Aetna, which is a CVS company, is a health insurance giant that provides healthcare, dental, and pharmacy drug coverage to about 39 million people across all 50 states.1 Additionally, Aetna provides coverage for medical management and behavioral health services. While some people may have an employer-sponsored Aetna plan, others may be enrolled in a private individual plan, Medicare, or Medicaid through Aetna.1
Aetna plans vary in type and coverage. Depending on the plan you have, your drug rehab treatment may be covered partially or fully. Rehab centers can check your coverage when you provide some basic information; be sure to call and ask a representative to check your coverage and benefits. Or, you can call the number on your Aetna insurance card to obtain more information about your specific health plan.
What Will Aetna Insurance Cover?
The breadth of your health coverage will vary based on your plan. However, all health plans in the United States are mandated by the Affordable Care Act (ACA) to provide coverage for 10 essential health benefits. Treatments for mental health and substance use disorders are considered essential health benefits, which means your plan must provide coverage for such services in some capacity.2
Some common treatments that may be partially or fully covered include the following:3
- Outpatient rehab or therapy. For those who do not need around-the-clock rehab or detox, an outpatient rehab or therapy program may work best. This type of treatment may be covered in some capacity under your Aetna mental health benefits. You would receive treatment within a facility and be permitted to come and go from appointments. 3, “How are behavioral therapies used to treat drug addiction?”
- Inpatient or residential rehab. This type of rehab may be recommended for people who need intensive care for their substance use and mental health disorders, or for both types of disorder if they are co-occurring. With inpatient rehab, you would receive medical care and therapy in a treatment facility for a set period of time while you recover.3, “How are behavioral therapies used to treat drug addiction?” Your Aetna plan may provide some level of coverage for inpatient or residential rehab programs.
- Partial hospitalization programs. Partial hospitalization programs combine elements of both outpatient and inpatient programs. They typically involve a structured day program for treatment; the patient doesn’t stay overnight in the facility.4 It is an alternative to full inpatient psychiatric care. In most cases, your Aetna plan will provide some level of coverage for this treatment.
Does Aetna Insurance Cover Mental Health Care?
Under the ACA mandate, all health plans, including your Aetna plan, must provide some level of coverage for mental health and substance use disorder treatments.2 This means you will be covered in some capacity for the following:2
- Behavioral treatment.
- Mental and behavioral inpatient care.
- Substance use disorder treatment.
By nature of this mandate, Aetna will also cover you for some level of treatment for co-occurring mental health and substance use disorders. The National Institute of Drug Abuse found that 7.7 million Americans have a co-occurring disorder, 20.3 million have a substance abuse disorder, and 42.1 million have a mental health disorder.5 If you’re experiencing a co-occurring substance use disorder and mental illness, you’re not alone.
How Long Does Aetna Insurance Cover Drug Rehab?
There is not a standard length of time across all Aetna policies for rehab coverage. Your Aetna insurance policy will determine the extent to which rehab is covered, whether the provider is an in-network provider or out-of-network. You will need to work with your provider to determine the best course of treatment for your personal recovery journey. Then, be sure to check your benefits to ensure that your treatment plan is covered. You can do this by calling the number on the back of your insurance card and speaking to a representative; you can also request a Summary of Benefits and Coverage, which will explain all of the benefits your plan will provide.
What if My Aetna Insurance Policy Does Not Cover Drug Rehab?
It is possible that your Aetna health insurance may not cover drug rehab, or may not cover a portion of your treatment, depending on your plan’s policy. This could also be the case if the provider you select is not within your network of approved providers. If this occurs, you may be responsible for paying for the cost of your treatment out of pocket.
However, you may be able to submit an out-of-network claim to your Aetna insurance in the hopes of recouping at least some of the cost of your treatment. Whatever out-of-pocket expenses you incur can go toward your plan’s out-of-pocket maximum limits. Be sure to talk to your Aetna insurance representative to understand all of your options.
You should also call your desired treatment facility to inquire about any financing options they may have. Many treatment facilities offer financing or scholarship opportunities to ensure that no one delays treatment due to cost. Remember, your health is of the utmost importance; getting care now should be your priority. Do not delay care due to insurance difficulties.
Aetna In-Network vs. Out-of-Network Rehab Centers
To keep your health care costs as low as possible, it’s important to find a treatment facility that is within your network. An in-network provider will typically be either fully covered or covered at a higher level than an out-of-network provider would be. In-network providers have a contract with Aetna to provide pre-negotiated rates. Out-of-network providers are those that have not entered into a contract with Aetna.
Be sure to call your facility of choice before seeking treatment and ask if they’re within your network. You can also contact Aetna by calling the number on the back of your insurance card and they can help you determine whether a provider is in- or out-of-network.
Check Aetna Coverage for Addiction Treatment
Checking your Aetna coverage for addiction treatment is easy—and your plan can help you obtain treatment for your addiction. Moreover, your plan may be able to help you get the care you need at little to no cost to you.
American Addiction Centers can help you recover. We can also help you verify your benefits and coverage within minutes. Enter your information into the form below or call us today to find out more.
- (2021). Aetna facts.
- National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2019). Treatment Approaches for Drug Addiction DrugFacts.
- Mental health care (partial hospitalization).
- Gov. Mental health & substance abuse coverage.
- National Institute on Drug Abuse; National Institutes of Health; U.S. Department of Health and Human Services. (2018). Comorbidity: Substance Use and Other Mental Disorders.