If you are considering drug or alcohol rehab for you or a loved one, insurance is a critical decision. Mental health services are considered essential as part of healthcare reform, but not all policies pay the same amount towards detox and treatment. Finding the right health insurance company is the first step to getting the help you need. Consider what Aetna brings to the table for Pennsylvania residents.
Aetna offers a diverse health insurance portfolio in the Keystone State. All policies fall under the brand names PinnacleHealth or Valley Preferred. Like most insurance companies, Aetna uses metal levels to structure their programs. When purchasing at the bronze level, you can expect to pay at least 40 percent of your overall health care expenses in a year. Bronze plans come with high deductibles, but low monthly premiums and are a reasonable choice for individuals with access to a health savings account.
At the silver level, your expense drops to 30 percent, but the monthly payments go up. The deductibles are often lower at this level, as well. For gold plan buyers, the deductible drops considerably, but the premiums go up. With a gold policy, you pay only around 20 percent of your overall health care bill.
All Aetna policies in PA are health maintenance organization plans or HMOs. This means you select a primary care physician to coordinate your medical needs. You must stay in-network for your primary care provider, as well, unless Aetna gives you the authorization to go outside of it.
Aetna offers healthcare consumers in PA four separate bronze level plans. The PA Aetna PinnacleHealth Bronze $15 Copay PD comes with a deductible of $6,850 for individual policies and $13,700 for families. With this plan, you are expected to meet the deductible before the company pays anything towards substance abuse treatment. Once you pay the deductible, Aetna covers all costs of treatment, whether you are an inpatient or attend outpatient therapy. There is no coinsurance fee as long as you stay in-network. If you choose to go out-of-network, the company will not pay for this service.
The PA Aetna PinnacleHealth Bronze Deductible Only HSA Eligible PD comes with a slightly lower deductible, $6,450 for individuals and $12,900 for families, but it is only available to those with a corresponding health savings account. For this plan, Aetna pays the full amount after deductible for both in and outpatient treatment.
The Bronze level Valley Preferred plans have a similar structure. You must meet the deductible first and then the company covers the remaining cost of drug treatment. You pay towards the deductible yearly, so any service, whether it is substance abuse treatment or chiropractic care, counts. The exception comes when you to make a copayment such as an office visit. Copayments do not count towards the deductible.
There are a total of four silver and gold level plans. The two silver plans come with deductibles of $3,500 for individual coverage and $7,000 for families. Both policies allow you to make a $75 copayment for outpatient drug treatment. You do not have to meet the deductible before the company pays for care. Inpatient, or residential, treatment requires you to make a $500 copayment for each admission and then pay 30 percent of the bill after the deductible is met.
The gold plans offer lower deductibles – just $1,400 for individuals and $2,800 for families. You make a $40 copayment for outpatient care regardless of your deductible status. Inpatient treatment costs 20 percent after the deductible is met.
If you are a Pennsylvania resident with an addiction or alcohol abuse problem, health insurance matters. Aetna has been serving healthcare consumers in this country for over a century and is there to help you find your way back to sobriety. To begin your journey towards addiction recovery, contact us today at DrugRehab.org.