Coventry Insurance Coverage For Substance Abuse Addiction Treatment Near Me

For those who may be considering attending alcohol and drug rehab, figuring out how to pay for the costs of rehab is often a top-of-mind concern. Many people look to see whether their health insurance policy can help them cover all or some of the costs associated with rehab. In most cases, the Affordable Care Act (ACA) requires U.S. health plans to provide some level of coverage for such services.¹ This may be true if you have a Coventry Health for Medicare, now known as Aetna Medicare, health insurance plan.²

Aetna’s Medicare solutions include Medicare Advantage plans, Medicare Prescription Drug plans, and Medicare Supplement Insurance plans.³ These plans may not be available in all states, as coverage options can vary based on where you live. And while the program is not affiliated with the U.S. government or federal Medicare offerings, they do abide by all U.S. Medicare plan guidelines.^{3 bottom of the page in disclaimer}

Since different plans may be available to you, how your specific plan covers alcohol and drug rehab costs may vary. Call the number on the back of your insurance card to learn more about your plan’s coverage details. You can also work with the rehab center directly to find out more about what coverage your Coventry insurance plan may provide.

Check Coventry Insurance Coverage for Addiction Treatment

Figuring out how you can check your insurance coverage for addiction treatment benefits can seem overwhelming. That’s why American Addiction Centers (AAC) is here. We specialize in providing industry-leading addiction treatment services and care. Our staff is well-trained in mental health and substance use disorder services and works with insurers daily. This means that we’re well-versed in reading your insurance information and helping you decipher what your coverage entails.

You can call our confidential helpline to speak with a person who can check your benefits right while you’re on the phone. What’s more, they can help you check whether your Aetna coverage extends to 1 of the handful of AAC facilities across the country. If an AAC facility isn’t covered under your plan, they can also help your find a nearby covered rehab facility. If you’d prefer to instantly check your benefits online, you can also do that. Enter your information in the form below and immediately find out if AAC is in-network with your Coventry plan.

What is Coventry Insurance?

Since 2013, Coventry Insurance and Aetna have been the same company, following Aetna’s acquisition of Coventry.^{4 pg 2} On a grand scale, Aetna is one of the top health insurance companies in the country.⁵ It was first founded back in 1853 when it began as an annuity fund used to sell life insurance.^{6, “1853-1873”} Nearly 50 years later, in 1899, Aetna sold its first health insurance policy.^{6, “1895-1915”} In present times, the company is most well-known for its health insurance offerings.

About 39 million people across the country are covered by one of Aetna’s many different health insurance product offerings and services, including medical, pharmacy, and dental plans, Medicare plans, Medicaid services, behavioral health programs, and medical management plans.⁶

If you had a Coventry Insurance plan, you now likely have coverage under the Aetna Medicare plan. Be sure to check with your plan representative to learn more about what your specific Aetna Medicare plan includes. Checking your benefits before seeking care whenever possible can help you keep healthcare costs as low as possible.

Coventry Health Plans

There are a few different Aetna Medicare plans that may be available to you. Where you live, and your personal eligibility may preclude the plans in which you are eligible to enroll. Here is a list of the plans that may be available to you:

• Medicare Advantage plans: These plans are made up of Medicare Parts A and B, and are sold by private health insurance companies like Aetna.^{7 “Medicare Part C — Combining your coverage”} Medicare Advantage plans cover everything Original Medicare plans cover, as well as prescription drugs, dental, vision and hearing benefits, and fitness club memberships. ^{7 “Medicare Part C — Combining your coverage”} Medicare Advantage plans use networks to deliver quality care at a lower price to covered members. ^{7 “Medicare Part C — Combining your coverage} This typically means that you will need to use an in-network provider for coverage for services through your plan. Coverage for addiction treatment may fall under the scope of the benefits provided to you through your Medicare Advantage plan. Here are the Advantage plans that may be available to you:⁸
  • Medicare Advantage HMO
  • Medicare Advantage HMO-POS
  • Medicare Advantage PPO
  • Medicare Advantage Dual Special Needs plans (D-SNP)
• Medicare Prescription Drug Plans (Medicare PDP): These plans do not provide any healthcare coverage; they only provide coverage for prescription drugs. ^{7 “Medicare Part D”} They may or may not provide coverage for any medications you’re prescribed to treat addiction. Here are the Medicare PDP plans that may be available to you:⁹
  • SilverScript SmartRx (PDP)
  • SilverScript Choice (PDP)
  • SilverScript Plus (PDP)
• Medicare Supplement plans: These plans are designed to help cover costs not covered by Original Medicare, such as copays or other out-of-pocket costs. ^{7 “Medicare Supplement”} If you have a Medicare Advantage Plan, you are not eligible to buy a Medicare supplement plan. ^{7 “Medicare supplement”} Depending on the Medicare plan you have, you may be eligible for a Medicare supplement plan, which could help cover some costs associated with addiction treatment.

