2021 Aetna Coverage

Aetna is an insurance company that sells health coverage to millions of Americans across the country. The company was founded in 1853 and has since expanded to become one of the largest health insurance providers in the nation. Aetna offers numerous insurance plans, including small business group plans and even Medicare plans. Over 22.1 million people are covered by Aetna health insurance plans, which have access to over 1.2 million providers.

Currently, Aetna does not offer any Short-term health insurance or Individual health insurance plans. 

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Aetna Operating States

Aetna insurance is available in the following states:

  • Florida
  • Georgia
  • New Jersey
  • New York
  • North Carolina
  • Ohio
  • Pennsylvania
  • Texas
  • Virginia

Aetna Health Insurance Overview

Aetna has numerous products available for its customer base. Aetna offers the following products:

  • Health insurance
  • Dental Insurance
  • Vision Plans
  • Behavior Health Coverage
  • Disability Insurance
  • Health Expense Funds
  • Prescription Coverage
  • Health & Wellness Coverage
  • International Insurance Plans
  • Voluntary Insurance Benefits

Aetna is best known for its health insurance plan options. With Aetna, the insured received items such as online access to help manage his or her health plan. Over 1.2 million providers across the country, wellness services, and even personalized wellness and disease management programs.

There are several options for insureds to choose from. The network only plans allow those insured to use doctors that are in-network only. It is a bit limiting. However, it is often more affordable than other programs available.

The Atena Network Option Plans allow those to see doctors both in-network and out-of-network. However, co-pays for out-of-network physicians may be higher.

The indemnity plans offer no restrictions as to whom a person can visit for medical care. These offer the most flexibility; however, they often come with higher premiums and copays.

Aetna also offers Medicare and retiree insurance plans. These plans are available to anyone eligible for Medicare as private Medicare options.

Does Aetna cover Acupuncture?

Some Aetna plans do cover acupuncture, but only if it’s used as an alternative to pain management. So, if a licensed doctor recommends acupuncture instead of surgery, the insurance will pay for it. 

It’s important to note that you should always read the fine print on your insurance policy and call to ask questions before moving forward with this treatment.

Does Aetna Cover Chiropractic Services

Aetna will only cover chiropractic services when the insured has a neuromusculoskeletal disorder, the medical necessity for treatment is documented, and improvement is documented within the initial two weeks of chiropractic care.

If there is no documented improvement within the first two weeks, additional chiropractic treatment is considered not medically necessary unless the treatment is modified. 

Does Aetna Cover Allergy Testing?

Aetna recognizes allergy testing as medically necessary for those with a clinically significant allergic history of symptoms when particular criteria are met. This includes: 

  • Foods
  • Hymenoptera venom allergy (stinging insects)
  • Inhalants
  • Specific drugs (penicillins and macromolecular agents)

The amount and type of testing that is covered vary from condition to condition. 

Does Aetna Cover Abortions?

Certain Aetna plans do cover elective abortion, although this depends entirely on where the patients live. In some states, elective abortions are illegal unless there’s a severe medical issue with either the fetus or the mother.

An elective abortion is a surgical procedure that removes the embryo from the woman’s uterus. In certain situations, women can also take a pill that contains the drug mifepristone, which induces a miscarriage. Because of this, Mifepristone can be equated to an elective abortion under specific plans.

Does Aetna Cover Gender Reassignment Surgery

Yes, Aetna covers gender reassignment surgery if specific criteria are met. As of 2021, Aetna has begun to broaden its coverage for gender reassignment surgery to include breast augmentation surgery. The update aligns coverage for breast augmentation with policies for other surgical procedures for transgender persons, such as breast removal or gender-reassignment surgery.

Does Aetna Cover Birth Control

Aetna does provide birth control coverage. Patients need to obtain a prescription from a medical doctor before heading to a pharmacy. Most plans cover the generic drug formulas, although it’s essential to check the plan details to understand the full scope of your coverage. Most Aetna plans also cover IUDs, hormonal, and copper as contraception or heavy menstrual bleeding. 

The Affordable Care Act requires that plans and issuers must cover, without cost-sharing, at least one form of contraception in each of the methods that the FDA has identified under the current Birth Control Guide. 

