Missouri residents who anticipate the need for drug or alcohol treatment this year will want to pay special attention to their health insurance policies. Substance abuse treatment is one of the essential services established by the Affordable Care Act. What this means for healthcare consumers is that all insurance policies must offer some form of coverage for people who need substance abuse treatment, but not all plans are the same. How much the company pays depends on where one lives and what policy he or she buys. Consider what a mainstream company like Aetna pays toward addiction detox and rehabilitation.
The healthcare reform measures in the U.S. require insurance companies to offer policies based on metal levels. Shoppers can use the metal level to pick a policy that fits their budget and lifestyle.
Bronze plans come with high deductibles, but low monthly payments. They work well for individuals with access to a health savings account. A bronze healthcare plan pays around 60 percent of your overall healthcare costs, including coverage for medically managed detox, outpatient individual and group therapy, plus inpatient, or residential, care. This leaves you paying 40 percent out-of-pocket.
Silver plans provide a lower annual deductible, but a higher monthly premium. This creates a plan that is more affordable in deductible than the bronze level programs for those who do not have a health savings account to subsidize their insurance. A silver plan will pay around 70 percent of the policyholder’s total healthcare costs.
Gold plans introduce an even lower deductible to the marketplace options, but with a higher monthly premium. Gold plans are designed to cover more of the total cost of care, with as much as 80 percent of services being paid out by the plan. Finding the right metal level depends on your monthly budget, your health, how often you see a doctor, and whether you have a health savings account to cover the deductible.
For Missouri residents, the exact Aetna benefits you have access to will depend on where you live. Many of the current plans from this provider allow you to go outside the network for drug detox and treatment, but it comes at a cost. On average, you can expect to pay a 50 percent coinsurance fee if you go outside of the network for either in or outpatient drug treatment. If you stay in-network, however, you only pay around $6,850 for individual policies and $13,700 for family coverage deductibles. Aetna will pay the full cost of the treatment once you meet the deductible.
The Aetna Whole Health program requires you to stay in-network for all healthcare services. This HMO plan pays the full cost of substance abuse treatment and managed detox after you meet the deductible, but will pay nothing if you go out-of-network.
You will find the silver and gold plans from Aetna follow a similar pattern with a few exceptions. The POS Aetna Silver Plan with Copay allows you to go outside the network for drug detox and treatment, but at a cost of 50 percent. In other words, you will pay half of the total bill whether you get inpatient or outpatient care.
When staying in-network, you pay a $75 copayment per visit, but do not need to meet the deductible. For residential or inpatient care, the copayment is $500 per admission and then 30 percent of the bill after the deductible is met.
The Silver HMO plan requires you to stay in-network for all healthcare treatment. There is no option to go outside the network. You make a $30 copay for outpatient treatment and a $500 payment towards residential care. The inpatient treatment requires you to make an additional 30 percent coinsurance payment after you meet the deductible of $3,500.
Aetna has two different gold plans, one POS and one HMO, with a lower deductible of around $1,400. You pay a $40 copayment for outpatient treatment and a 20 percent coinsurance fee for inpatient care.
Since insurance plans differ by region and provider, you need to look closely at what your plan pays before selecting a treatment solution. This will help you find a care option that works with your Aetna policy to help you get healthy. Take the first step by contacting us at DrugRehab.org today.