Sherilyn Moore

Understanding how to use insurance to pay for drug detox or rehab is critical if you are seeking addiction treatment. This article will walk you through the details of insurance coverage for detox and rehab care. You’ll learn how to check your insurance coverage, what drug addiction treatments are covered, and more. Does Insurance Cover Drug and Alcohol Treatment? Under the Affordable Care Act (ACA), mental and behavioral health benefits, such as substance use disorder (SUD) treatment, are considered essential to your well-being.1 This means that your insurance must cover drug and alcohol treatment in some way.1 In addition, the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) is a federal law that ensures you get the same level of treatment options for SUD treatment as you do for other medical conditions.2 So while your plan may not cover the full cost, your insurance can’t deny you coverage for addiction treatment or put a dollar limit on your care.1 But always check with your insurance company to see what is and isn’t covered and how much you might have to pay. Which Treatment Types are Covered? The types of treatment generally covered by insurance include, but are not limited to: Medical detox: this helps you manage withdrawal symptoms and get ready for the next phase of treatment. Inpatient rehab: this treatment involves staying at a treatment center 24/7 for the length of treatment. Outpatient rehab: you’ll go to set appointments during the day and return home at night. The length and number of appointments will vary based on your needs. Aftercare: this can include individual or group counseling or peer support groups such as AA or NA. Using Your Insurance to Pay for Detox and Rehab The first step in getting SUD treatment is often talking to your doctor. They can help assess your unique treatment needs. Then, you’ll need to find a detox or rehab center that takes your insurance. You may also need to get approval before starting treatment, which is called a “prior authorization.” Before you start treatment, it’s also a good idea to double check what is and isn’t covered with both the treatment center and your insurance plan. You can check this a few different ways: Visit the insurance web portal and log in to your online account. There, you’ll be able to check your benefits, co-pays, deductibles, and more. Call the insurance company. The phone number should be on the back of your insurance card. Verify your benefits with the treatment center that you plan to attend. Private Insurance Many people get insurance through their jobs. But some people, especially those who are self-employed, have private insurance purchased directly through an insurance company. Other people buy health insurance through the Health Insurance Marketplace. Anyone can buy insurance plans and get healthcare benefits through this program. Once you select a plan that is right for you, you’ll pay a monthly premium for coverage that gives you access to the healthcare benefits spelled out in your plan. In most cases, you’ll have office co-pays and a yearly deductible to meet. If you want to buy private insurance, it could be helpful to know a bit more about the different types of plans.3 Health maintenance organization (HMO): this type of plan works within a network of providers. For out-of-network service, you’ll usually have to pay the full costs of care, unless it’s an emergency. Exclusive provider organization (EPO): this managed care plan covers services, but you must use the doctors and hospitals within the plan’s network unless it’s an emergency. Point of service (POS): in this type of plan, you need a referral from your doctor before you can see a specialist. Preferred provider organization (PPO): this health plan has fewer out-of-pocket costs if you use providers in the network. You can also see out-of-network providers if you pay the additional cost. [link-bank title = "Paying with Insurance"] Aetna Insurance Blue Cross Blue Shield Humana Kaiser Permanente [/link-bank]   [substance-search]   In-Network vs. Out-of-Network Treatment Centers It is helpful to understand what is meant by in-network vs. out-of-network insurance coverage. In-network refers to providers—that is doctors, hospitals, clinics, and other care settings—within the insurer’s network. You’ll often pay less if you see an in-network provider, because they have agreed to charge less to the insurance companies they have contracts with.4 Out-of-network service refers to providers who are not within the insurer’s network. Since the provider has not signed an agreement with the insurance company to offer lower costs, you often pay more out-of-pocket costs if you see a doctor out of network. You may also have higher deductibles with these doctors.5 COBRA Coverage The Consolidated Omnibus Budget Reconciliation Act (COBRA) is another option for health insurance.6 This healthcare solution is managed by the U.S. Department of Labor and allows employees and their families to continue their group healthcare plan after they lose benefits under certain conditions. These include:6 Losing your job for reasons other than misconduct. Reduced hours, resulting in the loss of employer-covered benefits. COBRA extends benefits for a limited amount of time. The time depends on the conditions under which the benefits were lost.6 COBRA insurance covers SUD treatment at the same level as your previous insurance. It is an extension of the insurance you had before, so you’re covered while you’re out of work or between jobs. This means you will need to contact the insurance company you had to find out about the deductibles or co-pays they have for SUD treatment. Public Insurance Public insurance includes programs such as Medicare and Medicaid. These government-sponsored programs offer free or low-cost health benefits to people who meet certain conditions. Medicare Medicare is a federal insurance program that offers insurance to people 65 and older or younger people with certain disabilities. Medicare is split into the following parts:7 Medicare Part A covers inpatient care. Medicare Part B covers preventative care, doctor’s care, outpatient services, and supplies. Medicare Part C bundles together parts A and B, and often D Medicare Part D covers prescription drugs. Medicaid Medicaid is state-sponsored health insurance for low-income families, people with disabilities, and pregnant women. Who can get it and what it covers may vary by state. You can find out your state’s details by visiting the Substance Abuse and Mental Health Services Administration’s Directory of Single State Agencies. Find your state and then click on the link to your state’s agency. How to Find Drug and Alcohol Treatment Centers that Take My Insurance You can begin your treatment journey by finding a drug detox or rehab center that accepts your insurance. Search online for treatment centers and research what types of coverage they have. If you know which treatment center you plan on going to, check with them directly. Finally, if you want answers now, you can verify your insurance online immediately with American Addiction Centers. [link-bank title = "Other helpful information"] Paying without Insurance Find a Detox Center [/link-bank] Note: We try to offer the most updated information available about insurance. But insurance health plan information does change quickly. Please check with your insurance company to ensure that you have the most recent and correct information about your coverage. Sources Healthcare.gov. (n.d.). Mental health & substance abuse coverage. CMS.gov. (n.d.). The Mental Health Parity and Addiction Equity Act (MHPAEA). HealthCare.gov. (n.d.). Health insurance plan & network types: HMOs, PPOs, and more. Health insurance.org. (n.d.). What does in-network mean? Health insurance.org. (n.d.). What does out of network mean? Benefits.gov. (2020). Facts to help determine your COBRA eligibility. Medicare.gov. (n.d.). Your Medicare coverage choices ...

