Insurance is one of the biggest factors in choosing rehab centers for a lot of people, and rightfully so. Many people who even consider entering treatment or finding a facility for their loved ones have to figure out the financial details first.
Although drug and alcohol rehab programs are a necessity for those with addiction, the cost can be prohibitive to a lot of individuals who may not have the means to pay.
More insurance carriers are beginning to provide coverage for substance abuse treatment, but it isn’t a universal offering.
The private insurance industry can make it difficult to navigate finding coverage and understanding what will actually be paid by an insurance company.
Aetna is among the leading providers offering mental health coverage, which usually includes some type of addiction treatment. Every policy is different, of course, so it’s important to understand the Aetna insurance policy and available coverage options for addiction treatment.
How Do Rehab Centers Choose Whether They Accept Aetna?
There are a number of drug and alcohol rehab centers that accept Aetna insurance as a form of payment.
Usually, addiction treatment facilities have their insurance program set up in one of two ways:
- Rehab facilities may accept any insurance that provides coverage for addiction treatment, as long as the policy meets their criteria and the individual’s treatment needs. This offers more people the chance to get the treatment that they need without too many exclusions or limitations.
- Some rehab centers may only have relationships with one or two insurance carriers to assist with paying for rehab programs. In this situation, people will have to confirm that a rehab center accepts their specific insurance policy before choosing a facility.
Aetna was founded in 1853 and is one of the largest private health insurance companies in the country today. Its name alone gives it a good reputation, which means that many residential rehab centers will have no problem working with people who have this coverage.
If a drug rehab center doesn’t provide explicit details about their insurance policies, it will be up to the individual or a treatment specialist to ask whether coverage is available.
Aetna Coverage For Substance Abuse Treatment
Aetna insurance for addiction treatment offers a variety of coverage options. First, the insurer has partnered with CRC Health Group to provide treatment options for opioid addiction in light of the recent opioid epidemic.
Under the mental and behavioral health section of their insurance policy, Aetna members can find the details of drug and alcohol rehab coverage that may already exist on their policy.
Find a treatment program that accepts Aetna today.
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If you’re considering addiction treatment for you or a loved one and you have Aetna health insurance, you may want to explore which rehab programs and treatments are covered by your plan.
Does Aetna Cover The Cost Of Inpatient Drug And Alcohol Treatment?
Yes, inpatient rehab programs are generally covered by Aetna insurance plans. However, coverage will depend on your individual plan.
Whether Aetna will pay for a residential rehab program, what your co-pay amount will be, and what length of program will be covered by your Aetna health insurance (i.e. short-term vs. long-term) are items you’ll need to discuss with an insurance representative prior to starting treatment.
Does Aetna Cover The Cost Of Outpatient Addiction Treatment?
Aetna covers certain outpatient rehab programs.
Which outpatient treatment programs are covered by Aetna will depend on a few factors, such as:
- whether you have tried or need inpatient treatment
- the type of outpatient program
- whether you need medication-assisted treatment
Some health insurance plans require policyholders to enter an outpatient program before coverage kicks in for residential treatment. Others may only cover residential treatment.
Outpatient treatment comes in many forms, from partial hospitalization and intensive outpatient programs to outpatient therapy and counseling. Aetna insurance covers all forms of outpatient treatment for addiction to a certain extent.
For example, if you have completed a full continuum of care and need only therapy to stay strong in recovery, Aetna plans may pay up to $75 per session.
To know for sure, speak to your insurance carrier or one of our treatment representatives, who can quickly verify your insurance for you.
Does Aetna Cover The Cost Of Partial Hospitalization Programs (PHP)?
Partial hospitalization programs (PHP) are one of the outpatient rehab programs covered by Aetna.
Typically, partial hospitalization programs are a less intensive form of addiction treatment for:
- those who are ready to step down from inpatient treatment
- people who can’t commit to residential rehab programs due to work, school, family, or other constraints
- addicted individuals whose substance abuse issues don’t require inpatient treatment
PHPs are also called day programs and offer treatment that is intensive, occurring anywhere from 3 to 5 days a week, from 3 to 7 hours per day for anywhere from 8 to 16 weeks. The biggest difference between residential and PHP is that individuals in these outpatient programs do not live onsite at a rehab center.
A substance abuse assessment at either the end of inpatient treatment or prior to addiction treatment will help determine whether you need inpatient treatment or are ready for partial hospitalization.
Does Aetna Cover The Cost Of Intensive Outpatient Programs (IOP)?
Intensive outpatient programs (IOP) are also covered by Aetna health insurance plans, though as with other forms of treatment, coverage depends on insurance policy tiers.
IOPs are less intensive rehab programs meant for recovering individuals who no longer need residential treatment or day programs. Treatment may involve therapy, counseling, and case management and take place one to three hours per day, two or three days per week for a number of weeks.
Does Aetna Cover The Cost Of Suboxone?
Suboxone is a medication used in opioid treatment programs to treat opioid withdrawal and long-term addiction management. The cost of Suboxone is covered by Aetna insurance policies in certain states, such as California and Michigan.
Suboxone is often part of a long-term recovery plan for opioid-addicted individuals. While Aetna covers most major prescriptions in its pharmacy plan, the medication may not be 100 percent covered. Learn what your co-pay will be for Suboxone after speaking with an Aetna insurance representative.
Does Aetna Cover The Cost Of Methadone?
Methadone is the oldest form of medication-assisted treatment for opioid use disorders and is covered by most Aetna plans. Methadone maintenance therapy is also a long-term treatment plan for opioid abuse, with monthly methadone injections used for those who have completed addiction treatment programs of at least 30 days.
Whether you will be prescribed the daily methadone pill or the monthly methadone injection depends on your prescribing doctor, progress in recovery, and other factors. How these forms of methadone are priced and what portion of methadone prescriptions are covered by Aetna pharmacy benefits may vary by individual plan.
Does Aetna Cover The Cost Of Sober Living?
Sober living is considered a form of aftercare, meaning it is continuing care for residential rehab or partial hospitalization programs. Some Aetna insurance plans pay for part of the cost of a sober living facility, though the amount of coverage and length of coverage depends on which Aetna policy a person holds.
For those who are new to Aetna insurance, a simple call to Customer Support can provide insight as to what coverage is available.
Again, the exact coverage provided will vary from one policy to the next. Inpatient or partial hospitalization programs may require pre-authorization from Aetna. Typically, outpatient services don’t require this same pre-approval.
Finding Rehab Centers That Take Aetna Insurance
There are a few ways that people can check to find out whether a rehab center accepts their Aetna insurance.
Aetna members have access to more than 700,000 doctors and specialists, 5,700 hospitals and inpatient facilities, and a total of more than 1.2 million professionals in the healthcare industry across the United States.
As such, it shouldn’t be hard to find rehab centers that accept Aetna insurance, provided that the member has coverage for drug and alcohol rehab programs in their policy.
Policyholders, or those considering purchasing Aetna insurance for drug and alcohol treatment, can find rehab centers that accept insurance online.
They can search for local facilities, look up specific clinics that they have been referred to, and even check the Aetna website to find in-network and out-of-network rehab centers based on their exact policy coverage. Treatment specialists from referral services can assist with this process.
Do Rehab Centers Have To Be In-Network To Accept Aetna?
Although it will save a significant amount of money and offer better coverage, there is no requirement for a rehab provider to be in-network with Aetna for their services to be covered.
In-network services are typically covered at 80 percent in most plans, while out-of-network services may only be covered at 50 to 60 percent.
Plus, in-network providers often have discounted rates they negotiated with the insurance company previously, offering significant savings to members who choose them.
Aetna policyholders will need to check their individual plan to see what type of in-network and out-of-network coverage and costs are involved with their policy. This will allow them to make the best decision when choosing a rehab center.
Most policies will provide at least some type of coverage for out-of-network rehab services, but there may be limitations involved. Members are advised to speak to a representative regarding their specific policy to learn more.
Which Rehab Centers Accept Aetna Insurance?
Any drug rehab facility that accepts private insurance should take Aetna’s plans. Keep in mind that some plans are only good in certain states, so those who are considering travel for rehab programs should double-check their coverage before enrolling in an out-of-state program.
The best way to find drug and alcohol rehab centers that accept Aetna is to search on the insurer’s website or speak to an addiction treatment specialist.
Members can login to their policy and use the Provider Search to search for local alcohol and drug rehab centers.
This will not only provide a comprehensive list of options for addiction treatment, but it will offer peace of mind in knowing that the specific insurance policy that a member has will cover the addiction treatment services needed.
States That Offer Aetna Insurance
Aetna offers a variety of health insurance plans in all 50 states. These include individual and family medical and dental plans, employer-sponsored health insurance, Medicare and Medicaid plans and services, and behavioral health services.
Below is a list of health plans offered by Aetna in the United States. Select plans are only available in specific states. Some are employer-sponsored plans while others offer individual and family coverage options.
The most common Aetna plans include:
- Aetna Open Access and Open Access Choice (PPO or HMO)
- Aetna QPOS (Quality Point-of-Service)
- Aetna Elect Choice HealthFund HMO or PPO
- Aetna Managed Choice HMO or PPO
- Aetna Student Health
In addition to traditional health insurance plans for individuals and employer-sponsored insurance, Aetna also offers Medicare coverage plans in over 30 states, which include the following options:
- Aetna Medicare Plan HMO
- Aetna Medicare Plan PPO
- Aetna Medicare Open Access HMO
- Aetna Medicare Prime HMO
- Aetna Medicare Prime PPO
- Medicare Rx Saver
- Medicare Rx Premier
- Aetna Medicare Supplement Plan
Seeking Addiction Treatment Using Your Aetna Plan
The best way to go about finding addiction treatment with Aetna insurance is to login to the company website and review the individual coverage that is available.
It can be difficult to find information without having a specific Aetna policy because this company offers so many different insurance plans. Members will be able to get the details about their coverage online, which is the first step to seeking addiction treatment.
Members can also call Aetna or chat online to find out what type of insurance coverage they have for drug and alcohol rehab programs.
Support staff is available to help members better understand their insurance and find the right health services. They can even connect members to local rehab facilities and peer support services, making it easy for people to get the assistance they need.
To ease the process of finding a rehab center that accepts your Aetna plan, you can also speak to an addiction treatment specialist.
These trained professionals are well-versed in insurance coverage for specific plans and can help you find the right facility for you or a loved one. Learn more by contacting us today.
Updated on July 24, 2020
Addiction Resource aims to provide only the most current, accurate information in regards to addiction and addiction treatment, which means we only reference the most credible sources available.
These include peer-reviewed journals, government entities and academic institutions, and leaders in addiction healthcare and advocacy. Learn more about how we safeguard our content by viewing our editorial policy.
- Aetna — Company/Plan Names
- Aetna — Drug and Alcohol Treatment
- National Institute on Drug Abuse (NIDA)—Types of Treatment Programs
- Substance Abuse and Mental Health Services Administration (SAMHSA)—Medication-Assisted Treatment (MAT)