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Aetna Substance Abuse Rehab Insurance Coverage

On this page, you will learn about Aetna health insurance coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
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AETNA COVERAGE FOR DRUG AND ALCOHOL REHAB PROGRAMS

Provider Overview

When you or your loved one needs alcohol or drug rehab, you have many things to think about, including:

  • Where you should get treatment?
  • How does treatment works?
  • How long you will be in a rehab program?

You will also undoubtedly have concerns over how you will pay for drug and alcohol rehab.

Does Aetna Cover Drug and Alcohol Addiction Rehab?

If you are covered through Aetna insurance, you will likely have some form of healthcare coverage for drug and alcohol rehab. Addiction treatment coverage will vary depending on which Aetna insurance health plan you have.

Please note: American Addiction Centers (AAC) strives to provide you with the most updated information on each carrier’s addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels. AAC is not affiliated with or endorsed by Aetna or any of its licensees.

What Is Aetna Insurance & How Does It Work?

Aetna Insurance1 was founded in 1853 and is now one of the largest medical insurance companies in the United States. Aetna is a part of the CVS Health Corporation1 and provides a wide variety of insurance products to individuals and employers who provide group coverage to their employees. Aetna also offers plans for managed Medicare and managed Medicaid plans in 14 states.2,3


Aetna Insurance for Substance Abuse Rehab

Does Aetna cover rehab treatment for substance abuse? Aetna Insurance mental health coverage typically includes benefits for substance abuse rehab.

To see what coverage options your Aetna plan provides, you should check your Aetna drug alcohol rehab coverage. One easy way to do this is to call the number on the back of your insurance card and speak directly to an Aetna representative to determine what benefits you have for either inpatient or outpatient drug rehab.


Medicaid Coverage from Aetna Insurance

Aetna insurance therapy coverage varies by plan and includes managed Medicaid plans for people who qualify for Medicaid coverage based on income and other factors. Aetna Medicaid is offered in several states including California, Illinois, New York, and Florida.3

Medicaid covers alcohol and drug rehab, and you can link to your state’s program at Benefits.gov for more information.4 While Medicaid frequently covers inpatient rehab, not all treatment programs will accept Medicaid. Therefore, it is important that you check your healthcare benefits through Aetna Medicaid coverage5 and also make sure that the provider you are interested in accepts Medicaid.

When you are a recipient of Medicare, you can also get inpatient rehab with a deductible of $1,480. A deductible is a fee you are responsible for before the insurer contributes to the cost of treatment. You also must pay 20% of the costs of inpatient treatment.6 Aetna offers numerous plans that provide Medicare coverage.2


Aetna Insurance for Inpatient Rehab Centers

Some Aetna plans also cover inpatient rehab. For example, one Aetna plan in Maine for government employees has a $400 individual deductible and an $800 family deductible. After meeting your deductible, this Aetna plan covers the costs of inpatient treatment except for a 10% co-insurance payment. This means you will be responsible for 10% of the overall cost of inpatient treatment.7

One Federal Aetna plan lists 20% co-insurance rates for some plans for inpatient rehab with a $700 individual deductible and a $1,400 family deductible.9 Another Aetna insurance plan, for the employees of the State of Illinois, offers a no-deductible plan with a $375 co-pay for inpatient drug and alcohol rehab.8 These examples show that the coverage varies a great deal from one Aetna plan to another, but all Aetna insurance plans cover some part of inpatient rehab.

Aetna Insurance for Outpatient Rehab Centers

Medicare and Medicaid plans under Aetna provide coverage for outpatient drug and alcohol rehab if deemed necessary by a provider. The addiction treatment that Medicare covers may include intensive outpatient programs, which meet a few hours a week, and partial hospitalization programs, which meet 20 hours a week or more.10

As noted with inpatient addiction treatment, the amount of coverage provided for outpatient treatment through Aetna medical insurance plans varies. In one Aetna insurance plan in Maine, outpatient treatment has a coinsurance rate of 30% of overall treatment cost, whereas a plan in Illinois has a $35 per visit co-pay.7,8 A typical Federal Aetna plan offers a 20% coinsurance coverage option for outpatient treatment.9

Does Aetna cover mental health?

