Find Rehabs That Accept CVS Health Insurance

If you’ve heard of Aetna you’re familiar with CVS Health Corp’s insurance arm. Aetna originally started in the 1800s as a life insurance company. Throughout its history there have been a lot of fun highlights. For example in the 1920s they sponsored a women’s basketball team that won the first ever women’s basketball game at Madison Square Garden. In the 1960s the company wrote life insurance policies for the original seven astronauts — which was quite a risk to take. The company joined CVS in 2018 and today the company provides 22.1 million members with health insurance.

Does CVS Health Corp Cover Drug Rehab?

Through Aetna, CVS offers health coverage to millions of Americans. But if you’re struggling with substance use will the insurance help pay for rehab?

Most Aetna policies pay at least some of the cost of rehab treatment. That’s because a law passed in 2010, the Affordable Care Act (ACA), requires it for most plans. The law lists 10 services that are considered essential health benefits, and addiction treatment and mental healthcare are on the list. However, the law has some exceptions, so be sure to get the full details of your plan.

What types of rehab do they cover? Your insurance plan will have its own details, but in general they will focus on covering the type of addiction treatment your doctor recommends in your care plan. This could include inpatient or outpatient rehab.

Don’t forget that every insurance plan is different. Some plans have a big provider network, while others are smaller. Some plans will pay some of the cost if you use providers outside the network, and others won’t. Make sure you talk to the insurance company to get the specifics you need to get started with a great rehab.

What Types of Insurance Are Offered by CVS Health Corp?

The CVS health insurance company, Aetna, offers a wide variety of plans. You can get individual or family insurance through the ACA Marketplace in 21 different states. Or you might have Aetna through your employer. They also offer plans for students and insurance that covers you when you travel internationally.

If you qualify, you might have a Medicare Advantage plan through Aetna or have Medicaid through the company.

Most of these plans should have at least some level of coverage for drug rehab. You may have to pay some out of pocket costs, like a deductible or copayment. A deductible is an amount you pay before your coverage begins. For example, you might have to pay $1,000 before the insurance coverage kicks in. A copayment is an amount you pay for each service, and the insurance pays the rest.

Be sure to talk to the insurance company to get the details for your plan. It’s important to know what to expect.

What Types of Inpatient Rehab Does CVS Health Cover?

For those needing inpatient treatment, many CVS Health/Aetna plans cover options like inpatient detox and residential care. Their Aetna 360 behavioral health program will work with plan members and their healthcare providers to develop a treatment plan to support the individual’s path to recovery. This includes a 24/7 toll free call line where members can speak with a care advocate to help in locating participating providers and facilities and discuss treatment options.

For those who need it medically supervised detox can be done in an inpatient hospital setting or residential rehab facility. During medical detox individuals with alcohol and substance use disorder receive close medical supervision from qualified professionals and may receive FDA approved medications to ease withdrawal symptoms and prevent potentially serious health complications. This type of treatment is especially beneficial for those with serious addictions especially when the addiction is to alcohol or barbiturates and/or opiates. Detox can last anywhere from a few days to several weeks with the average completion time of 5 to 14 days. After completion of medical detox you will typically enter inpatient rehab or outpatient treatment depending on your needs.

Inpatient or residential rehab centers include individual and group therapy in a structured setting with 24/7 support. In some programs you can continue with a longer term medication assisted treatment (MAT) depending on your unique needs. Many inpatient programs also use other therapy methods such as music and art therapy along with holistic treatment options such as massage and yoga.

Coverage differs between plans so it is important for members to work with their insurance provider to determine whether a referral or prior authorization is required before starting treatment. Additionally it’s important to know what out of pocket costs to expect.

What Types of Outpatient Addiction Treatment Does CVS Health Corp Cover?

Outpatient alcohol and substance use disorder treatment is covered by CVS Health/Aetna. These services include medication assisted treatment and partial hospitalization programs (PHP) along with intensive outpatient programs (IOP) and peer support services.

