Aetna is a leading health insurance provider in the United States with a range of plans and services on offer, including medical, pharmacy, and dental plans, Medicaid services, Medicare plans, and behavioral health programs. Aetna Insurance works with individuals struggling with drug and alcohol addiction to help them find effective treatment in their area. Various Aetna health insurance plans include coverage for inpatient and outpatient rehab as well as additional services to aid recovery in people with substance use disorders.

Exact coverage for substance abuse and mental health treatment varies from policy to policy. However, since these are essential health benefits in the United States, all Aetna insurance plans cover these services at least partially.

Aetna: Company Overview

Founded in 1853 in Hartford, Connecticut, Aetna was named after Mt. Etna in Sicily, Europe’s most active volcano at the time. The company has grown from strength to strength over the past century and a half. In 1999, with the acquisition of Prudential Healthcare for $1 billion, Aetna became the largest provider of health benefits in the United States, with more than 21 million members.[1]It has been voted multiple times by Fortune Magazine as the most admired company in health care, insurance, and managed care.

In 2017, Aetna was acquired by the CVS Health Corporation with a valuation of $69 billion. By 2018, Aetna had a membership base of 39 million Americans in its various health insurance plans. The Aetna network of 1.2 million healthcare professionals includes 700,000 primary care physicians and specialists with services offered at more than 5,700 hospitals. The company’s mission is simplicity in healthcare systems, focus on keeping members healthy, and using technology to connect members and healthcare teams seamlessly. [2]

Aetna Initiatives for Substance Abuse Treatment

Aetna understands the importance of getting timely treatment for alcohol and drug addiction. To this end, the company operates a Screening, Brief Intervention and Referral to Treatment (SBIRT) program to help members with alcohol or drug abuse issues. [3]The goal is to reduce and prevent dependence on harmful substances. Under the SBIRT program, healthcare professionals are reimbursed for screening patients for alcohol and drug use. The three aspects of the SBIRT process are as follows:

  • Screen patients with standardized tools for the risk of substance abuse.
  • Engage with at-risk patients to motivate and advise them.
  • Refer patients for brief therapy and additional services, if needed.

Aetna’s SBIRT program reduces healthcare costs by identifying substance abuse issues early in their course. It also reduces the percentage of at-risk patients who do not receive specialized treatment for substance abuse. This program has been found to reduce the severity of drug and alcohol use and reduce the risk of trauma and distressing events related to substance abuse. As a result, there are fewer emergency-room visits and hospitalizations, fewer fatal and non-fatal injuries, fewer arrests, and fewer motor vehicle crashes due to driving under the influence.

Types of Addiction Treatment

Addiction is a complex disease, and no single treatment is suitable for everyone. People struggling with substance use disorders need multiple levels of care as they progress through recovery. Aetna insurance, through its various health plans, provides coverage for the following types of substance abuse treatments:

Detoxification: This is usually the first phase of treatment, during which the body is allowed to clear the toxic substances under the supervision of a medical team. 

Inpatient rehabilitation: This is a type of alcohol or drug recovery program where clients live on-site at a rehab facility and receive 24-hour care with a highly structured program, allowing them to focus on getting better. 

Partial hospitalization: A partial hospitalization program allows clients to receive intensive treatment for substance abuse and mental health issues without staying overnight at a rehab facility. Clients spend more time in treatment compared to a standard outpatient program. 

Intensive outpatient treatment: An IOP allows clients to continue living normal lives while receiving intensive treatment for addictions and mental health conditions. These programs are suitable for people who do not need detoxification and round-the-clock supervision. Sometimes IOPs are used to transition patients from inpatient programs back to life in the community. 

Outpatient rehabilitation: Clients attend treatment sessions several times a week while continuing to live at home and hold down a job or attend school. Although less intensive than inpatient care, outpatient drug and alcohol rehab programs are a more affordable option and are effective for people with mild addictions. 

Continuing care programs: After completing rehab, aftercare or continuing care is essential to prevent relapse and maintain sobriety. Clients participate in individual and group counseling, undergo monitoring for drug or alcohol use, and attend support groups and self-help meetings to remain accountable and motivated to stay sober.

