Aetna Coverage For Addiction Treatment

What is Aetna?

Aetna is one of the largest insurance providers in the United States, offering health, dental, and vision coverage to millions of members. Since being acquired by CVS Health in 2018, Aetna has expanded its offerings to include more robust prescription benefits and access to urgent care services, making it easier for individuals to receive comprehensive healthcare support.

If you’re struggling with substance use—whether it’s alcohol, prescription medication, or illicit drugs—your Aetna insurance plan may help cover the cost of addiction treatment. Depending on your policy, coverage may include inpatient or outpatient care, therapy, detox services, and more. Our team at Virtue At The Pointe can help you verify your benefits and explore your options.

Expanded Coverage For Substance Abuse Treatment

The Patient Protection and Affordable Care Act was a landmark piece of legislation passed during the Obama administration. Not only did the ACA expand access to health coverage, but it also defined 10 essential benefits that all health plans offered by Medicaid or sold on health insurance exchanges must offer. One of those essential benefits is coverage for substance abuse treatment, a serious condition that can have lasting physical and psychological effects. Professional treatment can help people with addictions stop using drugs and alcohol, heal from past trauma and develop the skills needed to cope with challenges in a healthier way.

Before the ACA defined substance abuse treatment as an essential benefit, many insurance companies provided limited coverage for addiction-related services. Some companies imposed annual limits, while others had lifetime limits for this type of treatment, making it difficult for patients to seek treatment for the first time or get help after a relapse. Now that many plans are required to cover treatment for substance abuse, it’s easier for patients to access inpatient treatment, supervised medical detox, outpatient addiction treatment and other services used to treat addiction and address underlying mental health conditions.

Aetna Insurance Coverage For Substance Use Disorder

Aetna grew to be one of the largest insurance companies in the nation by offering a wide variety of plans for individuals, families and organizations. For example, many employers purchase their group health coverage from Aetna. The company also sells health plans directly to individuals and families, offers Medicare Advantage plans in some states and provides Medicaid coverage in states that have outsourced their Medicaid programs to private health insurance companies.

One of the most common addiction-related services covered by Aetna is screening, brief intervention and referral to treatment (SBIRT). SBIRT isn’t a type of addiction treatment, but it helps health care providers screen for addiction and make appropriate referrals for additional services. If your plan covers SBIRT, your primary care provider may conduct the screening and refer you for inpatient or outpatient treatment as needed. Once you have a referral, it’s up to you to contact a treatment facility and arrange for short-term or long-term treatment.

Treatment Considerations With Aetna Insurance Benefits

Aetna covers millions of subscribers throughout the United States, but not all subscribers have the same level of coverage. The amount of coverage available for addiction treatment services depends on many factors, such as the terms of your plan, your annual deductible and whether you receive treatment from an in-network or out-of-network provider. If you’re not sure what to expect with your Aetna insurance plan, one of our admissions coordinators can verify your benefits and let you know if your plan will cover a stay at our residential treatment center.

Our Astoria Inpatient Addiction Treatment Center

Virtue At The Pointe offers inpatient addiction treatment in Astoria, Oregon, providing a medically supported, structured environment for those seeking lasting recovery. Surrounded by the serene beauty of the Pacific Northwest, our facility promotes focus and healing, free from outside distractions.

Our inpatient program includes 24/7 clinical care, medically supervised detox (when needed), and personalized treatment plans tailored to each client’s unique needs. Services include trauma-informed therapy, dual diagnosis treatment, and evidence-based modalities designed to address both substance use and underlying mental health issues.

We understand that navigating insurance can be overwhelming, which is why our admissions team works directly with Aetna to simplify the process. Most Aetna plans cover many of the services we provide, making high-quality, comprehensive treatment more accessible than you might expect.

If you’re covered by Aetna, your path to recovery may already be within reach. Contact us today to verify your benefits and explore how our inpatient program can support your journey toward long-term wellness.

Our Milwaukie Outpatient Addiction Treatment Center

Virtue At The Pointe’s outpatient center in Milwaukie, Oregon offers a clinically grounded, flexible approach to addiction treatment. Our programs are ideal for clients who require structured care while continuing to meet personal, professional, or family responsibilities. Located near Portland, the center provides access to comprehensive support without the need for inpatient admission.

Our Partial Hospitalization (PHP) and Intensive Outpatient Programs (IOP) offer personalized care plans that include individual therapy, group counseling, and relapse prevention strategies. Clients benefit from evidence-based modalities, including cognitive behavioral therapy (CBT), trauma-informed care, and support for co-occurring disorders.

For those with Aetna insurance, many of these services are covered, reducing the financial barriers to outpatient care. Our staff will work directly with your insurance provider to confirm your benefits and help you begin treatment as quickly and smoothly as possible.

Outpatient care offers a critical bridge between structured recovery and independent living. If you’re covered by Aetna, Virtue At The Pointe can provide high-quality care that keeps you on track without disrupting your life.

Your Insurance Network

When you’re discussing health insurance, a network is a group of providers who’ve agreed to provide health care to members of a specific plan. Insurance providers like Aetna typically negotiate lower rates with network members, so your choice of treatment provider has an impact on your out-of-pocket costs for addiction treatment.

Because in-network providers charge less, you’ll typically pay less for their services. If you decide to go to a provider that isn’t in your network, you may have to pay a larger share of the costs. Depending on the terms of your plan, Aetna may not cover any out-of-network services, or it may require you to pay more than you’d pay for the same services performed by an in-network provider. Virtue at the Pointe accepts many Aetna plans, but it’s important to verify your benefits ahead of time to make sure your plan covers residential treatment.

Coverage For Addiction-Related Services

Although addiction treatment is now considered an essential health benefit, health insurance providers don’t have to cover 100% of the costs. How much you have to pay depends on which plan you have. Some plans have no deductible, while others have an annual deductible of $1,000 or more. You may also have to pay coinsurance, or a certain percentage of the treatment costs. Therefore, the out-of-pocket costs of treatment may vary drastically from one plan to another.

If you have Aetna coverage, your plan may cover some or all of the following benefits:

• Inpatient/residential treatment
• Intensive outpatient treatment
• Outpatient therapy
• Family counseling
• Group counseling

What Are My Addiction Treatment Options?

Inpatient and residential treatment are similar, but there’s one key distinction: inpatient treatment occurs in a secure hospital unit, while residential treatment takes place in a comfortable environment that’s more like a home than a hospital or clinic. At Virtue at the Pointe, residential treatment typically lasts for 23 to 35 days, but it may last longer if you need additional support. When you arrive at our treatment center, you’ll undergo a thorough assessment to determine what services you need and how long you can expect your stay to last.

Intensive outpatient treatment typically takes place several days per week, while outpatient therapy may only occur on a weekly basis. Family and group counseling are used to help people with substance use disorders improve their communication skills, be assertive without being aggressive and develop coping skills that can help them abstain from drug and alcohol use.