Do I Have Aetna Substance Abuse Coverage?

Let’s face it, health insurance can be confusing and hard to understand and the answer to this question isn’t always immediately obvious.This question is usually at the top of the list: Do I have Aetna substance abuse coverage? In this case, we’re happy to tell you that the answer is YES, if you have Aetna health insurance, of course.

In this blog, 1st Step Behavioral Health answers some of the most common questions Aetna subscribers ask when it comes time to look for addiction treatment. We’re proud to say that 1st Step Behavioral Health is in-network with Aetna, so that may make your decision a bit easier. Keep reading to find out the rest of the details you should know about your substance abuse coverage from Aetna.

Why Your Aetna Substance Abuse Coverage is Protected

If you are currently covered under a private Aetna medical insurance plan in the U.S. then you have substance abuse coverage from Aetna. In fact, Aetna’s coverage for substance abuse is mandatory by law. Thanks to a few very important pieces of legislation, all private health insurance providers in the U.S. by law, must offer equivalent coverage for both substance abuse and mental health.

The key laws that made this possible are:

  • The Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA)
  • The Affordable Care Act (ACA) aka ‘Obamacare’

How Do I Use My Aetna Insurance For Addiction Treatment?

Now that you know you’re covered, you probably want to know how you can put your Aetna substance abuse benefits to work for you or your loved one. We’ve got you covered. The first thing you should know is that while all Aetna plans offer addiction treatment coverage, the level of coverage and the potential out-of-pocket costs for you vary depending on the plan.

Most people get their Aetna insurance from one of 3 sources:

  • Provided by an employer as a benefit of your job.
  • You are covered under a family members plan from their job
  • You purchased an Aetna plan privately, with your own money.

If you bought your insurance private through the Health Insurance Marketplace then your Aetna plan will fall under one of the following categories:

  • Platinum
  • Gold
  • Silver
  • Bronze

Note that these levels do not indicate the quality of care you will receive. Primarily what they indicate is your out of pocket and deductible costs. For example, the Platinum plans will have the lowest deductibles and out-of-pocket maximums, but the highest monthly premiums.

Bronze plans on the other hand have the lowest monthly premium payments, but the highest deductibles and out-of-pocket maximums.

How Does This Affect My Aetna Substance Abuse Coverage?

The Aetna plan you have, whether it’s from an employer or the exchange will cover substance abuse treatment and mental health. Your portion of the cost for addiction treatment is determined by your deductible, out-of-pocket max and co-insurances. What you pay will also be determined by whether or not the substance abuse treatment program is in-network for you.

Some Aetna plans, typically PPO plans, will also offer out-of-network benefits. However, when you go out of network your portion of the costs will be significantly higher. 1st Step Behavioral Health is in-network with Aetna. This means you get the most value from your Aetna substance abuse coverage and you can likely utilize your plan here, even if you have a plan that does not have out of network coverage.

What Does Deductible, Out-of-Pocket and Co-ins Mean Exactly?


Your deductible is the amount you pay out-of-pocket before your insurance coverage kicks in. Your deductible will vary depending on your plan, but a lower monthly payment generally means you’ll pay a higher deductible, and vice-versa.

Coinsurance or Co-ins

The coinsurance is the percentage you will pay for treatment, beginning after you meet your deductible. Many insurance plans are an 80/20 share, which means Aetna will pay 80 percent, and you will pay 20 percent.


Co-pays are flat, predetermined fees that you pay for treatment. The amount of your co-pay will depend on the type of treatment you receive. Depending on your plan, you may be required to pay both co-pay and coinsurance.

Out-of-Pocket Max

Your out-of-pocket maximum is the most you will need to pay for covered services within a year. Once you pay the maximum amount listed on your policy, Aetna will pick up costs for the remainder of the year. You won’t need to pay deductibles, co-pay, or coinsurance after that amount is met for the calendar year. .

Using Your Aetna Substance Abuse Coverage to Go To Rehab

Want to utilize your coverage, but still full of questions? Not to worry, we get it. Anytime a person is thinking about going to substance abuse treatment there’s a lot going on. It can be hard to settle yourself, sort through insurance jargon and formulate a plan to get yourself or your loved one to rehab. Luckily we deal with this stuff every day, so we understand it quite well.

One of the things you’re going to want to know is whether or not you or your loved one are eligible for substance abuse treatment. Part of the way that is determined is by an initial pre-admission screening which can be done right over the phone.

Pre-Admission Phone Screening

Our pre-admission screening is a 100% confidential interview where we ask some questions to get a better understanding of what the person who needs treatment is experiencing. This is usually where most people begin the process. It doesn’t obligate you (or your loved one) to go to treatment here, it simply lays the groundwork so you can, if you decide to.

During the call, we also gather your insurance information and perform what is called a “verification of benefits” for you. That just means we call your insurance company to confirm we have all your information correct and get all the relevant details on your Aetna substance abuse coverage. After that, we can usually let you know if you or your loved one are eligible for treatment.

We can also answer your questions about using your substance abuse coverage from Aetna at 1st Step Behavioral Health at that time and even let you know how much of your deductible or out-of-pocket costs (if any) are met for the year already.

Let’s Take the 1st Step Together

Remember, it’s never too soon to get help for a drug problem, but it’s possible to wait until it is too late. 1st Step Behavioral Health has over 22 years of experience in helping people just like you or your loved one overcome addiction. Give us a call at (855) 425-4846 with any questions you have about using your Aetna substance abuse coverage here or about our facility or treatment in general. You’re also welcome to submit your Aetna insurance info for verification using our confidential form here.

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