Work with an Aetna plan representative to determine which plan(s) you may be eligible to enroll in and find out what those plans may cover regarding addiction treatment and related costs.

What will Coventry insurance cover?

What your Coventry insurance, now Aetna insurance, will cover varies greatly. Your plan type and where you seek care may determine what is and isn’t covered under your insurance. Some of the following common addiction treatments may be covered under your plan:

• Inpatient or residential rehab. With an inpatient or residential rehab program, the patient would stay at a facility and receive round-the-clock medically supervised care, including detox, for the duration of their stay. Some patients stay for days, while others can stay for months.^{10, Pg 8, “What types of treatment programs are available?”}
• Outpatient rehab or therapy. With an outpatient rehab or therapy program, the patient would go to 1 or 2 treatment sessions a week but return home after the session, as no overnight stay is associated with outpatient care.^{10, Pg 10, Para 2}
• Intensive outpatient programs (IOP). With an IOP, the patient would attend a minimum number of hours of treatment weekly, which is more than standard outpatient rehab or therapy sessions, but not stay overnight.^{10, Pg 10, Para 3}
• Partial hospitalization programs (PHP). With a PHP, which is also commonly called a day program, the patient would go to a facility for 4–8 hours of addiction treatment a day but return home at night.^{10, Pg 10, Para 1}

Please note that these treatments may not be covered under your plan. As always, it’s recommended that you check your insurance benefits before seeking care whenever possible. Call the AAC helpline or the number on the back of your card for assistance checking your benefits and coverage.

Does Coventry Insurance Cover Mental Health Care Treatment Facilities?

Per the ACA, almost all health plans issued in the United States must provide some level of coverage for mental health and substance use disorder treatment, as they are considered to be 1 of the 10 essential health benefits under the law.¹ Aetna Medicare plans may be subject to this law, which, for you, means that your plan likely must provide some coverage for addiction treatment, which could be for stand-alone heroin rehab or co-occurring disorder.

Approximately 17 million American adults in 2020 were diagnosed with a co-occurring disorder, which is when someone has both a substance use disorder and mental illness at the same time.¹¹ While it is not believed that one directly causes the other, someone with substance use disorder is twice as likely to develop a mental health condition at some point in their life, and vice versa.¹²

Because the 2 are often interconnected and influence each other, many mental health experts recommend a tandem or integrated treatment approach where each condition is treated at the same time. ^{11, “What should I do?} The ACA’s mandate helps ensure that Americans have access to some level of coverage under most plans for co-occurring disorder treatment.

How Long Does Coventry Insurance Cover Rehab?

The length of time a Coventry Insurance, now Aetna Insurance, the health plan may cover rehab will depend largely upon the health plan that you have. Every plan has different coverage details, which is why it’s so crucial that you check your benefits before seeking care whenever possible. To do this, you can look up your insurance information on the back of your card, reach out to AAC, or call the number on the back of your card.

Regardless of what may be covered under your policy, it’s important to ensure that you follow a provider’s treatment plan. Remaining in treatment for an adequate amount of time is pivotal for positive outcomes following rehab. While every person is different and so are their needs, research shows that most rehab programs should last at least 90 days to improve overall outcomes and curb or stop patient drug use. ^{13, bullet 5}

What if my Coventry policy does not cover rehab?

Depending on your plan and where you attend a rehab program, your Coventry (now Aetna) plan may not cover all or some of the rehab costs. You’ll want to ask the rehab facility if there are financing or scholarship payment options available to you to help offset the out-of-pocket costs associated with care. Regardless of the cost, it’s critical to get the treatment now rather than pushing it down the road. Prioritizing your health and recovery is essential.

Coventry Insurance In Network vs. Out of Network Rehab Centers

Depending on the Aetna Medicare (formerly Coventry Insurance) plan that you have, you may be limited to seeking care from in-network providers if you want to use your plan to help with paying for the costs of care. A network physician is contracted with your Aetna plan to provide care to you at a lower cost.^{14″ How Do Medicare Advantage HMO Plans Work?”} Not all plans may require you to use a network physician but may not cover out-of-network providers at the same level as in-network providers, which could mean higher out-of-pocket costs. ^{14″ How Do Medicare Advantage HMO Plans Work?”}

You can work with AAC to find an in-network rehab near you that takes Aetna Medicare plans. You can also call the number on the back of your card to speak with an Aetna representative who can help you find a covered facility, or you can log in to your online Aetna portal and use their provider search tools.