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Using Aetna Insurance for Drug or Alcohol Treatment

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Does Aetna Cover Substance Use Treatment?

Under the Affordable Care Act (ACA), most insurance companies must cover substance use treatment in some way.1 Aetna does cover many forms of addiction treatment. But exactly what they cover will depend on your plan and the state you live in.

Treatment Types Covered by Aetna

Depending on your plan, the treatment types Aetna covers may include, but are not limited to:

  • Detox
  • Inpatient rehab
  • Outpatient rehab
  • Counseling and therapy

How Can I Find Out What My Aetna Plan Covers?

Before you begin any substance use treatment program, it’s a good idea to check what Aetna will and won’t cover. You can do this a few ways:

  • Sign in on the Member Login.
  • Call customer service at the number on the back of your card.
  • Call the treatment center directly.

How to Use Aetna for Drug and Alcohol Treatment

The first step for many on their treatment journey is talking to their doctor (sometimes called a “primary care physician,” or PCP). Your doctor can assess your needs and refer you to specialists or other treatment.

Next, call Aetna to ask what they cover. Some good questions to ask them include: how many days of treatment they cover, what you will have to pay for (called “out-of-pocket” costs), and if you need to get special approval (called “pre-authorization”) first.

Once you know what Aetna will and won’t cover, you can find a treatment center that accepts your plan. It’s a good idea to call them before starting treatment as well so you can confirm costs.

How to Find Rehab Facilities Covered by Aetna

One of the easiest ways to find treatment centers in Aetna’s network is to use their Find a Doctor tool. Simply log in and search for drug or alcohol rehab centers.

Aetna is a well-known insurance company that contracts with many treatment centers, so finding one that takes your insurance shouldn’t be a problem. In fact, American Addiction Centers works with Aetna. But if Aetna doesn’t cover your first choice for treatment, don’t give up. Your well-being is too important, and there are many options to pay for treatment.

Do Rehab Centers Need to Be In-Network?

You don’t have to stay in the network with some types of Aetna insurance plans.2 But it will almost always cost more if you do choose a treatment center that is out-of-network.2 Remember, you can always check who is in network by calling Aetna or searching their online list of providers.

Types of Aetna Insurance Plans

Aetna’s insurance plans fall into one of the following categories:3

  • Health Maintenance Organization (HMO): this type of plan has a low monthly premium (how much you pay each month). But you need to stay in-network and your PCP will need to refer you to any specialists.
  • Point of Service (POS): this plan is a little more flexible than an HMO. With this plan, you can see out-of-network providers, but you will pay higher premiums.
  • Preferred Provider Organization (PPO): with a PPO, you pay more for your monthly premiums, but you can see specialists and out-of-network doctors without a referral.
  • Exclusive Provider Organization (EPO): premiums in this plan cost more than what you’d pay in an HMO but are less than a PPO. While you must stay within the network, it offers a large group of providers.

Within each category outlined above, Aetna has several insurance plans to choose from. Each plan will give you different options in terms of how much you pay for addiction treatment and whether or not you’ll need referrals or can go out of network.

Medicare and Medicaid

Medicaid offers low- or no-cost health insurance for people with lower incomes, special needs, or disabilities. Aetna offers Medicaid insurance plans in the following states:4

  • Arizona
  • Illinois
  • Kentucky
  • Louisiana
  • Maryland
  • Michigan
  • New Jersey
  • New York
  • Ohio
  • Pennsylvania
  • Texas
  • Virginia
  • West Virginia

Aetna also offers Medicare Advantage plans, which combine original Medicare with other insurance coverage. Aetna has HMO-POS, HMO, and PPO Medicare plans. Some of these plans have no monthly premium.5

Check Your Aetna Coverage Now

Insurance can be confusing, but we try to make it easier to understand. You can check online if Aetna covers treatment with us.

Note: We try to offer the most updated information available about insurance. But insurance health plan information does change quickly. Please check with your insurance company to ensure that you have the most recent and correct information about your coverage.

Sources

  1. HealthCare.gov. (n.d.). Mental health & substance abuse coverage.
  2. Aetna. (2021). Network and out-of-network care.
  3. Aetna. (2021). HMO, POS, PPO, EPO and HDHP with HSA: What’s the difference?
  4. Aetna. (2021). DocFind.
  5. Aetna. (2021). Aetna Medicare solutions.

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