Aetna was founded in 1850 and has grown to become the third largest health insurance provider by membership. The national insurer was acquired by CVS in 2018, expanding treatment options within the drug store for those insured through Aetna.
Aetna rehab coverage helps reduce the cost of addiction treatment in a variety of settings.
Aetna is one of many national insurance providers to specifically cover addiction rehab. Aetna substance abuse treatment is included with both their HMO and PPO plans. You can expect to see the following types of addiction treatment covered to some extent:
Aetna’s substance abuse guidelines closely follow the American Society of Addiction Medicine’s criteria for diagnosing alcohol use disorder and substance use disorder. While this is not an exhaustive list, you can expect your initial discussions with an addiction specialist to include the following questions which help them determine what type of care your insurance may qualify you for:
With the passing of the Affordable Care Act all insurance providers were mandated to cover behavioral and substance abuse treatments. While each patient’s policy is unique, you can expect to see the most common addictions covered under your Aetna policy:
In short, yes. The medical community has come a long way in recognizing that addiction often goes hand-in-hand with mental illness; both of which needing treatment to encourage long-term sobriety. Aetna may cover many popular treatments like Cognitive Behavioral Therapy, Eye Movement Desensitization and Reprocessing, and even Biofeedback (depending on the plan).
Your specific plan will determine the exact medications Aetna covers. So long as you know your plan name and year you can search for the specific medication coverage on their site.
While medication-assisted treatment (MAT) is not necessary for all clients, many, especially those struggling with an opioid addiction can find lasting recovery with a combination of prescription medications and behavioral therapy.
At The Hope House, we offer a dedicated MAT program to help our clients overcome addiction and “stay sober for good.”
Suboxone (buprenorphine + naloxone) is an approved treatment for opioid use disorder. Typically, Aetna does cover Suboxone under your pharmacy plan. The exact amount covered varies by plan and deductible minimums. You may also need a referral to get a script from a doctor designated to provide the medication. However, if you’re covered through your employer, you likely do not.
While in treatment at The Hope House, our staff is qualified to prescribe on-site and will work with you and your insurance company closely to determine the most cost-effective treatment.
Methadone maintenance differs slightly from Suboxone coverage as the medication is distributed at a Methadone clinic. For this reason, Methadone is typically covered under your medical plan and not your pharmacy plan. This can impact the amount of coverage based on your unique plan.
For help understanding your unique Aetna benefits, call our addiction specialists today.
While substance abuse treatment is deemed an essential service under the Affordable Care Act, the level of coverage offered by insurance companies will differ. Typically, you can elect for a higher coverage plan at an increased monthly cost, or select a lower coverage plan at a reduced monthly cost.
The length of treatment covered depends on the client’s personalized recovery plan as well as the setting they are receiving treatment in. Approved Aetna residential treatment centers typically cover between 1-6 weeks of treatment, while approved Aetna outpatient treatment centers are typically covered for 4-12 weeks.
Those who’ve met their medical plan deductible for the year are likely to receive 100% coverage through insurance. However, for those who have not reached their deductible, they can expect to pay a portion of treatment costs. While there are numerous payment options available, the most popular include:
In Arizona, The Hope House has partnered with Aetna to help clients offset the cost of treatment while also receiving personalized treatment plans and care from masters-level clinicians. In 2017, Aetna was one of 16 health insurance providers to implement the National Principles of Care for Substance Abuse Treatment. These principles state that Aetna strives to work with treatment centers that: offer personalized diagnosis and treatment, provide access to FDA-approved medications, and employ trained and accredited behavioral health professionals.
At The Hope House, we work diligently to uphold the National Principles of Care for Substance Abuse Treatment.
Aetna is a national plan with coverage across all 50 U.S. states. This means that you can seek treatment in a different location from where you’re insured. While out-of-state treatment is not ideal for everyone, it can be a chance to break out of the environment leading to addiction and help you reset.
Aetna is one of many insurance providers offering addiction treatment coverage. If you or your loved one after an insurance policy other than Aetna, review their benefits specifically:
