Aetna Health Insurance for Substance Abuse Treatment

Aetna was formed in the 1800s with a name inspired by an 11,000 foot volcano in Sicily, Italy. In the 1960s, they were the first to write individual life insurance policies to protect American astronauts in the early days of the space program and paid the first Medicare claim in the country.

Today, Aetna is a leader in addressing health disparities; they recently hired their first woman president in the company’s history.

Aetna provides a variety of health-related insurance plans and is today one of the oldest and largest health insurers in the U.S.

In 2018, Aetna was acquired by CVS Health in a move that merged health insurance offerings with an extensive network of pharmacies and services. The company is known for a broad network of providers and a focus on giving members resources to maintain and improve their health.

Does Aetna Cover Drug and Alcohol Addiction Treatment?

Yes, most Aetna policies offer coverage for drug and alcohol rehab and are regulated by two federal laws: the 2008 Mental Health Parity and Addiction Equity Act and the 2010 Affordable Care Act.

However, there are exceptions to these laws, which is why you must verify your insurance coverage before beginning treatment. Benefits may be limited or require prior authorization and documentation.

Coverage typically includes a range of treatment options depending on your specific plan and medical needs. To ensure you get the care you need, work with your doctor to create a treatment plan. Aetna will use the treatment plan to determine what care is medically necessary for you.

Does Aetna Cover Suboxone & Methadone (MAT)?

Medication assisted treatment (MAT) is a specific type of addiction treatment. It is often an outpatient treatment program that uses FDA approved medications to treat opioid and/or alcohol misuse alongside counseling and recovery treatment. Suboxone and Methadone are two of the most commonly prescribed medications for MAT. MAT is covered by most Aetna plans if medically necessary. Some may cover a generic form of Suboxone instead of the brand name, and you may need to cover co pays for the prescriptions.

Does Aetna Cover Other Mental Healthcare?

Aetna’s behavioral health benefits generally include treatment for substance use disorders and mental health disorders. For those struggling with mental health concerns such as anxiety or depression, most Aetna medical plans provide resources and support. Resources include crisis support, preventive care, and treatment. Aetna members can visit the Aetna website or call the customer care number to find mental and behavioral health resources near them and learn which providers are in network and covered by their insurance plan.

Where Does Aetna Offer Coverage?

Aetna offers health insurance in every state of the U.S. and some international locations. While they offer all products in all 50 states and Washington D.C., the details, plan types, and network providers vary by state. Medicaid plans are limited to 16 states.

The availability and specifics depend on state partnerships and regulations. International coverage is provided for individuals and employers with members who live or work abroad. These plans access a global network of providers and facilities. They typically include coverage for emergency care, routine care, and other health services.

What Are Aetna Plans?

Aetna offers individual and family plans using the Insurance Marketplace in most states. These plans have four levels determined by the Affordable Care Act: bronze, silver, gold, and platinum. The medal tiers are based on the level of coverage and costs.

Bronze plans typically have the lower premiums with higher out of pocket costs if you need care, while Platinum plans have the highest premiums with the lowest out of pocket costs for care. Aetna also offers high deductible health plans often paired with health savings accounts for those who want lower premiums and need to save up for the high deductible when care is needed.

Aetna also offers Medicare Advantage plans, also called Medicare Part C. These plans coordinate care for Medicare Parts A, B, and D and often offer additional benefits like vision, dental, and hearing.

For those with Original Medicare, Aetna offers Supplement Plans and Medicare Part D plans. Medicare Supplement Plans, called Medigap, help cover out of pocket costs like copayments and deductibles. Medicare Part D covers the cost of prescription medications, typically including medication assisted treatment for opioid addiction.

Aetna provides Medicaid plans in 16 states, mostly on the East Coast, to help coordinate coverage for low-income individuals and families. Finally, Aetna offers several plans for employers to offer coverage for employees.

How to Verify Coverage With Aetna

Since benefits vary between policies, you must verify your coverage before beginning treatment. There are several ways to do this. For instance, when you purchase your plan, you receive documentation of the benefits for your policy.

Aetna maintains a member services phone number where you can call and ask questions about your coverage and limitations. You can also log in to your account online to look for in network providers or coverage information.

However, the easiest and often most efficient way is to work with the addiction treatment center. They can verify your coverage and answer questions about therapy. They can also do an initial assessment and help estimate your potential out of pocket costs.

What Kinds of Inpatient Addiction Treatment Does Aetna Cover?

Residential rehab is one type of treatment that Aetna may cover based on your needs. It’s the most well known type of inpatient addiction treatment. Residential rehab pairs intensive exposure to therapy with a stable and sober living environment. It may be a good option if you need to make major changes to your lifestyle to support your recovery.

Another treatment Aetna may cover based on your needs is medical detox. Medical detox also has you staying overnight in a facility. It tends to be shorter than residential rehab, lasting three to ten days on average. The focus is on getting you through withdrawal safely.

In either of these settings you may receive medications to help you with or even prevent you from experiencing withdrawal. You may hear people refer to this as medication assisted treatment (MAT). Qualified clinicians may treat you with MAT in any inpatient or outpatient setting.

With any of these treatments, it’s important to match the intensity of the treatment to the severity of the disease. That’s why a clinician will usually evaluate your situation to determine what treatment your condition warrants. Aetna uses the information from these assessments to inform their decisions about medically needed coverage.

What Kinds of Outpatient Addiction Treatment Does Aetna Cover?

Depending on your treatment needs Aetna may cover services like partial hospitalization and intensive outpatient treatment. These services have you spending time in treatment each day in a treatment center but going home at night. In a partial hospitalization program, you might need to be there all day for five days a week. In an intensive outpatient program you might be there for part of the day, two to three days a week. Either of these options can give you intensive support while you start to practice your new skills and mindsets.

The next step down from intensive outpatient treatment is standard outpatient. Aetna has many outpatient therapists in their network. In standard outpatient treatment you can expect to see an addiction counselor at regular intervals. Appointments can be weekly or monthly or you might agree on another schedule. You may also have appointments with someone to manage your medication if that’s appropriate for you.

MAT might be used together with any of these treatments or separately. Medications can help you manage cravings during treatment so you are able to focus on recovery and avoid relapse.

Again, a number of considerations go into determining what the right treatment is for you at the right time. As with inpatient, Aetna uses information about your clinical condition to inform their coverage decisions.

How Much Does Addiction Treatment Cost With Aetna?

This will vary widely based on what type of plan you have and the type of care you need. You can estimate your costs by knowing your plan’s deductible and copay or coinsurance amounts. You can also look at the out of pocket maximum.

Do take note that these figures might all be higher if you try to get treatment from outside Aetna’s provider network. Some Aetna plans may not cover out of network treatment at all.

How Long is Rehab When I Use Aetna Insurance?

The length of treatment varies from person to person. In general residential rehab can last from two weeks to three months. Partial hospitalization and intensive outpatient programs also can last a few weeks to a few months. Standard outpatient and MAT can continue indefinitely. You should always check ahead with Aetna to verify your coverage for a specific program.

What’s important is that you fully complete your treatment plan. This will give you the highest chance of long term recovery and help you avoid having to go through rehab again in the future.