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All about Aetna Substance Abuse Insurance

Insurance is always a major worry for those afflicted with substance abuse or similar mental disorders. In 1996, The Mental Health Parity Act sought to relieve those worries, but only partially met the need. Just 12 years later, the MHPA was updated by the Mental Health Parity and Addiction Equity Act, which gives Aetna substance abuse insurance similar restrictions as other medical and surgical coverage plans. It is important that Aetna customers are aware of the new guidelines and how they can positively impact someone seeking substance abuse coverage.

The MHPAEA and You

The Mental Health Parity and Addiction Equity Act seeks to bring the insurance coverage of those who suffer from substance abuse up to par with the rest of the population in terms of financial requirements, treatment limitations and out-of-network benefits.

Aetna subscribers on calendar year plans saw their coverage updated on January 1, 2011, so chances are that you will be eligible for the coverage in the updated Act. However, just because these new coverage rules have been created, it does not mean you will have access to them.

Though self-funded non-federal government plans provided by employers are subject to parity, they can choose to opt-out of the obligation to provide this coverage. Therefore, if your employer provides coverage funded in-house, you may not have coverage.

Substance abuse insurance with Aetna

Aetna substance abuse insurance coverage meets all the standard provisions in the new Act. As long as your specific sponsor makes the coverage available to you, you cannot be restricted more than someone seeking medical treatment for a broken leg or a virus. In other words, for plans that offer substance abuse coverage, you will have access to the same visitation and cost-sharing requirements as other medical plans.

Aetna has made it clear that mental health benefits (such as these substance abuse benefits) should be used in conjunction with physical medical benefits because they often affect one another. The Aetna Employee Assistance Program is one effort to help identify and intervene before mental health begins to decline too much. As per the Act, the EAP will not preclude normal health benefits unless medical and surgical beneficiaries are equally represented within the program.

Though your health coverage may improve under the updated Act, there are still differences between states, private employers and individually purchased plans. You will have to do additional research to find out how your individual situation fits into the big picture. And, of course, there are exceptions.

Exceptions to the MHPAEA

There are a few instances where Aetna’s substance abuse coverage does not apply. They are:
* Some Medicare recipients. Medicare Supplemental Insurers are not obligated to meet the requirements in the MHPAEA.
* Self-funded non-federal government plan sponsors that have applied for and cleared the exemption are not obligated to provide coverage.
* Small business employers. Any business that employs between 2 and 50 people is not required to meet the guidelines set in MHPAEA.

If you have questions about how you fit into Aetna substance abuse insurance coverage plans, fill out the insurance form to the right of this page to get answers right now.

About The Contributor
The editorial staff of Recovery First is comprised of addiction content experts from American Addiction Centers. Our editors and medical reviewers have over a decade of cumulative experience in medical content editing and have reviewed thousands... Read More