American insurance providers are required to provide substance abuse disorder coverage by the Affordable Care Act, as well as the Mental Health Parity and Addiction Equity Act. As such, Aetna health insurance plans do include coverage for drug and alcohol rehab. Aetna mental health insurance is also available.
However, it’s important to note that the amount of substance use disorder treatment coverage does vary from plan to plan, so patients should expect to pay some out-of-pocket costs for their alcohol and drug rehab in treatment facilities. Additionally, while some plans only include detox, others cover both detox, outpatient rehab and ongoing rehabilitation services.
At Aetna, some policies cover out-of-network healthcare providers, but as with all insurance carrier and provider plans, it’s important to check with your administrator to find out what’s covered. In some cases, authorization from a health care provider or pre-certification might be required before insurance coverage is authorized in treatment centers. Pre-certification is conducted by Aetna to confirm that treatment is provided by qualified addiction counselors, medical professionals and licensed treatment centers.
Aetna rehab coverage may be under a Health Maintenance Organization (HMO) or Preferred Provider Organization plan through an employer. Alternatively, Aetna insurance coverage also administers Medicare and Medicaid plans with support from the federal government for seniors, disabled persons and low-income individuals.
The substance abuse insurance coverage you have will vary depending on which type of Aetna plan you have, as well as a variety of other factors, including the services you need during your stay at a treatment center and how long your inpatient treatment plan is.
In the information that follows, you’ll learn more about accessing drug and alcohol addiction treatment at Behavioral Health Centers while using your Aetna health insurance plan.
If you have questions about your Aetna addiction treatment coverage or other ways to pay for our treatment options and services, our representatives are always available to help you access the treatment you need and make recommendations for other resources that may be available to help you pay.
Making Sense of Aetna Insurance
While understanding your unique carrier’s addiction insurance coverage is important, there are several common insurance terms you may need to understand first. These include:
Once your Aetna insurance provider approves treatment, this is the amount you need to pay for each health care service. For example, if your coinsurance rate is 30%, Aetna will require you to pay 30% of all covered costs while your policy pays the remaining 70%.
The amount of out-of-pocket health care costs you need to pay your treatment provider each year before your policy begins to cover you.
This is the limit on how much your Aetna insurance cover requires you to pay before your plan will cover the total cost of your healthcare services.
Aetna Insurance Premium:
The premium is the monthly or annual amount you pay to your insurance provider for coverage.
What Else to Know About Aetna’s Coverage for Substance Abuse Treatment
Most Aetna plans require your primary care physician to authorize your treatment provider. Aetna will also conduct a review of your treatment plan prior to authorizing coverage.
When accessing care at a treatment facility, Aetna plans that include a co-payment require you to pay your portion at the time of treatment.
If you need help navigating your insurance policy to determine what you’re covered for, reach out to speak with one of our representatives today.
The Affordable Care Act made it a requirement for health insurance providers sold via the Health Insurance Marketplace to cover 10 essential benefits. One of those benefits is mental health care, including treatment for substance use disorders. Due to this requirement, many major insurance carriers, including Aetna Inc., provide some type of mental health coverage to plan members.
Aetna Rehab Coverage: Medicare Plans
Aetna provides a variety of health insurance options for those who are qualified for Medicare coverage. These plans may be HMO or PPO plans, and while they do vary depending on where you live and which plan you select, you can expect deductibles and premiums to be relatively low. Plans may include medical coverage, prescription coverage or both.
As with all Medicare plans, Aetna’s coverage includes primary and hospital care as well as specialized services in a rehab center, such as medical detox. Although each plan’s coverage is different, most of Aetna’s Medicare plans include drug and alcohol detox, inpatient addiction treatment, outpatient services and individual and group therapy sessions when required as part of an authorized treatment plan.
It’s worth noting that Medicare plans are typically only offered for those aged 65 and older, as well as those with end-stage renal disease or other severe disabilities.
Aetna Group Insurance Plans
Aetna is one of the country’s largest group insurance providers. It offers a broad range of plans for businesses of all sizes, ranging from small companies that employ fewer than 10 people up to enterprise-sized businesses with hundreds or even thousands of employees. As such, you can expect drug and alcohol rehab treatment options coverage to vary based on a variety of factors, including the size of your company, the plan your employer has chosen and where you live.
To provide you with an idea of what Aetna may have available, we’ll look at one of the company’s most common group insurance policies: the Basic HMO Copay Plan 1.
This plan is designed to meet the needs of smaller businesses. It comes with a $2 million lifetime maximum benefit and out-of-pocket maximums of $5,000 for single policyholders or $10,000 for families.
Substance abuse treatment is covered to a lifetime maximum of $2,000 and is subject to a $750 co-payment per day for inpatient care or a $25 co-payment per visit for outpatient care. Outpatient care from accredited treatment centers is covered to a maximum of 44 visits.
Admission for Behavioral Health Treatment
At Behavioral Health Centers, our knowledgeable staff members aim to help you get the addiction and mental health treatment you need at the lowest possible out-of-pocket cost. We have extensive experience working with Aetna Inc. and figuring out exactly what your plan covers in terms of mental health benefits.
If you need mental health care and have Aetna insurance, you can expect the following during our admissions process:
- You’ll talk with one of our mental health experts to discuss your personal health information, which allows them to assess and determine what type of treatment you need to improve your mental well-being.
- Based on your needs, you’ll select a treatment program. We offer inpatient treatment for obsessive-compulsive disorder, anxiety, depression, substance use disorders and other mental health conditions. We also offer intensive outpatient treatment and partial hospitalization programs for those who can’t fully commit to residential treatment.
- Our staff members will research the mental health benefits available under your Aetna health insurance plan. Aetna tends to cover a wide range of mental health services.
- You’ll learn more about the financial assistance options available for paying your out-of-pocket mental health expenses.