Like most insurance companies, Aetna will cover drug rehab at least partially.
The Affordable Care Act mandates that substance abuse treatment must be covered to the same degree that traditional medical treatments are covered by a plan. The specifics of how much will be covered by Aetna vary according to the particulars of a plan.
Aetna is a large insurance company. They provide coverage in at least 13 states:
In a 2017 Aetna guide discussing the federal Mental Health Parity and Addiction Equity Act (MHPAEA) of 2008, they discuss how, barring some edge cases, mental health coverage is generally covered like any other medical procedure. Substance abuse treatment is included under the umbrella of mental health coverage.
People who intend to get treatment for a substance use disorder should always discuss what will be covered with both their insurance provider and a representative from the prospective rehab. Both parties can confirm the individual’s level of coverage and give specifics on what can be expected in terms of out-of-pocket costs.
This all said, your insurance will usually cover your substance abuse treatment, at least partially, as required by law.
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As discussed in an article from the Hartford Courant, the federal government has established four broad categories of care, defined by the percentage of costs they cover for approved medical procedures.
While it’s a bit difficult to compare numbers at a glance, Aetna’s pricing and coverage are generally fairly affordable. The only group that it usually charges more than average are people over the age of 55.
There are some limitations on what these plans will cover. A procedure usually has to be based on accepted medical practices; experimental or investigative procedures are not covered. This also means treatments that are labeled as “alternative” won’t often be covered, but this is not exclusively the case. This is in line with MHPAEA and common practice.
If a procedure or medication can be deemed “medically necessary,” which in the case of mental health and substance abuse treatment usually means it is verifiably likely to help you more than cheaper alternatives, it will likely be approved and therefore covered. Discuss this designation with your substance abuse treatment provider to ensure treatment will be covered by your plan.
Most plans will also place a limit on the number of sessions or days of care. For example, outpatient therapy may be limited to a specific number of days per quarter or calendar year. A stay in a rehab facility may be limited to a set number of days.
In many instances, there may be steps to take before coverage for a specific type of treatment is approved. Inpatient rehab may not initially be approved since it is more expensive than outpatient care. Some plans may require that a client has first attempted outpatient treatment and then relapsed before they approve inpatient treatment.
Exact insurance costs for different tiers of coverage can vary wildly, mainly based on where you live. This is not unique to Aetna. For example, in many areas, it can be cheaper to buy a gold-level plan over a silver one.
Navigating the best insurance is complicated. Sometimes, it can be wise to contact an insurance broker. They can often help you find the best plan for your needs.
If you have an Aetna plan, you can rest assured that drug rehab will be covered to some degree. Confirm your exact level of coverage prior to enrolling in treatment. Getting specific on what you can expect to pay out of pocket can help you determine what kind of care will make the most sense for your needs and your financial situation.
Aetna Review. Purch. Retrieved from https://www.toptenreviews.com/services/insurance/best-health-insurance-providers/aetna-review/
Claims & Coverage. Aetna. Retrieved from https://www.aetna.com/individuals-families/member-rights-resources/claims-coverage.html
(2019) The Best Health Insurance Providers of 2019. Purch. Retrieved from https://www.toptenreviews.com/services/insurance/best-health-insurance-providers/
(2017) Understanding Mental Health Parity: Aetna Behavioral Health. Aetna. Retrieved from http://www.aetna.com/individuals-families-health-insurance/document-library/understanding-mental-health-parity.pdf
Glossary of Health Coverage and Medical Terms. Centers for Medicare and Medicaid Services (CMS). Retrieved from https://www.cms.gov/CCIIO/Resources/Files/Downloads/uniform-glossary-final.pdf
(May 2013) Aetna Becomes Third Insurer to Submit Rates for State Health Exchange. Hartford Courant. Retrieved from https://www.courant.com/business/hc-xpm-2013-05-31-hc-aetna-rates-exchange-20130531-story.html
State Specific Information. Aetna. Retrieved from https://www.aetna.com/individuals-families/member-rights-resources/rights/state-specific-information.html
When Silver Costs More Than Gold: How Trump’s Actions Have Scrambled Insurance Prices. The New York Times. Retrieved from https://www.nytimes.com/2017/10/27/upshot/when-silver-costs-more-than-gold-how-trumps-actions-have-scrambled-insurance-prices.html