Individuals who have Aetna health insurance policies are in a good position to get addiction treatment that easily fits within their budget. However, there’s no health insurance provider or policy that covers all addiction treatment for any duration of time. Instead, most providers operate on a case-by-case basis, making it a little trickier for prospective patients to gather all the facts. Thankfully, in the wake of the Affordable Care Act, Aetna health insurance can and often does cover the cost of addiction treatment.
Addiction is Treated as a Health Condition
It’s important to note that in recent years, virtually every medical journal, physician and addiction specialist agrees that addiction is a medical illness. Being addicted to any substance, whether it’s drugs, alcohol, or both, isn’t a personal defect, a lack of willpower or a character flaw. It’s a health condition just like high blood pressure or cancer, and it should be treated in the same objective manner.
This is excellent news for those with health insurance policies, because it means that things like drug detoxes and addiction rehab are typically covered. However, it’s necessary for all policy holders to understand that there can be limitations on coverage, just like there might be for getting cancer treatment. Patients dealing with all medical conditions will need to be aware of things like treatment networks, available physicians and co-pays, which impact individuals whether they are going to detox or visiting the doctor for a physical.
The ACA and Health Insurance Coverage for Addiction Treatment
The ACA, or the Affordable Care Act, is a relatively new piece of legislation that changed the way that individuals in the United States qualified for and received medical treatment. To start, the ACA eliminated the notion that those with pre-existing conditions couldn’t qualify for proper care, or they couldn’t receive medical care for those specific conditions. This has enormous implications for addiction treatment, because many patients in the past were told that since they had a history of addiction, they weren’t eligible for current care. Today, anyone who needs medical attention for addiction, regardless of how long they have struggled with addiction, can’t be discriminated against because of a pre-existing condition.
Another way that the ACA has impacted how patients can receive medical coverage, and how much needs to be covered by health insurance providers, is by introducing the concept of the 10 essential health benefits. One of these essential health benefits is mental health, which is the category under which addiction falls. This is pivotal, because it means that those seeking addiction treatment are legally allowed to receive some kind of care, since it falls under the scope of mental health and essential wellness. In short, the ACA has guaranteed that any health insurance policy sold in the United States, including Aetna policies, are required by law to offer some level of coverage to patients seeking addiction treatment.
Personal Policy Details
Every health insurance policy, including those policies sold by Aetna, can vary significantly from person to person. This means that while a bronze policy might include a high deductible, a gold policy might not require policyholders to pay any deductible or any co-payments. For this reason, individuals always need to take a closer look at their own policies and get an idea of what will and won’t likely be covered.
One of the first things to glance at is any information about a personal deductible. Often, this deductible is a set amount that individual policyholders need to pay before their coverage can kick in. In many cases, this deductible will need to be met before patients can start receiving paid coverage for their addiction treatment.
Another important policy point to look at is network coverage. This is the scope of treatment options approved by Aetna, and it could be a geographical limitation or a set number of facilities preferred by the health insurance provider. Many patients will receive full coverage if they attend a specific rehab program in their local area, but they will need to pay more out of pocket if they venture further afield or choose a higher-end facility with greater overall costs.
Policies may also stipulate the length of treatment provided and how that is determined. Those with severe addictions may be eligible for long-term residential treatment, while others may only qualify for a drug detox or short-term outpatient care. Again, these are specific to individual policies and should be checked carefully before deciding to attend any particular detox or rehab facility.
Paying for What Won’t Get Covered
Aetna health insurance policies should, in many cases, pay for some or all of a patient’s addiction treatment. However, there are often still some out-of-pocket costs that will need to be handled by patients. This could be because they want to seek treatment out of network, because they need to handle the deductible or just because they want to extend their treatment duration. Regardless, there are thankfully a number of ways to handle these costs.
If budget allows, paying for these costs from personal savings is ideal, and the investment is well worth the cost since it sets patients up for a better, healthier future. Another option is to ask for a gift or a loan from friends or family. Many patients about to undergo addiction treatment are surprised at just how much their loved ones are willing and able to help on the journey to recovery. Finally, there are some scholarships available from specific rehab facilities, and there are also typically a range of third-party financing options, letting patients take control of their rehabilitation.
Having an Aetna health insurance policy means that there’s a very good chance that addiction treatment, in some form, will be covered. However, there are several factors that can impact the scope of coverage, including severity of addiction, past treatments and type of treatment desired. Thankfully, there are many ways to get the exact facts about what a specific policy entails, like speaking with rehab assistance specialists who can confirm coverage.
Addiction isn’t something that should be tolerated in your life. With health insurance helping you out, there’s no longer any reason to hesitate pursuing addiction treatment.