Does Aetna Cover Substance Use Treatment? Under the Affordable Care Act (ACA), most insurance companies must cover substance use treatment in some way.1 Aetna does cover many forms of addiction treatment. But exactly what they cover will depend on your plan and the state you live in. Treatment Types Covered by Aetna Depending on your plan, the treatment types Aetna covers may include, but are not limited to: Detox Inpatient rehab and outpatient rehab Counseling and therapy How Can I Find Out What My Aetna Plan Covers? Before you begin any substance use treatment program, it’s a good idea to check what Aetna will and won’t cover. You can do this a few ways: Sign in on the Member Login. Call customer service at the number on the back of your card. Call the treatment center directly. How to Use Aetna for Drug and Alcohol Treatment The first step for many on their treatment journey is talking to their doctor (sometimes called a “primary care physician,” or PCP). Your doctor can assess your needs and refer you to specialists or other treatment. Next, call Aetna to ask what they cover. Some good questions to ask them include: how many days of treatment they cover, what you will have to pay for (called “out-of-pocket” costs), and if you need to get special approval (called “pre-authorization”) first. Once you know what Aetna will and won’t cover, you can choose a treatment center that accepts your plan. It’s a good idea to call them before starting treatment as well so you can confirm costs. How to Find Rehab Facilities Covered by Aetna One of the easiest ways to find treatment centers in Aetna’s network is to use their Find a Doctor tool. Simply log in and search for drug or alcohol rehab centers. If more convenient, you can also use our detox center directory and filter your search accordingly. Aetna is a well-known insurance company that contracts with many treatment centers, so finding one that takes your insurance shouldn’t be a problem. In fact, American Addiction Centers works with Aetna. But if Aetna doesn’t cover your first choice for treatment, don’t give up. Your well-being is too important, and there are many options to pay for treatment. Do Rehab Centers Need to Be In-Network? You don’t have to stay in the network with some types of Aetna insurance plans.2 But it will almost always cost more if you do choose a treatment center that is out-of-network.2 Remember, you can always check who is in network by calling Aetna or searching their online list of providers. Types of Aetna Insurance Plans Aetna’s insurance plans fall into one of the following categories:3 Health Maintenance Organization (HMO): this type of plan has a low monthly premium (how much you pay each month). But you need to stay in-network and your PCP will need to refer you to any specialists. Point of Service (POS): this plan is a little more flexible than an HMO. With this plan, you can see out-of-network providers, but you will pay higher premiums. Preferred Provider Organization (PPO): with a PPO, you pay more for your monthly premiums, but you can see specialists and out-of-network doctors without a referral. Exclusive Provider Organization (EPO): premiums in this plan cost more than what you’d pay in an HMO but are less than a PPO. While you must stay within the network, it offers a large group of providers. Within each category outlined above, Aetna has several insurance plans to choose from. Each plan will give you different options in terms of how much you pay for addiction treatment and whether or not you’ll need referrals or can go out of network. Medicare and Medicaid Medicaid offers low- or no-cost health insurance for people with lower incomes, special needs, or disabilities. Aetna offers Medicaid insurance plans in the following states:4 Arizona Illinois Kentucky Louisiana Maryland Michigan New Jersey New York Ohio Pennsylvania Texas Virginia West Virginia Aetna also offers Medicare Advantage plans, which combine original Medicare with other insurance coverage. Aetna has HMO-POS, HMO, and PPO Medicare plans. Some of these plans have no monthly premium.5 Check Your Aetna Coverage Now Insurance can be confusing, but we try to make it easier to understand. You can check online if Aetna covers treatment with us. [vob] Note: We try to offer the most updated information available about insurance. But insurance health plan information does change quickly. Please check with your insurance company to ensure that you have the most recent and correct information about your coverage. [link-bank title = "Other Insurance Options"] Blue Cross Blue Shield Humana Kaiser Permanente [/link-bank] Sources HealthCare.gov. (n.d.). Mental health & substance abuse coverage. Aetna. (2021). Network and out-of-network care. Aetna. (2021). HMO, POS, PPO, EPO and HDHP with HSA: What’s the difference? Aetna. (2021). DocFind. Aetna. (2021). Aetna Medicare solutions. ...