Aetna covered Alcohol and Drug Treatment Rehabs
Does Aetna Insurance Cover Drug Rehab?
Yes, Aetna insurance plans cover part or all of drug rehab services.
The Affordable Care Act (ACA) requires that insurance plans provide basic coverage for behavioral health services.1Behavioral health services include both mental health and substance abuse treatments.1 This means that your Aetna insurance plan will cover part or all of your drug rehab services.1 The amount your Aetna insurance will cover will depend on the specific Aetna plan you have.1
Aetna offers a variety of plans:2
- Health maintenance organization (HMO) plans have low monthly premiums and deductibles and often require that you pay a copayment when you visit doctors, specialists, and hospitals.
- Point of service (POS) plans require that you select a primary care provider (PCP) who will provide you with referrals to see specialists as needed.
- Exclusive provider organization (EPO) plans cover only in-network services but generally have a much more extensive network than other plans.
- Preferred provider organization plans do not require PCP referrals for in-network or out-of-network services. PPO plans typically have low copayments but high monthly premiums.
- High deductible health plans have higher deductibles and lower monthly premiums than some plans and often offer a healthcare savings account to help offset out-of-pocket expenses.
To learn more about your Aetna drug rehab coverage, you can call the number on the back of your Aetna insurance card. Many drug rehab centers are also able to verify your Aetna coverage.
What Will Aetna Insurance Cover?
Aetna will cover all or some of your drug rehab treatment, depending on your specific plan and the types of services you seek. Drug rehab services may include:3; 4; 5; 6
- Inpatient/residential rehab, which requires you or your loved one to live at a drug rehab center temporarily. During inpatient/residential rehab, you may receive medical detoxification; medication-assisted treatment; individual, group, or family therapy; drug education; relapse prevention; or life skills classes. You may also be required to participate in 12-step programs.
- Outpatient rehab, which allows you or your loved one to remain in the comfort of your home while receiving drug rehab services at a community center, doctor’s office, rehab facility, or other location. You may receive detoxification services; medication-assisted treatment; individual, group, or family therapy. drug education; relapse prevention; or life skills classes. You may also be required to participate in 12-step programs.
- Intensive outpatient programs (IOPs), which provide more intensive treatment than traditional outpatient services but do not require residency at a drug rehab center. They sometimes serve as a step-down program from inpatient services or a step-up service from traditional outpatient treatment. An IOP typically offers the same services and treatments as the outpatient and inpatient/rehab programs described above.
- Partial hospitalization programs (PHPs), which provide increased supervision for people who may have significant challenges or experience notable withdrawal symptoms due to medical or mental health issues. You or your loved one will be able to go home, but will be required to be at the service location for a certain number of hours each day.
Does Aetna Insurance Cover Mental Health Care?
Yes, with Aetna mental health care is covered.
Under the ACA, all insurance plans must provide at least basic behavioral health treatment coverage, which includes both mental health and substance abuse care.1 Sometimes, people suffer from mental health and substance abuse issues that occur simultaneously. Co-occurring disorders are pretty common. Study results have shown that roughly 53 percent of people with a substance use disorder are also diagnosed with a mental health disorder.7
Integrated care is the preferred method of managing mental health illness symptoms without turning to substances as a coping mechanism. Integrated care offers both substance abuse treatment, including detoxification services if needed, as well as therapy and aftercare. Your Aetna insurance plan will determine how much coverage you’ll have for the specific mental health care services you receive.
How Long Does Aetna Insurance Cover Rehab?
The length of time Aetna will cover rehab services depends on the specific plan and the types of services involved. There are many coverage levels within the Aetna insurance plans. Each level is associated with different monthly premiums, deductibles, and coverages.1; 2 There are also many different types and levels of drug rehab services.
Aetna drug rehab services are tailored to meet each person’s specific needs. Research indicates that more extended treatment is most effective. People engaging in long-term treatment (90 days or longer) are more likely to remain abstinent 6 months later. They are also less likely to experience homelessness.10; 11
If you have Aetna, verify benefits for Aetna drug coverage by calling the number on the back of your Aetna insurance card or visiting the Aetna insurance website. Many drug rehab centers are also able to verify your Aetna insurance plan coverage.
What If My Aetna Policy Does Not Cover Rehab?
If your Aetna insurance plan does not cover drug rehab services, some facilities offer flexible payment plans or scholarships. There also some nonprofits that provide funding for drug rehab services.
Delaying drug rehab treatment for financial reasons is usually detrimental to you or your loved one. Not seeking help as soon as possible is also likely to result in a more inadequate treatment outcome.12 Research results have shown that substance abuse care should not be postponed, but rather strengthened.12
In-Network vs. Out-of-Network Rehab Centers
The Aetna rehab provider network consists of an extensive network of Aetna-approved providers, such as doctors, specialists, hospitals, and facilities.14 To be in-network means that a doctor, specialist, hospital, or facility has a contract to provide services to Aetna policyholders, often for a cheaper rate.14 Providers and facilities that do not contract Aetna are considered out-of-network,14 and you’re likely to be charged a much higher rate for their services. If the provider is out-of-network, the policyholder would be responsible for covering the extra cost of care.14
To verify a provider’s network status, you can visit the Aetna website at https://www.aetna.com/individuals-families/using-your-aetna-benefits.html or call the number on the back of your Aetna insurance card.
Check Your Benefits
Some drug rehab centers can provide instant verification of your Aetna insurance benefits.13 American Addiction Centers provides a 24/7 helpline to connect you with knowledgeable and understanding Admissions Navigators who can verify insurance coverage for you or your loved one.15 Simply call877-640-1943to speak.15 You can also submit the form underneath to check your Aetna insurance plan benefits.
You can also check your insurance benefits by calling the number on the back of your Aetna insurance card or visiting the Aetna insurance website.
- American Addiction Centers. (2020). Aetna covered drug and alcohol treatment rehabs.
- (2021). HMO, POS, PPO, EPO, and HDHP with HSA: What’s the difference?
- American Addiction Center. (2021). How to choose an inpatient drug rehab.
- American Addiction Centers. (2020). Frequently asked questions about outpatient treatment.
- American Addiction Centers. (2021). What is an intensive outpatient program?
- American Addiction Centers. (2020). Drug rehab guides for addiction & mental health.
- Missouri Department of Mental Health. (2021). Co-occurring psychiatric and substance use disorders.
- Drake, R., Mueser, K., & Brunette, M. (2007). Management of persons with co-occurring severe mental illness and substance use disorder: Program implications. World Psychiatry, 6(3), 131 – 136.
- American Addiction Centers. (2021). Co-occurring disorder and dual diagnosis treatment guide.
- Brunette, M., Drake, R., Woods, M., & Hartnett, T. (2001). A Comparison of long-term and short-term residential treatment programs for dual diagnosis patients. Psychiatric Services, 52(4), 526 – 528.
- Proctor, S., & Herschman, P. (2014). The continuing care model of substance use treatment: What works, and when is “enough,” ‘‘enough?’’ Psychiatry Journal, 14(3), 1 – 16.
- Ornell, F., Moura, H., Scherer, J., Pechansky, F., Kessler, F., & Diemen, L. (2020). The COVID-19 pandemic and its impact on substance use: Implications for prevention and treatment. Psychiatry Research, 289, 1 – 2.
- (2021). Aetna insurance coverage for drug and alcohol rehab treatment.
- (2021). Network and out-of-network care.
- (2021). Provider referral directory.