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Does Aetna Insurance Cover Heroin Rehab?

Heroin rehabilitation is stressful even without worrying about the costs that come with it. When you choose to get treatment, you should know what your insurance will cover before you start so that you can prepare for any out-of-pocket payments.

Aetna is a popular insurance option when it comes to drug rehabilitation treatment. They offer individualized plans to help you get the treatment you need based on your unique situation and experience.

Aetna is available across all 50 states, including Washington, D.C. However, not all plans are offered everywhere, so you should check your plan to find out more about your specific coverage.

To learn more about what your insurance covers, call the number on the back of your insurance card and talk to an Aetna representative. Rehabilitation centers like American Addiction Centers can also check your coverage and determine whether you are eligible for benefits at that specific treatment center.

What Will Aetna Insurance Cover?

Aetna offers inpatient, residential, detox, and outpatient benefits with various insurance plans. Your policy may cover prescription medications for assisting with opioid addiction recovery, like suboxone and methadone.

While Aetna is not currently offering individual health plans to new customers, they have several other options, including: 1, Available Plans

  • Aetna Medicare.
  • Aetna Medicaid.
  • Student plans.
  • International plans.

Aetna substance abuse treatment programs cover both intensive outpatient programs and partial hospitalization programs.

You can get an HMO or PPO plan with Aetna. Aetna heroin treatment coverage varies based on your plan, but a PPO will allow you to get treatment at more facilities. PPOs generally give you more options than HMOs. Some states also offer Point of Service and Exclusive Provider Organization policies.

Aetna policies are organized under 3 tiers:

  • Bronze: These policies charge higher out-of-pocket costs and a higher deductible but require lower monthly payments.
  • Silver: This tier means paying less than Bronze but more than Gold in both monthly costs and out-of-pocket payments.
  • Gold: Gold has the highest monthly costs, but you have significantly lower out-of-pocket costs.

With many different plans attached to each tier, we can’t say exactly what you will pay based on this information alone. To find out more about your specific Aetna heroin detox treatment costs, you can call the number on the back of your insurance card or call your chosen treatment center to speak with a representative.

Because Aetna is not currently offering new individual insurance plans, it may be more difficult to get health insurance through Aetna to cover your treatment needs if you do not already have it.

Does Aetna Insurance Cover Mental Health Care?

Under the Affordable Care Act, insurance companies are required to provide coverage for mental health care, including substance abuse and co-occurring disorders. Aetna heroin treatment is covered along with treatment for other mental health disorders.

While addiction does not always co-occur with another mental illness, it does in many cases. With this in mind, it is important to treat addiction along with other mental health conditions.

One study explored the relationship between ADHD and heroin addiction. The study found that 19.4% of participants tested positive for ADHD alongside heroin dependence.2, Highlights We see similar statistics for people with anxiety, depression, bipolar disorder, and other mental health disorders. Without treating the underlying cause of the substance abuse disorder, we are not truly treating the addiction.

When people have the support they need, not just for substance abuse conditions but for other mental illnesses and trauma, it can offer them the resources they need to maintain drug abstinence beyond treatment. Support in these areas shows people that they are capable of healing from their addiction and that they can achieve long-term recovery.

When it comes to mental health coverage, you will most likely have to pay for a portion of your care out-of-pocket. The extent of that coverage with Aetna insurance depends on your plan and specific treatment needs.

How Long Does Aetna Insurance Cover Rehab?

Studies have shown us that long-term treatment often yields better results than short-term treatment times. One study that included people addicted to both drugs and alcohol showed that treatment and consultation increased the number of days sober and clean after the end of active treatment. 3, Key Results

Most people who go through rehabilitation for 6 months or longer are more likely to continue their recovery and treatment plan after they leave the treatment facility. Long-term treatment gives people routine, continued support, and builds trust in the recovery process. It also allows for access to more and better resources, as well as letting people see the possibilities of what they could achieve, whereas a shorter program may not give them the chance to explore those options completely. An external support system proves vital when recovering from heroin addiction, which we cannot always build with shorter treatment periods.

