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Aetna Insurance For Addiction Treatment

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Does Aetna Cover Alcohol Rehab?

Under the Affordable Care Act (ACA), health insurance companies such as Aetna must provide coverage for substance abuse treatment. This includes treatment for alcohol use disorder (AUD) and related mental health issues. Other substance abuse issues, like opioid addiction, are also covered.

There’s no guarantee Aetna will fully cover treatment. The state you live in and whether the program is in- or out-of-network can play a role in coverage. 

The most important factor, however, is your Aetna plan.

Aetna Health Plans

Aetna offers three types of health insurance plans:

  1. Open-access plans allow people to see any doctor they choose without a referral from their regular provider.
  2. Co-pay-only plans guarantee your out-of-pocket expenses, after paying your deductible, are only co-pays. Primary care physician visits and generic drugs are covered before you reach your deductible.
  3. High-deductible plans offer screenings, check-ups, and counseling before you meet your deductible. Sometimes, general practitioner visits are covered as well. They also offer health savings accounts (HSAs).

You will likely have to pay for some of the cost out-of-pocket. It’s important to check your plan in detail to know the cost of your treatment.

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Cost of Alcohol Rehab

The cost of alcohol addiction treatment will depend on two factors:

1. Type of Facility

Treatment at privately owned alcohol rehab facilities will cost more than non-profit facility stays. A for-profit facility may cost up to $17,500 per month, on average.4 This is because they tend to have more amenities than non-profit sites and market themselves to wealthier clients.

An insurance company like Aetna is unlikely to cover privately-owned facilities.

There are also non-profit rehab alcohol addiction treatment programs. These programs offer the basics: a room with a bed, a bathroom, and a place to store your possessions. 

Rehab for alcohol addiction at a basic facility is more affordable and costs around $5,700 per month.4 Insurance is more likely to cover treatment at these facilities. However, you may still need to pay some of the cost yourself.

If the facility is outside your health insurance network, this may increase the cost. Smaller programs also tend to be more expensive.

Note: Treatment success is not dependent on whether you attend a ‘luxury’ or less expensive facility. Both treatments have been shown to be effective.

2. Type of Treatment

The treatment type can have a significant impact on cost:

  • Outpatient treatment can cost between $32 to $385 per week.5
  • Inpatient treatment can cost between $213 to $2070 per week.5

Inpatient treatment tends to cost more. It involves 24/7 professional care in a hospital-type setting with beds, meals, and medical care.

Any treatment involving medication will also be more expensive. For example, medication-assisted treatment (MAT) with naltrexone might cost up to $14,000 per year.7

Which Substance Abuse Treatments Does Aetna Cover?

Aetna covers a variety of treatments for alcohol addiction and other substance abuse issues, including:

Detoxification

The first step toward sobriety for someone with an alcohol addiction is detoxification. During detox, the person stops drinking entirely. This allows alcohol to completely leave the body. 

When the body becomes dependent on alcohol, brain and body chemistry change. The body depends on alcohol to keep some body systems running. Stopping alcohol suddenly without medical support can result in brain and body malfunction, fluid balance upset, and even seizures and death.

Similar occurrences may occur when a person’s body becomes dependent on other drugs.

Alcohol withdrawal symptoms can be painful or even deadly, often requiring medical attention at an inpatient facility.

Inpatient Treatment

Alcohol rehab at an inpatient rehab center involves around-the-clock medical care and support. This type of addiction treatment is often used for more serious cases of alcohol abuse.

Outpatient Treatment

During outpatient treatment, a person keeps their regular routine because the treatment fits their schedule. Program attendance is usually for several hours per day, for a few days a week, and then they go home at night. 

People with severe addictions often start with inpatient care and then move to outpatient treatment, which is generally for less severe cases.

Aetna also covers intensive outpatient care and partial hospitalization.

Medication-Assisted Treatment (MAT)

Medication-assisted treatment (MAT) is the use of medications to manage withdrawal symptoms and cravings. It's often used in conjunction with mental health counseling and inpatient treatment.

Common medications used for alcohol rehab include:

  • Acamprosate (Campral)
  • Disulfiram (Antabuse) 
  • Naltrexone (Vivitrol)

All three of these drugs are FDA-approved for MAT to treat alcohol addiction.

Mental Health Treatments

The relationship between substance abuse and mental health disorders is complex. 

Mental health problems often lead to substance abuse issues. At the same time, substance abuse can also cause mental health problems. This is known as dual diagnosis.

There are several mental health disorders linked to alcohol addiction, including:

When dealing with a dual diagnosis of alcohol addiction and a mental health disorder, it’s essential to treat both at the same time. This is referred to as integrated treatment

Integrated treatment combines mental health counseling with a mix of both psychiatric and addiction medications. 

Some mental health treatment approaches for alcohol addiction include:

Keep in mind: The cost of addiction is often many times that of a successful treatment program.

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How to Check Your Aetna Coverage 

Before moving ahead with treatment, it's important to know the extent of your Aetna cost coverage. 

To find out the details of your Aetna alcohol rehab coverage, call the number on the back of your insurance card or log into your Aetna account. The number for Aetna Behavioral Health is 1-888-632-386.

Knowing how much your insurance company will or won't cover is essential before seeking medical treatment. You don't want to be surprised by an unexpected bill.

Updated on May 17, 2022
8 sources cited
  1. Aetna. “ACA health insurance plan coverage.
  2. Aetna. “Alcohol and Drug Treatment.
  3. Better health outcomes for substance use disorders.
  4. Beetham, Tamara. “Admission Practices And Cost Of Care For Opioid Use Disorder At Residential Addiction Treatment Programs In The US.” Health Affairs, vol. 40, no. 2, 2021.
  5. French, Michael T. “The Economic Costs of Substance Abuse Treatment: Updated Estimates and Cost Bands for Program Assessment and Reimbursement.” Journal of substance abuse treatment, vol. 35, no. 4, 2008, pp. 462-9.
  6. HealthCare.Gov. “Mental health & substance abuse coverage.
  7. Kaskutas, Lee Ann. “Costs of day hospital and community residential chemical dependency treatment.” The journal of mental health policy and economics, vol. 11, no. 1, 2008, pp. 27-32.
  8. National Institute on Drug Abuse. “How much does opioid treatment cost?” 2021.

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