Deciding to go to a drug or alcohol addiction rehab is difficult enough without having to worry about whether your insurance covers the treatment service. This page will help you learn more about:
- The Aetna Insurance health plan.
- Healthcare coverage levels and plans offered by Aetna.
- How to learn more about your healthcare benefits.
- Whether Aetna offers addiction treatment coverage.
Aetna Insurance was started in 1853 and has grown over the years.1 It is now a part of CVS Health Corporation and provides health insurance to nearly 40 million people.1, 2 Aetna plans cover medical, dental, behavioral health, and pharmacy care.2
Please note: American Addiction Centers (AAC) aims to provide the most accurate information on insurance coverage for addiction treatment, but policy changes and errors do occur. Always be sure to confirm your coverage directly with your insurance carrier. AAC is not affiliated with or endorsed by Aetna or any of its licensees.
Aetna Insurance Coverage Levels and Coverage Plans
Aetna medical insurance plans differ between states and are divided into 2 types and 3 tiers.3,4 Health maintenance organization (HMO) plans offer lower premiums and deductibles with set copays, but you need to see doctors who are in-network and obtain referrals from your primary care doctor to see specialists.3 Preferred provider organization (PPO) plans have higher premiums and lower copays and coinsurance and offer specialist and out-of-network visits without obtaining a referral.3 The PPO tiers include:4
- Bronze plans—These cost less in premiums but have the highest deductibles and will cost you more in out-of-pocket expenses. Aetna pays about 70% of the cost of care after the deductible is met.
- Silver plans—These cost more in premiums but have lower deductibles and will cost you less in out-of-pocket expenses than bronze plans. Aetna pays about 80% of the cost of care after the deductible is met.
- Gold plans—These cost the most in premiums but have the lowest deductibles and will cost you the least in out-of-pocket expenses. Aetna pays about 90% of the cost of care after the deductible is met.
Medicaid is a government-funded health insurance program for people who have disabilities or special health needs or meet specific income requirements.5 Aetna provides plans for Medicaid in many states across the United States.5 Aetna also offers Medicare plans, which offer health insurance through the federal government for adults aged 65 or older, and in some cases, younger people who have disabilities.6
Depending on your Aetna medical coverage policy, you may be able to seek addiction treatment out of state. HMO plans cover only in-network providers, and that may be limited by geographic area, while PPO plans may provide more coverage for providers outside of your state. However, checking with your plan to ensure that you will be covered first is always a good idea.
Checking Your Insurance Benefits
If you want to confirm if Aetna covers drug rehab or just check your insurance coverage, you can do so by calling the number on the back of your insurance card and speaking with a representative. You can also view your coverage by using an online account. Logging into a member account also allows you to utilize a cost estimator to roughly estimate how much treatment might cost.
Aetna offers a variety of plans tailored for federal workers and retirees. These plans vary based on your location and personal needs.7 For more information on what is available in your area, visit this page.
Does Aetna Insurance Plan Cover Drug and Alcohol Addiction Treatment?
You may have concerns about Aetna insurance mental health coverage, but under the Affordable Care Act, this is covered as an essential health benefit.8 Depending on your insurance plan, Aetna drug and alcohol rehab coverage may include:
- Inpatient treatment.
- Partial hospitalization programs.
- Intensive outpatient treatment.
- Outpatient treatment.
Services are often based on medical necessity and may require a referral and prior authorization to be approved. If you aren’t sure if your insurance will be accepted at American Addiction Centers (AAC), you can check on this page.
Aetna insurance therapy coverage can be confusing to navigate, but a wide range of plans is available. Benefits do cover treatment for addiction, although what is covered and where you can seek treatment may depend on what type of plan you have. It is always a good idea to confirm your coverage before starting treatment.
Check if your insurance covers addiction treatment
To see if your insurance coverage includes rehab treatment for drug or alcohol addiction, use our verify insurance form.
We also explain insurance coverage levels of some household health insurance brand names via the links below:
We also have a guide on how to pay for rehab with or without insurance.
- Aetna. (2020). Our corporate profile.
- Aetna. (2020). Aetna facts.
- Aetna. (2020). HMO, POS, PPO, EPO, and HDHP with HSA: What’s the difference?
- Aetna. (2019). Aetna Life/Aetna Health 2020 small group plans.
- Aetna. (2020). Medicaid health plans.
- Aetna. (2020). What is Medicare?
- Aetna. (2020). Compare plans.
- Healthcare.gov. (n.d.). Essential health benefits.