Aetna healthcare

Aetna Coverage for Alcohol and Drug Rehabs

Aetna provides coverage for drug and alcohol addiction treatment. The exact scope of the coverage varies and depends on the individual plan and the state you live in.

Depending on your policy, Aetna will pay for a range of substance-abuse treatment services, including brief interventions (short treatment sessions typically lasting 30 minutes after initial screening), residential rehab programs, partial hospitalization programs, and outpatient care, including individual and group therapy. 

Choosing an Aetna Plan

Aetna offers a range of health plans with varying levels of coverage and services and different deductible and co-payment requirements. There are two main formats of insurance policies offered by Aetna:

Aetna HMO (health maintenance organization) plans: HMO plans offer a good choice of providers and the convenience of guided care at an affordable price. When you sign up for an Aetna HMO plan, you’ll get straightforward medical care with predictable costs. You’ll need to choose a primary care provider who will guide and coordinate your overall health care as well as provide referrals to specialists if needed. However, coverage is only in-network (except emergency care). Preventive care is covered. If you want more flexibility, the Aetna Health Network Only plan is a unique network-only plan that also includes the freedom to not choose a primary care physician and not require referrals (these are encouraged but not required).

Aetna PPO (preferred provider organization) plans: If you want more flexibility in your healthcare, Aetna PPO plans offer a broad network of providers, both in-network and out-of-network. However, costs are lower if you stay in-network and choose a primary care physician. If you need to see a specialist, you don’t need a referral from a primary care physician with an Aetna PPO plan, so these plans are great choices for self-funded clients. For example, the Aetna Choice POS II plan allows you to visit any specialist at any hospital in or out of network without a referral.

Aetna Metal Tiers

Aetna uses the traditional metal tier classification in some states. You can purchase an Aetna plan from the Marketplace, which is an online, one-stop shop to compare and buy health coverage. Some of the key terms that can help you decide between various plans are listed below:

  • Monthly premium is the amount you pay for health coverage each month. You’ll pay this amount whether you need medical care or not. When and if you need medical care, your costs above and beyond the premium will depend on the deductible, co-payment, and coinsurance outlined in your plan.
  • Deductible is an upfront amount you pay for medical services before your insurance kicks in. For example, if your plan has a $1,000 deductible, you’ll pay 100% of your healthcare expenses until you reach $1,000. After you reach the deductible, some services will be covered while others will require a co-payment.
  • Co-payment is a fixed dollar amount that you pay for each service. It varies from service to service. For example, your Aetna health plan may require a $25 co-payment for each doctor’s office visit and $100 for emergency room visits. Co-payments don’t usually count towards the deductible.
  • Coinsurance is a fixed percentage of each service. For instance, if your plan has a 30% coinsurance, you’ll pay 30% of the costs ($300 out of every $1,000) after you’ve met the deductible.
  • Out-of-pocket maximum is the maximum you need to pay before the insurance company starts paying 100% of the allowed amount. Your premium and the money you pay for services not covered by your plan (for example, cosmetic surgery) do not count towards your out-of-pocket maximum.

To participate in the Marketplace, all companies, including Aetna, must offer plans that cover essential health benefits (addiction treatment and mental health services are essential health benefits). The metal tiers of Aetna health care plans are as follows:

  • Platinum plans cover up to 90% of your medical expenses and offer the lowest deductibles but have high monthly premiums.
  • Gold plans cover up to 80% of your healthcare costs.
  • Silver plans cover on average 70% of medical costs.
  • Bronze plans cover on average 60% of medical expenses (you are responsible for the remaining 40%). Bronze plans have the highest deductibles but lowest monthly premiums.

Paying Out-of-Pocket for Addiction Treatment

Chances are you are going to pay something out-of-pocket for your addiction treatment. While it may seem discouraging because you have bills to pay and other financial obligations, it shouldn’t stop you from getting the help you need. After all, addiction therapy is an investment in your future health and well-being.

To put things in perspective: How much money have you spent on your drug of choice? Has it impacted your career and family life? What if you finally have the chance to get clean? Think of the money you will save and how your career and family will benefit. As you can see, the money you spend on treatment can pay off in the long run.

Last updated: March 8, 2023

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