If you or a loved one is struggling with a mental health condition, whether it’s depression, bipolar disorder, schizophrenia, or one of the many other disorders that can afflict people of all ages, you need to know where to turn for compassionate, effective help. But it’s also important to understand your options for treatment – and what you can expect your health insurance policy to cover when you reach out for help. Before choosing the right mental health therapist for treatment, you might be wondering about the specifics of Aetna mental health coverage. If so, you’re not alone – Aetna is one of the major providers of Medicare Advantage policies and health insurance policies in America, offering coverage to an estimated 39 million people today.
Fortunately, the vast majority of people in America with a health insurance plan will receive coverage for mental health and substance abuse treatment. One requirement of the Affordable Care Act (ACA) is that all plans offered on the Health Insurance Marketplace have to cover behavioral health treatment, including therapy and counseling, as well as inpatient services for mental or behavioral health conditions. Substance use disorder, or addiction, treatment also needs to be covered. Pre-existing conditions need to be covered, and Marketplace plans can’t put yearly or lifetime spending limits on these treatments. These same rules apply to health insurance plans that come from employers as well as individual or private health insurance policies. Additionally, Original Medicare and Medicare Advantage also help cover mental health treatment. Because of this, you can rest assured that mental health coverage using Aetna insurance is available to help you or a loved one get the best help possible.
Still, like any healthcare in America, some specific conditions and rules will apply based on the specific terms of a health insurance policy. That’s why it’s important to work with a treatment provider, such as Moment of Clarity in Southern California, to determine the coverage you can expect to receive once you start treatment for a mental health challenge.
Does Aetna Cover Psychiatric Medication?
Whatever treatment you choose, whether it’s an inpatient program for weeks or months or a long-term intensive outpatient program for mental health treatment, it’s common for treatment programs to include multiple components. In addition to individual or group counseling, many mental health conditions benefit from simultaneous treatment with psychiatric medications, such as antidepressants, anti-anxiety medicines, or mood stabilizers, for example. If you’re looking into Aetna mental health coverage, you’ll likely want to understand how medications will be covered as well. Aetna plans typically will cover therapy and counseling services in addition to medications for diagnosed mental health conditions that are prescribed by a doctor or psychiatrist. The terms will depend on the specific policy. For example, policies will often have a preferred or required network of physicians and medical providers that the patient must work with if they’re going to get the best coverage and lowest out-of-pocket prices. Additionally, there can be requirements to use generic medications when possible instead of name-brand medications.
Mental Health Treatment That Works
Is Aetna No Longer Covering Telehealth?
Aetna made headlines in November 2023 when it announced that it would no longer cover some telehealth services for employer-based plans that it had expanded during the COVID-19 pandemic. Self-insured commercial plans, which make up the majority of Aetna’s commercial business, would no longer cover certain remote services, such as remote evaluation of patient videos or images, virtual check-ins, and certain e-visits. The changes went into effect in December 2023. Audio-only behavioral health counseling was also included in the list of things that would no longer be covered by certain plans. However, the changes didn’t apply to fully insured commercial plans due to federal and state regulations, and many telehealth services are still covered by Aetna policies. It’s important to check the specifics of your health insurance or Medicare Advantage policy to determine what can be covered and work with your doctor or treatment provider to find covered alternatives for treatment if necessary.
Does Aetna Cover Anxiety Medication?
Just like other psychiatric medications as explained earlier, Aetna insurance mental health coverage will typically help cover the cost of anti-anxiety medications if prescribed to treat a diagnosed mental health condition. Aetna policies will usually cover a wide variety of anxiety medications, including generic versions and some name-brand medications if necessary in treatment. The specific amount of coverage can vary greatly depending on the terms of someone’s Aetna health insurance or Medicare Advantage policy, and patients will often have to pay co-pays or co-insurance toward the cost of medications. However, many anti-anxiety medications are available at a low cost in generic form, and the amount that patients will have to pay out of pocket is often quite low.
Does Aetna Cover Marriage Counseling?
Another component of Aetna mental health coverage you might be wondering about is how this insurance provider looks at marriage counseling or couples counseling. Again, the specifics of how this specialized form of therapy or counseling will be paid for by Aetna will depend greatly on the terms of the policy.
Many factors can affect the overall Aetna coverage of marriage counseling, including if the patients are working with an in-network therapist or provider or if they’re choosing to get help from someone outside of their network. Even if the therapist is in-network, patients will often be subject to co-payment or co-insurance out-of-pocket costs for sessions. In addition, patients might be required to receive prior authorization before starting marriage counseling to be covered. Another thing to keep in mind is that some coverage will depend on whether the counseling is recommended to treat or address a diagnosed mental health struggle.
The terms of coverage will vary greatly from one plan to another, and some patients might receive better coverage for online therapy than going into an office for counseling sessions, while others won’t be eligible for online or telehealth coverage. Before starting marriage counseling, you’ll want to check with your insurance policy and work with your treatment provider of choice to ensure your therapist is in-network and that you’re eligible or authorized to receive Aetna coverage for counseling sessions. Prior authorization processes can help greatly in making it clear how much financial responsibility will fall on the patient’s shoulders once treatment begins and alleviate any kind of uncertainty about how much this specialized treatment will ultimately cost.
Call Moment of Clarity to Determine Your Aetna Mental Health Coverage
If you or a loved one is ready to seek treatment for mental health conditions and you’re wondering about how to pay for this much-needed help, you’re not alone. In Southern California, Moment of Clarity’s outpatient mental health treatment can help people struggling with a wide variety of mental health disorders. We offer comprehensive treatment plans that include therapy, counseling, and medication as needed to learn to overcome mental health struggles and thrive in the future. Our team of experts can work with you to figure out your best treatment options and how to pay for this treatment, no matter if you’re wondering about GEHA coverage for treatment or want to determine the specifics of your Aetna mental health coverage. We’re ready to help you get started today. Take the first step by calling us at 949-997-1677 today.
External Sources
- Aetna – About Us
- Healthcare.gov – Mental Health & Substance Abuse Coverage
- American Academy of Family Physicians – Aetna Rolls Back the Telehealth Coverage It Expanded Due to COVID-19
