcare credit card or take out a specialized healthcare loan.
  • Use your savings or a credit card.

Make sure to do thorough research when looking for rehab so that you can find one that meets your financial needs.

Here are additional resources that provide more information about other ways to pay for rehab with or beyond what Aetna covers:

We know that finding a rehab center is a confusing task, but we’re ready to help you navigate through the world of treatment centers. Call one of our admissions navigators if you’re worried about a loved one or you’re ready to take action to begin the process toward recovery.


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Health Insurance Providers and Coverage Levels


Sources

  1. Aetna. (n.d.). Aetna Home Page.
  2. Aetna. (n.d.).  Aetna Facts.
  3. Healthcare.gov. (2021). Mental Health and Substance Abuse Coverage.
  4. Aetna. (n.d.). Medical Insurance Plans for Individuals and Families.
  5. Aetna. (n.d.). Aetna Better Health of New York.
  6. Aetna. (n.d.). Aetna Better Health of Ohio.
  7. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  8. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.
  9. Aetna. (2020). Medicare Advantage Plans.
  10. Aetna Better Health. (2020). Medicaid plans.

More resources about Aetna Insurance for Addiction Treatment: