Does Aetna Cover Opioid Rehab?
The opioid epidemic is an ongoing nationwide issue that takes almost 50,000 lives each year.1 Seventy-two percent of overdose deaths can be attributed to opioids. This percentage has increased by 519.38% in the last 20 years.1
These disastrous outcomes can be prevented if the people struggling with addiction get adequate support. If you or a loved one are battling opioid addiction, it’s worth noting that all health insurance carriers, including Aetna, have to provide coverage for drug treatment. This means that the help you need is readily available.2
Aetna operates throughout the 50 states with a network of more than 46 million members, 1.2 million healthcare professionals, 690,000 primary care physicians, and more than 5,700 hospitals.3
What Does Aetna Insurance Cover for Opioid Treatment?
Opioid treatment is typically conducted in the form of medication-assisted treatment (MAT), which can be fully or partially covered under different Aetna healthcare plans.4 MAT includes using approved medications for opioid addiction treatment coupled with behavioral therapies and counseling. 5
It’s usually used to treat heroin addiction or prescription pain reliever addiction by restoring normal brain chemistry, relieving cravings, and reducing withdrawal symptoms. Methadone, naltrexone, and buprenorphine are some of the medications that are often included in MAT.5
Methadone given for addiction treatment is covered by medical plans (not through pharmacy claims) because methadone centers provide their patients with it.5
All Aetna healthcare plans cover Narcan, which is distributed as either nasal or injectable naloxone. Patients get this medication with a pharmacy claim. Alternatively, they can pay for the medication on their own and then submit their reimbursement claim afterward.5
As for buprenorphine, Aetna drug coverage doesn’t require prior authorization if a member has an employer-based plan. However, the use of buprenorphine needs to be authorized beforehand if a member has Aetna Medicaid or Aetna Medicare. The quantity may be limited.5
All healthcare plans have to cover behavioral health services at least to some extent, so your Aetna coverage will include at least some of the therapy that’s part of substance abuse treatment.6
What Aetna Does Not Cover for Opioid Treatment?
While Aetna insurance includes coverage for many standard aspects of opioid rehab, it will likely not cover certain aspects that are deemed non-essential, such as:6
- Alternative medicine.
- Food delivery.
- Recreation.
- Holistic treatment.
- Services outside the scope of medical care.
To understand exactly what services are covered by your Aetna healthcare plan, you can call the telephone number on your member ID card to learn more and explore your options for opioid addiction treatment. Everything you share during the conversation is strictly confidential.5
How Much Does Opioid Rehab Cost?
While the exact price of opioid rehab depends on different factors, there are official estimates that can give you a better understanding of the typical cost. For example, the U.S. Department of Defense provides these estimates for the cost of participation in opioid treatment programs:7
- Treatment involving methadone, behavioral therapy, and medical care on a daily basis: $126.00 a week.
- Buprenorphine treatment for patients in a stable condition, which covers medications and two appointments a week: $115.00 per week.
- Naltrexone treatment including the medication and associated care: $1,176.50 a month.
What Is the Cost of Inpatient Opioid Rehab?
Aetna works with inpatient drug rehab centers nationwide so its members can access round-the-clock treatment in a residential setting. A 2018 study showed that an opioid-related inpatient stay cost $4,383 on average, which varied between $2,894 and $5,835 depending on the location. Based on the specifics on your plan, your Aetna insurance coverage will cover the price at least partially.8
What Is the Cost of Outpatient Opioid Rehab?
In a 2018 study, the average cost of an opioid-related outpatient visit was found to be $533, with a range of between $395 and $802 depending on the region. The members of Aetna can count on some extent of coverage for their outpatient addiction treatment. The exact scope of coverage depends on your plan.8
What Is the Cost of Opioid Partial Hospitalization Programs (PHP)?
Partial hospitalization programs provide high-intensity outpatient services on a daily basis. This type of treatment may cost several hundreds of dollars per day. Your Aetna insurance will cover the cost of this kind of rehab either in part or in full. You can find out more about the extent of your coverage by contacting Aetna directly.8
What Is the Cost of Medication-Assisted Treatment (MAT)?
