Insurance coverage is a major consideration in choosing a drug rehab facility. Many people cannot commit to addiction treatment before sorting out the financial details first.
Most private insurance carriers, particularly those available through the Affordable Care Act (ACA) marketplace, are required to cover at least some form of addiction treatment.
Aetna is a private insurance company that offers addiction treatment and mental health coverage. Policies provided through Aetna differ in coverage and prices.
Does Aetna Cover Rehab?
Yes, Aetna does cover drug and alcohol addiction treatment. The ACA requires that all insurance companies offer some form of coverage for substance use treatment.
The extent of coverage for a rehab program will depend on the state, the healthcare plan, and whether the facility is considered in-network or out-of-network.
Currently, Aetna is active in all 50 states and has nearly 6,000 medical centers that are classified as in-network.
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Substance Abuse Treatment Services Covered By Aetna
Aetna insurance covers multiple levels of care and a range of evidence-based treatment options. Below are some of the services people with Aetna insurance may or may not have access to.
|Treatment Type||Covered||Not Covered|
|Partial Hospitalization Program (PHP)||✔️|
|Intensive Outpatient Program (IOP)||✔️|
|Outpatient Medication-Assisted Treatment||✔️|
|Dual Diagnosis Treatment||✔️|
Aetna Coverage By Treatment Type
All Aetna insurance plans are required by law to cover some level of addiction treatment. Below are some of the treatment options covered by Aetna policies.
Aetna Plan Types
Aetna insurance plans are offered in coverage tiers. When purchased on the Health Insurance Marketplace, plans come in Gold, Silver, and Bronze coverage levels.
Types of plans:
- Bronze — costs the least but features higher deductibles and less overall coverage
- Silver — less expensive than Gold but offers more coverage than Bronze
- Gold — highest monthly premiums but provides the most coverage and the lowest deductibles
The price will differ depending on the level of coverage and state where insurance is purchased.
Another important consideration when searching for Aetna insurance is whether the plan is an HMO, PPO, or POS.
A health maintenance organization (HMO) is the most affordable type of insurance, with low premiums and deductibles as well as fixed copays. HMOs require clients to use only doctors in the HMO network, however.
A preferred provider organization (PPO) has higher premiums but lets holders see specialist and out-of-network doctors without a referral. In-network visits will feature low copays and coinsurance costs.
Point of service (POS) plans will typically require clients to get a referral to see a specialist. POS plans do have higher premiums than HMOs, but they do cover out-of-network doctors.
How To Use Aetna Coverage For Substance Abuse Treatment
The first step in using Aetna insurance for substance use treatment is talking to your primary care provider or the drug rehab facility directly.
Depending on the specifics of your plan, you may need to get a referral from a doctor before insurance coverage will kick in.
If no referral is necessary, the intake staff at a rehab program will confer with Aetna during the admissions process and confirm the details of your coverage.
Aetna Co-Pays And Deductibles For Addiction Treatment
A deductible is the amount of money paid out-of-pocket for covered services before the health plan kicks in. For example, if the deductible for your plan is $1,500, you will need to pay that amount out of pocket before insurance will start covering services.
Co-pays are flat fees charged for each visit to a regular doctor or specialist. This is a separate charge from a deductible and is usually more expensive for specialized services such as addiction care.
The cost of deductibles and co-pays will vary depending on what type of coverage you have. You can contact an Aetna representative to learn more about the co-pays and deductibles for substance use disorder treatment.
What Addictions Does Aetna Cover?
Listed below are some of the addictions that Aetna is required by law to cover under its insurance plans.
Addictions covered by Aetna insurance include:
- alcohol use disorders
- opioid use disorders
- prescription drug addiction
- dependence on illicit drugs such as ecstasy, cocaine, and methamphetamines
- marijuana addiction
- benzodiazepine addiction
Aetna will also cover mental health treatment as well as dual diagnosis treatment for co-occurring mental health and substance use disorders.
What If My Insurance Plan Doesn’t Cover The Treatment Program I Need?
If you or a loved one has inadequate insurance coverage and are seeking addiction treatment, you may be wondering what other options you have for payment.
Luckily, there are several resources that can help you get the recovery services you need.
Other ways to pay for addiction care include:
- Substance Use Prevention, Treatment, and Recovery Services Block Grant (SUBG) — The SUBG program helps pregnant women, people with HIV/AIDS, and people with limited finances in all 50 states pay for substance abuse treatment.
- Medicaid insurance — Medicaid is a state and federally-funded insurance program for people who are disabled or under a certain income limit. If you qualify for Medicaid, you can use it at many drug rehab facilities.
- payment assistance plans — Many rehabilitation centers will offer a payment plan for clients who cannot afford to pay for treatment all at once.
- sliding fee scale — A sliding scale is a payment system that is adjusted based on a person’s income, family size, and other criteria.
- nonprofit or faith-based organizations — Some rehab facilities are funded entirely through donations and will not require any payment from clients.
Finding A Rehab Center That Accepts Aetna
There are several ways to find a drug and alcohol rehab center that accepts Aetna insurance.
Talk To Aetna
Contacting an Aetna representative and asking about which nearby addiction treatment centers accept Aetna insurance is one of the easiest ways to find a facility.
Aetna also uses a screening, brief intervention, and referral to treatment (SBIRT) practice that helps identify, reduce, and prevent alcohol and drug use.
Participating providers who treat patients with Aetna medical benefits can use the SBIRT method to help people get substance use treatment.
Contact A Drug Rehab Program
Reaching out to the rehab center of your choice with your insurance information in hand can be a quick way to confirm whether Aetna is accepted.
You should contact the facility before arrival so you don’t waste the time and money to travel to the rehab center only to be denied.
Use The Aetna Provider Directory
Visiting the Aetna website and using its online provider directory can help you search for rehab facilities in your area that accept Aetna.
You can also download the Aetna Health mobile app and manage your benefits from your phone, including the option to search for in-network rehab centers near you.
Find A Drug And Alcohol Treatment Center Today
Reach out to AddictionResource.net today for more information about substance use disorder treatment.
Updated on October 23, 2023
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)