For people facing drug or alcohol issues, the right insurance plan can be a lifesaver. Substance abuse treatment is part of the essential services provided for in the Affordable Care Act, but not all policies have the same benefits. Companies like Aetna develop plans that fit communities. Consider what Aetna offers residents living in the state of Oklahoma and the surrounding area.
Insurance providers established metal levels in conjunction with health care reform. This allows policy shoppers to get a feel for the plan just based on the metal level. Bronze plans tend to carry high deductibles, but lower monthly payments. They work well when partnered with a health savings account. In general, Aetna pays 60 percent of the overall healthcare costs if you buy a bronze plan. This would include medically managed detox, outpatient individual and group therapy plus inpatient, or residential, care.
With a silver plan, you can expect to pay a lower annual deductible, but a higher monthly premium. The lower deductible makes the plan more affordable for those who do not have a health savings account to cover the annual payment. Silver plans generally pay around 70 percent of policyholder’s total health care costs.
The gold plans from Aetna provide a low deductible, but a high monthly premium. Gold plans also cover more of the total cost of care, usually as much as 80 percent. Picking 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.
In this area, Aetna provides a diverse list of health care options. The exact benefits will depend on where you live, though, and the metal level you choose. Many of the plans are Exclusive Provider Organization, or EPO. For healthcare consumers, this means staying in-network for all services including substance abuse treatment. Straying out-of-network nullifies your policy, so the first thing you need to consider when selecting a treatment plan is whether the facility or organization is part of the Aetna network.
With the bronze level plans around Oklahoma, the company pays for drug detox and treatment in full after you meet the deductible. Your contribution towards the deductible includes anything you pay for any service, so it is not limited to substance abuse treatment. Deductibles do not apply to some types of office visits, like seeing your primary care doctor, preventive or urgent care. In other words, if you cover a $15 copayment when seeing the doctor, that money does not count towards your deductible.
With a bronze plan, if you have met the deductible, you can expect Aetna to pay the entire bill for both inpatient and outpatient care as long as you stay in-network. There is no copay or coinsurance fee to make. Deductibles average around $6,850 for individual plans or $13,700 for families.
The silver plans offered in this region follow a similar model, but with a lower deductible requirement – usually around $3,500 for individuals and $7,000 for families. Most are EPO plans, so you must stay in-network when selecting an inpatient facility or outpatient treatment program.
The payment structure does change for the higher metal levels, though. At silver, you make a $75 copayment towards outpatient therapy, whether you have met the deductible or not. For inpatient care, meaning you spend time living in a facility, your responsibility is a $500 copayment and then 30 percent of the bill. This is after you meet the deductible for the year.
The gold plans follow that same basic structure, but with an even lower deductible. Gold plan policy owners pay just $1,400 dollars a year as a deductible for individual plans and $2,800 for families. For outpatient care, your contribution is a $40 per visit copay. Inpatient treatment requires a 20 percent coinsurance payment after you meet the deductible.
If you are an Oklahoma resident considering insurance options, Aetna may be one possible choice. This company does cover drug and alcohol treatment, allowing you to focus less on your care budget and more on getting healthy. Contact us at DrugRehab.org to start your journey towards addiction recovery.