Aetna Insurance Coverage for Addiction Rehab
Under the Affordable Care Act, most health plans are required to cover essential health benefits, including behavioral health services such as substance use disorder treatment. If you have an ACA-compliant plan, you can use those benefits to access care for drug or alcohol addiction and move toward better health.
Faith Recovery Center collaborates with numerous commercial insurers, including Aetna, a CVS Health company trusted by over 36 million people. Aetna focuses on making care easier and more convenient, offering plan options and services that include medical, pharmacy, and dental coverage, as well as Medicare and Medicaid plans, behavioral health programs, and medical management.
My stay at Faith Recovery Center facility was very pleasant. The staff and accommodations were excellent. They treated me with dignity and helped me get back on my feet. Mentally, emotionally, and physically. Highly recommend.
- Sara B
Verify Your Insurance
Please complete the following information for the person seeking treatment. One of our dedicated team members will contact you immediately to go over your coverage, treatment options and information on admissions.
Contact Person
Does Aetna cover addiction treatment?
In many cases, yes. Federal parity rules require health plans that offer mental health and substance use disorder benefits to apply them on terms that are no more restrictive than medical or surgical benefits. These protections apply across treatment limits, financial requirements, and care management practices so that it is not harder to access addiction treatment than it is to access other covered medical care.
If you bought coverage through the Health Insurance Marketplace, mental health and substance use services are part of the law’s essential health benefits. Plans must cover behavioral health treatment, such as therapy, inpatient services, and substance use disorder treatment, and they cannot impose yearly or lifetime dollar limits on essential health benefits. Preexisting conditions are covered from the first day of your plan’s effective date.
Coverage still varies by plan type, employer selections, state rules, and network status. The fastest way to determine what your plan includes is to verify benefits directly, which our team can assist you with.
What levels of care can Aetna cover?
Many Aetna plans include benefits for the full continuum of substance use treatment when medically necessary:
- Detox and withdrawal management. Medically supervised services to help you stabilize and reduce risks during acute withdrawal.
- Inpatient hospital or residential rehab. Twenty-four-hour care in a structured setting when safety and stabilization require it.
- Partial Hospitalization Program (PHP). Full daytime programming with the ability to return home in the evening.
- Intensive Outpatient Program (IOP). Multiple therapy sessions per week with strong structure and flexibility for work or school.
- Standard outpatient therapy and medication management. Ongoing counseling, relapse prevention, and medical follow-up.
- Medication-assisted treatment. FDA-approved medications, when appropriate, as part of a comprehensive plan.
Aetna publishes a behavioral health precertification list that shows which services commonly require approval before care begins. The August 1, 2024, version notes that many inpatient behavioral health services and intermediate levels of care, like PHP, require precertification. Always check your specific plan, as employer plans may add additional requirements.
Do routine outpatient visits need precertification?
For many fully insured plans, routine therapy visits do not require prior authorization or precertification. There can be exceptions based on plan design, state rules, or the type of service. Verification confirms what applies to you at this time, so you avoid surprises.
Prior authorization, medical necessity, and appeals
Precertification and prior authorization are processes that confirm a service meets your plan’s medical necessity criteria and that the care setting matches your clinical needs. Aetna provides public information on precertification workflows and criteria for health care professionals, and it maintains a formal disputes and appeals process when a provider or member disagrees with a utilization review decision. That appeals pathway includes reconsiderations and formal appeals with timelines and instructions.
At Faith Recovery Center, we handle the paperwork and clinical notes that Aetna may request. If an authorization is required, we submit the necessary information and keep you informed. If a denial occurs, we discuss appeal options and next steps right away.
In network vs. out-of-network care
Using in-network providers is usually the most cost-effective path. In-network care takes advantage of contracted rates and often lower cost-sharing. Some Aetna plans include limited or no out-of-network benefits. If you need out-of-network services, special approvals may be required and are not guaranteed. You can confirm your network status and benefits on your secure Aetna member website or Aetna Health app, or you can use our confidential form to help verify your benefits.
Understanding your out-of-pocket costs
Your financial responsibility depends on your plan design. Most members will encounter some combination of:
- Deductible. The amount you pay before your plan starts to share costs.
- Copay. A flat fee for a service, such as an office visit.
- Coinsurance. A percentage of the allowed cost that you pay after your deductible.
- Out-of-pocket maximum. A yearly cap on what you pay for covered services. After you reach this maximum, the plan typically pays 100 percent of covered costs for the remainder of the plan year.
Aetna provides clear definitions of these terms and how they work together in its member learning center. You can also see your personal deductible, copays, and coinsurance amounts inside your secure online account.
Will Aetna cover addiction medications and MAT?
Programs and support at Faith Recovery Center
Care is individualized and built around what you need to feel safe, steady, and supported.
- Outpatient services: Individual therapy, group therapy, and care coordination with a focus on relapse prevention and practical coping skills.
- Intensive Outpatient Program: More structure with several sessions per week, plus flexibility for work, school, and family life.
- Care coordination for higher levels of care: If the assessment indicates that detoxification or residential treatment is necessary to stabilize, we coordinate those referrals and authorizations.
- Medication support: Collaboration with prescribers for medication-assisted treatment when appropriate, with education on benefits and side effects.
- Family involvement: Education and support for loved ones, since recovery often strengthens when the home environment is informed and aligned.
- Aftercare planning: A step-down plan that may include ongoing therapy, support groups, and relapse prevention tools.
FAQs About Aetna Insurance Coverage
Will Aetna cover medication-assisted treatment at Faith Recovery Center?
Many plans cover FDA-approved addiction medications when medically necessary and on the formulary. We verify drug tiers and any prior authorization for the medication itself, so you know the exact cost at the pharmacy.
Do I need prior authorization for rehab?
Often yes for inpatient, residential, and PHP. Some plans also require authorization for certain outpatient services. Our team confirms the requirements of your plan and submits the clinical notes that Aetna requests.
What if I only have out-of-network options nearby?
Some plans include out-of-network benefits while others do not. Special approvals may be required in limited situations. We outline all available options after we verify your plan details.
Can Faith Recovery Center coordinate care if I need detox or residential?
Yes. If the assessment indicates that a higher level of care is necessary, we coordinate referrals and authorizations to ensure a seamless transition without delays. We remain involved in discharge planning to support a safe transition into our outpatient or IOP services.
Help is here when you are ready
You do not have to figure this out alone. If you have Aetna insurance and require addiction treatment, Faith Recovery Center can assist in verifying your benefits and help you establish a plan that works for you. Contact our admissions team for a confidential conversation and a clear path forward.
Sources:
- Aetna. (n.d.). Precertification. https://www.aetna.com/health-care-professionals/precertification.html
- Centers for Medicare & Medicaid Services. (2024, September 10). Mental Health Parity and Addiction Equity Act (MHPAEA). https://www.cms.gov/marketplace/about/oversight/other-insurance-protections/mental-health-parity-and-addiction-equity-act-mhpaea
- HealthCare.gov. (n.d.). Mental health and substance use disorder coverage. https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
- Niasse, A. (2024, September 9). Biden administration finalizes rule to strengthen mental health parity law. Reuters. https://www.reuters.com/world/us/biden-administration-finalizes-rule-strengthen-mental-health-parity-law-2024-09-09/
We Accept Most Insurances