Aetna and American Addiction Centers know that everyone’s ideal treatment plan looks different. Some people do well with short-term treatment, whereas others need longer treatment and more long-term support for their recovery.

The length of your treatment and coverage depends on your personal situation. Whether you need a shorter detox treatment or several months of inpatient rehab, Aetna insurance has plans that cover different needs. To find out where you can find Aetna insurance heroin centers and determine your specific coverage, call the number on the back of your insurance card, or talk to a representative at AAC.

What if My Aetna Policy Does Not Cover Heroin Rehab?

If your Aetna insurance policy does not cover your treatment, you have other options. Many rehab centers offer scholarships and other types of financial resources to help you get the treatment you need. Some also let you finance your treatment, so you don’t have to pay for it all at once.

Even if your insurance does not cover heroin rehab, you should still look at your options. It’s critical that you get help now rather than later. The earlier you start your recovery, the more manageable the process will be. While it will be challenging, getting treatment now prevents your condition from worsening. It allows you to begin living the life you want sooner and reduces the risk of long-term damage caused by substance abuse.

While treatment is always worthwhile, quitting heroin sooner will help you avoid problems you may face if you continue to use without treatment. Professional help with treatment can also reduce the risks that come with withdrawal4, paragraph 1

Continued heroin use can put you at risk of health problems like heart attack and stroke and may ultimately cause death. The sooner you seek treatment, the better chance you’ll have to improve your quality of life and build better relationships.

In Network vs. Out of Network Rehab Centers

If a provider is in-network, it means that the provider has accepted the costs associated with your insurance provider. For example, if your doctor charges $200 for a visit without insurance and Aetna charges $150 with their insurance, you save $50 on your visit. Aetna covers part of the cost, so you have a consistent copay each time.

Out-of-network providers do not offer that benefit. In these cases, you can either pay for your visit out-of-pocket or check your Aetna insurance plan to see how much your policy covers. PPO plans with Aetna may mean that your insurance covers some of your treatment needs.

However, you’re still essentially paying the provider’s price, not the one determined by your insurance company for an in-network provider. Out-of-network providers are almost always more expensive than if you were to choose an in-network treatment center.

To find out whether a provider is within your Aetna insurance network, you can call the rehab center and give them your insurance information. They will tell you whether your plan is in-network and the possible associated out-of-pocket costs. You can also call the Aetna insurance phone number on the back of your insurance card to talk directly with your insurance company about whether the rehab center you chose is in-network.

Check Your Benefits

At American Addiction Centers, we can verify your insurance coverage for heroin rehabilitation. We accept most types of private insurance and we work with you to the best of our ability to make heroin rehab treatment available to you.

Once we understand your treatment needs, we will walk you through how to get that treatment and start you on the road to recovery. All we need is some information about your Aetna insurance plan, and we can look up your coverage while we’re on the phone with you.

Talk to our representatives today by calling our helpline at 1-888-496-8059 Who Answers?. Ask us what we can do to help you get started with heroin rehabilitation treatment.


  1. Aetna. (2021). Medical insurance plans for individuals and families.
  2. Lugoboni, F., Levin, F. R., Pieri, M. C., Manfredini, M., Zamboni, L., Somaini, L., … & Gruppo InterSert Collaborazione Scientifica. (2017). Co-occurring attention deficit hyperactivity disorder symptoms in adults affected by heroin dependence: Patients characteristics and treatment needs. Psychiatry Research 250, 210-216.
  3. Wakeman, S. E., Metlay, J. P., Chang, Y., Herman, G. E., & Rigotti, N. A. (2017). Inpatient addiction consultation for hospitalized patients increases post-discharge abstinence and reduces addiction severity. Journal of General Internal Medicine 32, 909-916.
  4. American Addiction Centers. (2021). Can heroin, benzo, or alcohol withdrawal cause death?

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