Yes, nearly all Aetna Behavioral Health plans cover therapy for mental and behavioral health conditions. You may be concerned about other diagnosed or undiagnosed mental illnesses. It’s important to note that substance misuse and addiction are  mental health disorders. However, many people who have a substance use disorder also have another mental illness.11 In fact, according to the National Institute on Drug Abuse, it’s common for people to have co-occurring conditions. 11

It is not clear whether substance abuse leads to mental illness or mental illness drives people to use substances—it could be a bit of both.11 Whatever the case may be, it’s vital to work with one of the Aetna rehab centers that specialize in co-occurring disorder treatment, as well as treat these two conditions in tandem. Doing so will ensure you receive adequate care for both issues.11

The Affordable Care Act, which creates certain mandates for insurance providers, requires that carriers provide for mental health care and substance abuse treatment. 12


Does My Aetna Insurance Policy Cover Addiction Treatment?

It is important that you check your benefits and coverage under your Aetna medical insurance plan to see what levels of coverage your plan offers for drug and alcohol rehab. Call the number on the back of your insurance card or check your Aetna insurance coverage and benefits underneath.

Federal employees who are covered through Aetna can get more information regarding benefits and coverage under their Aetna health insurance plans.9

Whether you have Aetna as a federal employee, through another employer, or as part of your managed Medicare or Medicaid plan, you have some level of coverage for inpatient or outpatient alcohol and drug rehab. Check your benefits by calling Aetna or go online to find the best, most affordable addiction treatment program for you or your loved one.

How Can I Check My Aetna Coverage for Inpatient Drug Rehab Centers?

Before you select a treatment facility, it’s important to check your Aetna benefits to understand which costs will be covered by insurance and what you will be expected to pay out-of-pocket. Call the number on the back of your insurance card or log in to your account on the Aetna website to learn more about the specifics of your plan, including deductibles and copayments.

American Addiction Centers can verify your insurance coverage for you. Call our helpline at to speak to an admissions navigator who can check your benefits with you while you’re on the phone.

Related Guides on Rehab Treatment Covered by Insurance


Check Your Policy Coverage

With the form below you can quickly and privately check your insurance benefits to see if you're covered for addiction treatment services. We’ll be able to tell you if your policy is in-network at an American Addiction Centers location.
Verification of Benefits Form

Please fill out the form below to verify your insurance coverage.

* These fields are required

First Name
*
John
Last Name
*
Smith
Phone Number
*
(555) 555-5555
Email
*
jsmith@mail.com
Date of Birth
MM/DD/YYYY
Find Insurance Carrier * 1
Aetna
Policy Membership ID
WXY1030Z0
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How to Read Your Insurance Provider Card
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  • 1Insurance Provider Name
  • 2Policy Member's Full Name
  • 3Policy Membership/Subscriber ID
Verification of Benefits Form

Please fill out the form below to verify your insurance coverage.

* These fields are required

First Name
*
John
Last Name
*
Smith
Phone Number
*
(555) 555-5555
Email
*
jsmith@mail.com
Date of Birth
MM/DD/YYYY
Find Insurance Carrier * 1
Aetna
Policy Membership ID
WXY1030Z0
Disclaimer
HIPAA badge
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Frequently asked questions

How Long Does Aetna Precertification Take for Alcohol Rehab or Drug Treatment?
The precertification process assesses a person’s eligibility for receiving care.13 Patients receive thorough diagnostic testing to determine what type of SUD treatment is medically necessary.13 Aetna will decide if a member qualifies for the proposed level of care within 5 business days or 3 days for urgent treatment.14
Does Aetna Cover Drug and Alcohol Evaluation Cost?
Yes, Aetna has a comprehensive evaluation program in place.13 They cooperate with healthcare professionals to carefully assess patients’ needs, offer them a suitable treatment plan, and provide them with helpful resources and ongoing support.13
What Does Aetna Medicaid Cover for Addiction Treatment?
Depending on the assessment of the patient’s needs and their insurance plan, Aetna may help pay for inpatient or outpatient care, including medically supervised detoxification, medication, and counseling.13
Does Aetna Cover Online Drug Treatment Therapy?
Aetna Behavioral Health provides telemedicine treatment to commercial self-insured plan sponsors and commercial fully insured members unless the plan sponsors have decided against it.13 This way, more patients can access quality mental healthcare services and their distance from the rehab facility doesn’t pose a problem.13