The U.S. Department of Defense estimates that the average cost of MAT is $6,552 a year for methadone, $5,980 a year for buprenorphine, and $14,112 a year for naltrexone.7 Your Aetna insurance will cover at least some of the expenses associated with using these medications as part of your substance abuse treatment.5
What Is the Cost of Opioid Rehab vs. the Cost of Opioid Addiction?
The cost of untreated opioid addiction far exceeds the cost of rehab. Opioid addiction is hugely detrimental to the health and well-being of the individual who battles it, as well as their family and community. Opioid abuse increases the risk of:7
- Criminal activity.
- Giving birth to a baby who’s dependent on opioids.
- Getting an infectious disease.
- Overdosing.
- Getting injured while intoxicated.
- Losing income.
What Length of Opioid Rehab Does Aetna Cover?
Since every patient is different, their progress through the course of treatment will vary, and so will their rehab duration requirements. In general, longer treatment lengths are connected to better treatment outcomes. Undergoing treatment that lasts only 60 days or less provides lower success rates than staying in treatment for longer and participating in an aftercare program.9
Since Aetna substance abuse coverage varies based on your set of benefits, the duration of treatment that it covers is variable too.6 You can check the details of your plan by calling the number on the back of your ID card and having a conversation with our support team.5
How to Choose Between Aetna Inpatient vs. Outpatient Opioid Rehab Centers?
Aetna has a system of in-network inpatient drug rehab centers and outpatient treatment facilities. Inpatient rehabilitation is typically more costly, but it also provides higher-intensity care. Patients live at the facility throughout the duration of treatment, with 24/7 medical and psychological support at their disposal. They have favorable conditions to have their withdrawal symptoms carefully managed, avoid triggers, and focus on their recovery.9
Generally, inpatient rehab provides a multitude of advantages that enhance the probability of a long-lasting drug-free lifestyle:9
- Consistent availability of resources that facilitate the patient’s progress.
- A drug-free environment, where nothing deters the patient from their goal.
- Focused and tailored medical attention.
- A clearly outlined daily routine that promotes recovery.
- Having ample opportunity to accept accountability for their actions.
On the other hand, outpatient care isn’t as extensive and time-intensive. While it may suit people who have lower treatment needs and don’t want to uproot from their support network at home, inpatient drug rehab is usually recommended at least for a portion of treatment, especially if the person has a severe, long-standing addiction or co-occurring disorders and medical conditions. Patients receiving inpatient care can still choose a local center so that they remain close to their loved ones.9
How to Use Aetna Insurance for Opioid Rehab?
Individuals who have Aetna insurance and wish to enter drug treatment need to:10
- Consult their doctors: Treatment seekers need to share their concerns with their primary care providers, who will likely suggest a clinical evaluation and let you know how to take the next step toward recovery.
- Browse drug treatment providers: Treatment-seeking individuals can browse treatment resources provided by Aetna and choose an in-network rehab facility that fits their requirements.
- Check their benefits: Finally, patients can contact Aetna’s Member Service or call their preferred treatment center to check their insurance coverage.
- Undergo an initial assessment: Patients can then arrange the time to visit the facility and undergo an intake procedure complete with a thorough medical and psychological assessment. In some cases, patients can start their recovery process on the very same day.
How to Find Opioid Rehabs That Accept Aetna Insurance?
Usually, a treatment center needs to be in the Aetna network because your coverage won’t work for out-of-network centers and you will need to cover the costs yourself. You can find Aetna-covered drug treatment programs by calling their helpline and discussing their services with their care advocates. Another option is to use SAMHSA’s treatment finder to explore rehab centers that could be of interest.11
There is also the possibility of contacting American Addiction Centers to verify the extent of your insurance coverage as well as explore different financing opportunities and go over various payment options while on the line. Our team will hear you out, help you assess your options, and suggest some of our leading rehab centers and certified rehab programs. Our facilities work with Aetna insurance nationwide, so excellent evidence-based care is available to you across the U.S.