Medication assisted treatment has been proven to decrease relapse rates and cravings that can lead to overdose deaths. For some individuals the use of FDA approved medications to support the recovery process is a short term need. For others the use of MAT is needed for weeks or months or even years. It is important to remember that each individual has their own unique needs in their sobriety journey and that each treatment plan is created to meet those specific needs.

CVS/Aetna has partnered with MAP Health Management to offer peer support as a covered benefit. This program benefits people in their recovery journey through telephonic or video chat for up to one year after discharge from a treatment program. These peer support professionals can share knowledge about the recovery process and teach practical recovery techniques. Peer support programs have been shown to be an important part of post treatment care and can decrease relapse rates and support long term recovery.

A Partial Hospitalization Program (PHP)is a full day program that’s similar to residential care except you don’t live at the facility — you go home at night.

In deciding if a PHP is right for you The American Society of Addiction Medicine suggests that you and your healthcare provider consider several factors including the severity of the substance use disorder and your overall physical health. Your doctor will also consider if there is a strong support system available and how great the risk of relapse may be along with your willingness for change before choosing this type of treatment.

The goal of a PHP is to help with sustained recovery and prevent relapse by helping individuals improve coping skills and develop a relapse prevention plan while putting together a community support system.

An Intensive Outpatient Program (IOP) is often the next step in recovery once residential or PHP treatment is completed. Understanding that early recovery can be difficult an IOP offers individuals intensive treatment for nine or more hours per week and a structured plan for recovery. You might also be able to receive MAT during treatment.

The goal of IOP is to help individuals prevent relapse and develop coping strategies and behavioral change along with establishing or re establishing support systems. Individuals participate in individual counseling and group therapy sessions and may include vocational training and case management services.

You should check with their insurance provider to determine if a referral or prior authorization is needed before starting treatment. Some insurance plans require that deductibles be met before services are covered and you may have other out of pocket expenses.

Does CVS Health Corp Cover Methadone & Suboxone (MAT)?

Medication Assisted Treatment (MAT) is used during medical detox and for some individuals it is appropriate for longer term treatment. MAT is generally used for those who struggle with opioid or alcohol use.

MAT uses FDA approved medications combined with other therapies to treat substance use disorders. These medications may include naltrexone or methadone or buprenorphine. MAT programs generally include counseling and individual and group therapy in addition to medication maintenance. Keep in mind you may need a referral to a MAT program to get insurance coverage, and your doctor might need to preauthorize the care with the insurance company before you begin.

CVS Health plans may cover expenses for any prescription medications that are required for your addiction treatment including MAT. The specific plan determines how much you’ll have to pay out of pocket.

As with all addiction treatment it’s important to reach out to the insurance company to verify your coverage before you begin the program. You may need a referral or preauthorization depending on your plan.

Does CVS Health Cover Other Mental Healthcare?

Services for mental health care are covered by most CVS Health insurance plans. Under the Affordable Care Act (ACA) these services are part of the 10 required essential health benefits. However not all plans are subject to the ACA so it’s important to verify your coverage before you start treatment.

A co occuring disorder refers to situations where an individual has alcohol or substance use disorder while also having one or more other mental health conditions. For example if you struggle with substance use and also have bi-polar disorder or anxiety or depression that would be a co occurring disorder.

Treatment for co occurring disorders needs to address both mental health and substance use at the same time. Integrated treatment is the best way to ensure long term recovery. Treatment may include approaches such as cognitive behavioral therapy(CBT) and dialectical behavioral therapy (DBT) along with eye movement desensitization reprocessing (EMDR). Holistic treatments can also be helpful such as meditation and yoga and nutrition support.

As with all health services coverage differs between plans. Be sure to check with your insurance provider to determine if a referral or prior authorization is required. You’ll want to look into your out of pocket costs as well.

Can I Travel Out of State for Treatment With CVS Health Corp?

Out of state treatment may be covered for individuals with CVS Health/Aetna insurance but it depends on your plan. Some plans require you to stay within the provider network and that is unlikely to extend beyond your state.

Some plans do allow out of network coverage but you’ll pay far more out of pocket. If possible it’s best to find a high quality in network provider to maximize your insurance and minimize your personal costs.

CVS Health Corp Insurance Coverage for Addiction Treatment