Does Aetna cover drug rehab? Yes!

According to Aetna, over 21 million Americans have a substance abuse disorder, yet only one in 10 receives treatment. The company states that substance abuse frequently leads to poor health outcomes, increased illness, hospitalization, motor vehicle accidents, and premature death.

Therefore, Aetna Insurance Company offers several plans, and most cover some form of addiction treatment for drug and alcohol abuse. We’ve outlined some details below, but the best way to find out for sure what your plan covers is to call the treatment facility for verification of benefits.

Aetna Drug Rehab Coverage

Although most Aetna health insurance plans cover drug and alcohol rehab, the coverage level and length of covered substance abuse treatment vary. Each plan defines which services are covered and if coverage is subject to caps or other limits. 

One thing to note: All behavioral health services, including treatment for substance abuse and addiction, require pre-certification or authorization to ensure the treatment program meets the company’s criteria for coverage. Treatment decisions are made on a case-by-case basis.

SBIF: Screening, Brief Intervention, and Referral to Treatment

Aetna relies on SBIF (Screening, Brief Intervention, and Referral to Treatment), an evidence-based program that helps health care providers identify substance abuse problems. If intervention is needed, the program allows for up to five counseling sessions. Referrals are provided for patients who require more in-depth treatment.   

Aetna also uses tools and guidelines established by ASAM (American Society on Addiction Medicine), Applied Behavior Analysis (ABA), Clinical Policy Bulletins, Medicare and Medicaid Services Coverage Determinations, the Agency for Healthcare Research and Quality (AHRQ), and Aetna’s Level of Care assessment tool. 

Your Aetna substance abuse insurance coverage may include:

Aetna Insurance and Drug Rehab: Terms You Should Know

There are several factors to consider when trying to determine the cost of Aetna covered substance abuse treatment or rehab:

The 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 vise-versa. 

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. 

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.

Aetna Drug Rehab Facilities: Is the Treatment Center in Network or Out-of-Network?

Before selecting a treatment center, it’s essential to know if that treatment provider or rehab is in-network or out-of-network for Aetna. In-network providers are generally substantially less expensive because Aetna has negotiated lower rates with treatment centers. Your plan may cover certain out-of-network treatments, but many plans offer no coverage for out-of-network providers. The only way to know for sure is to check your benefit plan or call Aetna’s Member Services. If you’re considering a specific treatment center, they can tell you if the facility is in your network. 

Aetna Substance Abuse Coverage Specifics

Naloxone (Narcan)

If you’re struggling with opioid addiction, it’s essential to know that naloxone is a life-saving drug that can prevent an overdose by blocking its effects. Also sold as Narcan, naloxone is covered by all of Aetna’s insurance plans through the company’s pharmacy claims system. You can also pay up-front and send the bill to Aetna for payment.  

Medication-Assisted Treatment   

Medication-assisted treatment (MAT) is highly effective for substance abuse and addiction, particularly when used along with traditional treatment or counseling. The medications, such as methadone, disulfiram (Antabuse), buprenorphine, or naltrexone, work in different ways. In general, they either block the euphoric effects of alcohol or drugs, or they reduce cravings. 

Most of Aetna’s plans provide some coverage for medication-assisted treatment, although requirements vary. For instance, Aetna will cover buprenorphine without prior authorization if you are insured through an employer-based plan; however, you’ll need authorization from your medical provider if you have Aetna Medicare or Medicaid coverage. There may also be a limit on the quantity prescribed. 

Substance abuse treatment varies from place to place, and not all treatment centers offer medication-assisted treatment, even those that accept Aetna Insurance. For instance, some rehabs may provide treatment for co-occurring issues, opioid maintenance, on-site detox, holistic therapies, or treatment to specific populations, such as men, women, adolescents, LGBQ individuals, certain faiths, or business executives. 

Aetna Better Health Coverage 

Aetna Better Health is a federal and state-funded program that provides health benefits for people enrolled in Medicaid or the Children’s Health Insurance Program. Although Better Health plans vary, they generally cover all or part of the costs of addiction treatment. The program is available in several states, and each maintains its own website and contact information. This is the best place to go for specific information about your particular plan or availability in your state.

1st Step Accepts Aetna Coverage for Substance Abuse Treatment 

If you have Aetna health insurance, drug rehab at 1st Step Behavioral Healthcare is in-network, and there’s a good chance that all or part of your treatment is covered. We offer a continuum of care with a step-down level of treatment that begins with inpatient care. Going through graduating levels of care allows patients to take steps towards recovery at their pace so they can slowly make the life changes necessary for a lasting recovery. 1st Step Behavioral Health offers the following options in treatment programs:

  • Long-term care up to one year
  • Family therapy
  • Relapse treatment
  • Essential life skills
  • Residential treatment

Give us a call 855-425-4846 or contact us online and we’ll help you determine what your plan offers and what you may be expected to pay. You can also verify your insurance online. We’re here, and we’re ready to help. 

Reviewed for Medical & Clinical Accuracy by Brittany Polansky

Brittany PolanskyBrittany has been working in behavioral health since 2012 and is a Primary Clinician at our facility. She is an LCSW and holds a master’s degree in social work. She has great experience with chemical dependency and co-occurring mental health diagnoses as well as various therapeutic techniques. Brittany is passionate about treating all clients with dignity and respect, and providing a safe environment where clients can begin their healing journey in recovery.