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Updated on March 10, 2022

Aetna Insurance For Addiction Treatment

Does Aetna Cover Rehab for Drugs and Alcohol?

Aetna health insurance plans cover some or all of the cost of addiction treatment. Options vary based on the plan.

Aetna believes there are no one-size-fits-all solutions for drug and alcohol treatment. For this reason, Aetna works with individual needs to determine the right plan.

Aetna’s Continuing Care Programs

Additionally, Aetna is committed to patient follow-up through its Continuing Care support programs.

In these programs, members meet weekly and offer support for alumni of various treatment programs. The results of these aftercare programs are significant. According to Aetna, they keep people connected to their community with ongoing support.1

The financial responsibility a policyholder has for addiction treatment varies based on: 

  1. Their state of residence
  2. Their specific plan
  3. The treatment needed
  4. Whether the treatment provider is in-network or out-of-network

The cost of drug and alcohol rehab for Aetna customers varies from person to person. It depends on the addiction facility, the type of program, and any additional services.

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What Rehab Services Does Aetna Cover?

Most Aetna treatment plans cover at least part of the cost of addiction treatment. However, coverage varies based on the intensity and frequency of treatment, as well as the plan’s level.

With Aetna insurance, people may be covered for the following addiction treatments: 

Detoxification

Detoxification is the first step to sober living. Many people in this phase require medical supervision and attention. This is because symptoms are uncomfortable, painful, and sometimes dangerous.

Medical detox programs often include prescription medications that ease withdrawal symptoms and speed up the recovery process. 

Inpatient Treatment

Inpatient treatment offers full-time, around-the-clock care and supervision. People in these programs can focus entirely on recovery.

Participants live on-site at the rehab facility and receive ongoing access to medical supervision and support.

Most inpatient programs offer:

  • Medically supervised detox
  • Individual therapy
  • Group therapy
  • 12-step meetings
  • Recreation
  • Relapse prevention

Outpatient Treatment 

Outpatient treatment utilizes many of the same recovery tools as inpatient programs. In outpatient programs, however, participants live off-site while receiving care. This offers flexibility and makes treatment more manageable for many people. It’s also less expensive than inpatient care.

Outpatient programs operate for 10 to 12 hours a week, sometimes more. This allows attendees to work, spend time with family and friends, and sleep in their own homes during recovery.

Intensive Outpatient Programs (IOP)

Intensive outpatient programs (IOP) provide outpatient arrangements that are more intensive than traditional outpatient programs. 

In IOPS, participants continue to work or attend school, while also receiving the treatment they need, including ongoing medical, psychiatric, and peer support. 

Partial Hospitalization Programs (PHP)

Partial Hospitalization Programs (PHP) are a blend of inpatient and outpatient care. They usually meet 5 days a week for most of the day. Unlike inpatient programs, participants live at home.

How to Check Your Aetna Coverage

Before choosing a rehab program, check the coverage your Aetna insurance provides for treatment.

If you’ve chosen a rehab facility, Aetna can help you determine what coverage is available and the total treatment cost. You can do this by calling the number on the back of your insurance card or by logging in to your account on Aetna’s website.

It’s important to know exactly what your insurance plan covers in advance. This gives you peace of mind and allows you to focus on recovery without worrying about unexpected costs.

Many Aetna insurance plans have deductibles, copays, coinsurance, or a combination. This means you’ll be responsible for paying a portion of your care out of pocket, even with insurance coverage. 

Deductible

The deductible is the amount you pay for covered services before Aetna begins to pay any expenses. 

Co-Pay

The co-pay is the amount you pay for each covered service before and after you’ve met the deductible obligation.

For example, a co-pay might cost $10. You’ll pay this each time you go to the doctor, and Aetna covers the remaining amount of your care and treatment once you reach your deductible.

Coinsurance

Coinsurance is the percentage of the cost of a covered service you pay before and after you’ve met your deductible. 

If you have a 20% coinsurance amount, you will be responsible for 20% of the allowed costs of treatment after meeting the deductible and co-pay for care. Aetna will cover the remaining 80%.  

It’s also important to know if you need pre-authorization for care. In some cases, you’ll need to have Aetna approve a service and/or service provider to guarantee coverage. Speak to your insurance provider to find out what coverage limitations you might have. 

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Paying for Uncovered Rehab Costs 

Insurance coverage isn’t always enough for the entire cost of addiction treatment. Anyone struggling to pay out-of-pocket costs for rehab shouldn’t give up. There are many resources available that make rehab affordable for those who need it. 

Remember: The cost of continuing an addiction may be many times that of a successful substance abuse treatment program.

The best thing you can do is speak to an Aetna insurance provider. You can also contact the rehab facility you’ve chosen to get information about what you’ll need to pay.

Treatment providers often provide ways to cover the gap between your coverage and what you owe. Some offer grants or scholarship programs. Other treatment centers accept incremental payments or credit card payments, so you won’t pay the entire amount upfront.

Nobody should neglect treatment or choose an unsuitable program due to costs.

Aetna, or the staff at the facility of your choice, can help determine the best way to proceed if cost is a concern for you.

Call to find out how much your insurance will cover
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Resources

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  1. Alcohol and Drug Treatment.Aetna.com, Aetna.
  2. Alcohol & Drug Use Screening & Intervention – Health Care Professionals | Aetna.” Aetna.
  3. Opioids FAQs | Aetna.” Aetna.
  4. Substance Abuse and Mental Health Services Administration. “SAMHSA - Substance Abuse and Mental Health Services Administration.” Substance Abuse and Mental Health Services Administration (SAMHSA), 2000.
  5. National Institute on Drug Abuse. “Treatment Settings.”.
  6. Inpatient vs. Outpatient: What Is the Difference?” Medical University of the Americas.
  7. Partial Hospitalization IOP | Ohio State Mental and Behavioral.” The Ohio State University Wexner Medical Center.

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