More than 20 million American adults suffer from drug or alcohol addiction, and countless families are feeling the weight of substance abuse. For those dealing with the reality of substance abuse and addiction, navigating the insurance world can feel overwhelming. Private insurance companies like Aetna exist to ensure individuals and families have access to healthcare and addiction treatment.
Because addiction is medically recognized as a treatable disease, insurance companies now provide plans that help reduce the cost of drug and alcohol rehab programs. Although coverage details differ by plan, individuals suffering from addiction can get their health concerns addressed holistically with Aetna drug rehab coverage.
Using Aetna Insurance For Addiction Treatment
Aetna Insurance has been serving the American public since the mid-1800s. Currently offering health care coverage in all 50 states, Aetna is one of the largest health insurance companies in the United States. Aetna offers coverage that includes co-pay only plans, open-access plans, and coverage with high deductibles. With this wide range of services, it’s understandable why Aetna has been chosen by 46 million Americans.
When it comes to Aetna drug and alcohol addiction treatment, both private and employer-funded insurance plans can greatly reduce the cost. Because Aetna insurance offers a variety of coverage options, there are usually multiple ways that addiction treatment and associated costs can be addressed.
Some of the Aetna addiction treatment services likely to be covered include:
- detoxification and stabilization
- inpatient (residential) care
- partial hospitalization programs
- intensive outpatient programs
- continuing care
Addiction treatment has become a lot more affordable, thanks in part to the Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008. This legislation went into effect in 2010, and requires insurance companies to provide coverage for mental health conditions at the same level that they provide coverage for physical health issues. For example, if someone is diagnosed with alcohol use disorder, they will be given the same coverage options as someone diagnosed with an autoimmune disease.
The MHPAEA also allows for inpatient rehabilitation or addiction-related hospital stays to be covered in the same way that a physical health condition would be covered. In other words, if an individual’s plan provides coverage for up to 30 days in a hospital, their plan must also provide coverage for up to 30 days in a drug rehab facility.
For those that have pre-existing mental or physical health conditions, the Affordable Care Act ensures that they are not denied coverage. Uninsured individuals struggling with addiction can enroll in an Aetna insurance plan and be empowered to explore treatment options.
How Much Will Aetna Insurance Cover For Addiction Treatment?
Each plan that Aetna health insurance offers will have variations in cost and coverage. To best explain these ranges, it’s important to understand a few key insurance terms.
Some of the basic insurance terms include:
- Copay: Sometimes called coinsurance, a copay is a partial payment—usually a predetermined flat fee—that the policyholder is responsible to pay for each visit or day at a drug rehab facility. For example, if an individual is staying at an inpatient treatment center, their Aetna plan may cover 75 percent of each day’s cost, and the policyholder is responsible to pay the other 25 percent as their copay.
- Deductible: This term refers to the money that the policyholder will pay in total before Aetna is responsible for any payment at all. Some plans have higher monthly costs (“premiums”), but have much lower deductibles. Many plans that have low monthly premiums will come with higher deductibles.
- Maximum Out-of-pocket: Most insurance plans have a cap on the amount of out-of-pocket expenses a policyholder can incur. Once that maximum has been met, Aetna assumes full responsibility for all remaining costs associated with the plan.
Although the percentage that Aetna alcohol rehab coverage and drug rehab coverage will cover depends on your specific plan, the overall cost of treatment is determined by the specific facility. If a drug and alcohol rehab program costs $30,000, and Aetna covers 75 percent of that, Aetna pays $22,500 and the policyholder is responsible to pay $7,500.
Each of the coverage options available will likely reduce the overall cost of addiction treatment. Many Aetna plans will work with treatment facilities to ensure drug and alcohol rehab programs remain affordable, and some drug rehab centers provide partial scholarships, sliding-scale payment plans, personal grants, and financing options.
Prior Authorization Requirements For Aetna Insurance Plans
Certain medical services require precertification, or prior authorization, in order to be covered by an Aetna insurance plan. This is to protect both the policyholder and the insurance company from incurring expenses from unnecessary procedures. Many behavioral health services, including addiction treatment, will likely require prior authorization.
Some of the behavioral health services that require precertification include:
- inpatient admissions
- residential treatment center admissions
- partial hospitalization programs
- intensive outpatient programs
- psychological testing
- neuropsychological testing
- outpatient detoxification
Do Rehab Centers Need To Be In-Network For Aetna Insurance Coverage?
