What Is Aetna Insurance?
Founded in Hartford, Connecticut in 1853, Aetna provides healthcare professionals, employers, and individuals quality health insurance products.1 Today the company is owned by CVS Health and provides insurance to 39 million people across the country.2 Members can choose from a variety of medical, pharmacy, and dental policies as well as a wide range of other services.2
Who Takes Aetna Insurance?
While Aetna partners with many providers for your care, you’ll need to choose an in-network provider if you want your services to be covered. Currently, patients have access to 1.2 million healthcare professionals, more than 700,000 primary care doctors and specialists, and more than 5,700 hospitals that are classified as in-network.2
Like most providers, every plan is a bit different, with some plans offering a coinsurance amount that you’ll pay for out-of-network services, and others using Medicare-based rates. It’s best to check directly with Aetna before seeking any care just to verify what will and will not be covered.3
Aetna Insurance Plans and Coverage Levels
Aetna offers a wide range of insurance plans depending on your needs and location. If you’re seeking health insurance through the Health Insurance Marketplace, you’ll need to decide if you want a Bronze, Silver, or Gold plan. The exact coverage levels and prices for these plans vary by state.
- Bronze plans typically cost the least and offer less coverage with a higher deductible.
- Silver plans are a mid-tier plan with slightly more cost-effective benefits.
- Gold plans cost the most, but you’ll have the lowest deductibles and most coinsurance.
It might help to use the state of Maine as an example. Aetna offered 12 plans to Maine residents in 2020: 2 types of Bronze, 8 kinds of Silver, and 2 Gold plans.4 Costs ranged from $414.96 for the cheapest Bronze plan to $635.94 for the most expensive Gold plan.4 Aetna’s Bronze plan covered 70% of expenses after the deductible was met. This increased to 80% with a Silver plan and 90% with a Gold plan.4
Another thing you’ll want to consider when choosing Aetna insurance coverage is whether it’s an HMO, POS, or PPO.
- An HMO, or health maintenance organization, typically limits your coverage to in-network doctors. This means you’ll usually be eligible for care only within a certain geographic area.5
- A POS, or point of service, is similar to an HMO in that it requires you to use an in-network doctor to get coverage. However, it takes things a step further by also requiring you to get a referral from your primary care doctor before seeing a specialist. 5
- A PPO, or preferred provider organization, offers you a discount on services if you use a provider in the plan’s network. However, it will still provide coverage for an out-of-network doctor—just not as much as if you were in-network. This will allow you to see the doctors you want while still having peace of mind that you won’t be stuck with the full cost.5
Aetna allows offers specific plans for those on Medicare and Medicaid. You might qualify if you’re over age 65, have limited assets, or have a disability.6
Does Aetna Cover Alcohol Treatment?
Yes, Aetna insurance coverage includes treatment for alcoholism. With the passing of the Affordable Care Act (ACA), all insurance providers must offer some rehab services for alcoholism. The Mental Health Parity and Addiction Equity Act was also passed in 2008 to prevent health insurance providers from offering less coverage for mental health or substance abuse disorder benefits than for medical and surgical benefits.7
This means that any plan you get from your employer or from the Health Insurance Marketplace will cover behavioral health treatment, including psychotherapy and counseling. It should also cover mental and behavioral health inpatient services as well as substance use disorder treatment.8 Certain small group health plans may not qualify, though, so it’s always best to check directly with Aetna to see what services they will cover.7
Aetna will likely partially cover both inpatient and outpatient stays, though you’ll need to check with the specifics of your plan for details. There is also usually a determined length of treatment time they will cover—depending on your specific plan.
Does Aetna Cover Mental Health?
Yes, Aetna offers a range of coverage for co-occurring mental health disorders. Its current network comprises more than 160,000 behavioral health providers nationwide as well as 60,000 employee assistance program providers.9 Patients can also get in touch with an Aetna behavioral healthcare manager to get assistance with arranging outpatient care, connect with community resources, and find caregivers after an inpatient stay. 9
Some of the treatments currently covered by Aetna include behavioral therapy and medication therapy in conjunction with treatment for substance abuse disorder.10 Behavioral therapy can help you find the root of your substance abuse problems and work to manage those issues in one-on-one, group, or family sessions with a qualified therapist.
In medication therapy, you’ll work with your doctor to find medicine that can make you feel better during treatment. They’ll help you manage any side effects and investigate new treatments for any co-occurring conditions.
How to Check Aetna Coverage for Alcohol Rehab
The best way to verify what Aetna does and doesn’t cover is to call the number on the back of your card. You’ll speak with an official Aetna representative who can look up costs for your specific plan. You may also be able to check costs in your summary of benefits and coverage booklet, which should be located in your online account.11
Remember to ask questions about how long substance abuse treatment is covered, how many days of rehab is covered, and which programs take Aetna insurance in your area.
Paying Aetna Out-of-Pocket Costs
Even with the best Aetna insurance coverage plan, you’ll likely still be left with some costs that aren’t covered. Rather than emptying out your bank account, you may be able to find creative ways to help foot these bills.
Many rehab centers offer payment plans where you pay off a small bit at a time, so you don’t owe the full cost of treatment upfront. You may even qualify for a sliding scale payment, making the costs more manageable with your income level.
The Substance Abuse and Mental Health Services Administration frequently provides states and individual rehab centers with grant money to defray the cost of treatment for patients. You may want to find programs in your area that have received a grant and can offer you treatment for free or at a lower cost.
Other options include taking out a specialized healthcare loan or putting the treatment costs on your credit card. Just make sure you’re financially stable enough for these options. Defaulting on your loan payments could sink you into debt, making it harder to get back on track with life.
Finally, if you can’t find low-cost treatment and don’t want to put your financial future at risk, use a crowdfunding website to ask for donations. This is a way to ask your friends and family for help by contributing whatever they can.
Verify Your Aetna Insurance for Alcohol Rehab
When you’re ready to seek help for your substance abuse problems, don’t let the idea of insurance coverage stand in your way. Alcohol.org is a subsidiary of American Addiction Centers (AAC), a nationwide provider of addiction treatment centers and can help you verify your insurance coverage as well.
AAC can help you understand your coverage benefits so you can get into treatment right away. Call our admissions navigators at 1-888-685-5770 to find out just what your insurance covers at one of our rehab facilities or fill out the form below. All calls are 100% confidential and we’re available 24/7 to speak with you. Plus, there’s no obligation to make any decisions today; we’re here to support you and help you better understand how to successfully work toward recovery.
. Aetna. (n.d.). Our corporate profile.
. Aetna. (n.d.). Aetna Facts.
. Aetna. (n.d.). Network and out-of-network care.
. Maine.gov. (n.d.). Aetna Life / Aetna Health 2020 Small Group Plans.
. HealthCare.gov. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more.
. Aetna. (n.d.) Medical insurance plans for individuals and families.
. CMS.gov (n.d.) The Mental Health Parity and Addiction Equity Act (MHPAEA).
. HealthCare.gov. (n.d.). Mental health & substance abuse coverage.
. Aetna. (n.d.). Removing barriers to mental health care.
. Aetna. (n.d.). Helping you feel your best.
. Aetna (n.d.). Summary of Benefits & Coverage.