Because Aetna offers coverage in all 50 states, there should be ample options for finding an in-network Aetna rehab treatment facility, as these will offer the most cost-effective and comprehensive treatment options to policyholders. However, if an individual prefers a treatment center that is outside their network, Aetna may provide some coverage, however, the overall cost will likely be higher for the policyholder.
Some employers may offer Aetna plans as part of a benefits package. With these plans, employees may gain access to discounted health policies, as well as special discounts that can be used for out-of-network treatment.
Addiction Treatment Services Covered By Aetna Insurance
Addiction treatment has come a long way in recent years, in part as a much-needed response to the addiction and overdose crisis facing the United States.
Fortunately, insurance companies have responded as well, working to fund efficient, effective addiction treatment through their policies. Some of the treatment services frequently covered by Aetna insurance plans include inpatient care, partial hospitalization programs, intensive outpatient programs, and opioid addiction treatment.
Drug And Alcohol Detox Services
Detox services can be offered in either inpatient or outpatient treatment programs, and typically consist of a supervised withdrawal period. When someone has used a substance heavily for any length of time, their body develops a physical dependence on that drug.
If the drug use stops suddenly, their body will likely experience withdrawal symptoms. Detox services offered in inpatient and outpatient programs will usually include medical supervision, encouragement, and support, along with specific medications that aid in the withdrawal process.
Aetna Inpatient Addiction Treatment Services
The term “inpatient care” refers to residential-style treatment facilities, where patients newly in recovery are provided a supportive and secure environment. In inpatient treatment facilities, patients have their entire day mapped out and structured for them, so they can be reintroduced to daily routine and practice new sober life skills. Detox services are offered at many inpatient rehab centers, followed by an average treatment stay of 30 to 90 days.
During this time, patients engage in activities such as individual and group therapy, health and wellness groups, and experiential therapies such as yoga and equine therapy. Inpatient treatment is often considered most effective, due to the fact that patients are away from home and immersed in a recovery-focused environment.
Aetna Outpatient Addiction Treatment Services
Outpatient addiction services usually refers to any nonresidential treatment. This can occur during day or evening sessions, and usually places a strong emphasis on group therapy.
Some common outpatient treatment services include:
Partial hospitalization programs (PHPs): This style of treatment is often considered the next treatment level after an inpatient stay. PHPs hold required sessions five days a week for up to six hours per day. The structure is similar to inpatient treatment, but participants do not stay overnight. During PHP sessions, patients participate in various therapies, recovery meetings, and recreational activities related to recovery.
Intensive outpatient programs (IOPs): Often considered a “step down” treatment, intensive outpatient is a less secure, yet still vigorous form of addiction treatment. Patients attend morning or evening sessions that will largely consist of group therapy and individual counseling. Guest speakers and life skills workshops may be included in many IOPs. IOPs can be an excellent option for those who are unable to stay at an inpatient facility, due to work or family commitments.
Opioid addiction treatment programs: This style of treatment is becoming well-known due to the current opioid addiction and overdose crisis facing our nation. Opioid treatment programs can occur in either inpatient or outpatient treatment facilities, and will likely include many of the same components as PHPs.
One of the most vital components of opioid treatment programs is medication-assisted treatment (MAT), where patients engage in various therapies while also taking medication. MAT usually refers to buprenorphine-based medications, which reduce drug cravings and work to relieve the painful withdrawal symptoms associated with opioids.
Identifying Your Aetna Insurance Coverage
As an Aetna policyholder, individuals have access to a host of benefits within the Aetna network. Understanding your rights and responsibilities around health care coverage is a key component to accessing the care you or your loved one needs for addiction treatment.
If you have an Aetna HMO plan, you will likely need to see a primary care physician who will refer you to an in-network treatment facility. With an Aetna PPO plan, you have more freedom in selecting a care provider or treatment facility.
The most financially sound way to utilize Aetna insurance is to stay in-network, which will likely minimize your overall costs. If you have questions about your coverage, Aetna has an experienced team of customer service representatives that can assist you in navigating your health care benefits.
To learn more about using Aetna insurance for drug and alcohol addiction treatment, contact us today.
Disclaimer: This site is not affiliated with, nor endorsed by, Aetna. The information about Aetna’s benefits are meant for informational purposes only, and the details of your plan’s coverage may be different.
SAMHSA — Mental and Substance Use Disorders