The contraceptive methods presently recognized by the FDA with at least one form that Aetna covers at zero dollar member cost share for women and medically documented transgender members are as follows:

  • sterilization surgery for those with female reproductive organs
  • surgical sterilization implants for those with female reproductive organs
  • implantable rod
  • IUD copper
  • IUD with progestin
  • shot/injection
  • oral contraceptives (combined pill)
  • oral contraceptives (progestin only)
  • oral contraceptives extended/continuous use
  • patch
  • vaginal contraceptive ring
  • diaphragm
  • sponge
  • cervical cap
  • female condom
  • spermicide
  • emergency contraception (Plan B/Plan B One-Step/Next Choice)
  • emergency contraception (Ella)

Following the Affordable Care Act, claims for Non-Preferred Brand or formulary excluded contraceptives that meet medical exception criteria are eligible to members at zero co-pays. Click here for more information on Atena copay exception for contraceptives.

Does Aetna Cover Breast Reduction

At this time, Aetna considers most breast reductions cosmetic and will not cover the surgery. However, suppose the breast hypertrophy causes significant pain to the insured. In that case, Aetna recognizes breast reduction surgery medically necessary for non-cosmetic indications for women aged 18 or older when specific criteria are met as outlined in their Breast Reduction Surgery and Gynecomastia Surgery bulletin.

Does Aetna Cover Infertility

Some plans will cover diagnostic infertility services such as laboratory or imaging studies, biopsies, and physical examinations. Covered treatments include hormone management, injectable endocrine therapies, surgical interventions, and artificial insemination. 

Basic Aetna plans do not cover in vitro fertilization. However, Aetna does cover diagnostic tests to discover the reasons behind infertility. On the higher-end plans, Aetna does provide infertility treatment, including multiple rounds of IVF.

Does Aetna Cover STD Testing

Following the recommendations of the U.S. Preventive Services Task Force and the Centers for Disease Control and Prevention, Aetna recognizes HIV and Chlamydia testing as medically necessary. Aetna does not cover home HIV test kits that are not prescribed. 

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Aetna Mental Health Insurance Overview

Aetna Insurance Plans know the importance of staying healthy. The philosophy is that a healthy person is in the office more often and needs less medical care. Therefore, Aetna offers health and wellness benefits to its insureds. Some of these benefits include:

  • Aetna Maternity Program
  • Infertility Precertification Unit
  • Breast Health Education Nurse
  • Cancer Support Centers
  • BRCA Genetic Testing Program
  • Personal Health and wellness coaching
  • Mindfulness Programs
  • Workplace Wellness
  • Metabolic Syndrome Solution
  • The Get Active Program
  • Informed Health Line

Does Aetna Cover Mental Health? 

Behavioral health, in many ways, is as important if not more important than physical health. This is why Aetna has extensive coverage for behavioral health programs. Many of these programs are incorporated into Aetna’s numerous health insurance plans. These coverages include treatment, counseling, and even the trademarked “Resources for Living,” which helps individuals achieve well-being in all areas of their lives.

Does Aetna Cover Therapy? 

Yes, most Aetna plans offer therapy to members, although there are certain restrictions. Individual plans cap out at a maximum, and if you’re on an HMO plan, you’ll have to see your primary care practitioner to get a referral to a psychologist.

Aetna Dental Insurance Overview

Much like Aetna health insurance plans, Aetna’s dental plans offer Network Only Plans, Network Option Plans, and Indemnity Plans. However, Aetna provides the ability to mix and match your plans as a hybrid fund. This means you can have one plan that includes options for two different programs.

Another option available through Aetna is the DentalFund plan which allows you to use untaxed dollars to pay your co-pays and out-of-pocket expenses.

Does Aetna Cover Dental

Aetna Life Insurance Company offers an Aetna Dental Direct insurance plan covering preventative care 100% with no out-of-pocket cost.  

Does Aetna Cover Braces

It depends. Not all plans provide orthodontic coverage, which is why it’s essential to ask questions to your insurance broker and read all documents. The policies that do offer orthodontics typically cover 50% of the treatment costs for individuals under the age of 18.

Does Aetna Cover Braces for Adults

Some Aetna plans do cover Invisalign treatment, although it’s important to read the fine lines of your policy. Some programs have an age cap for both dependents and beneficiaries and only cover a certain amount. The standard plan covers up to 50% of the cost of a treatment plan valued at $2,500.

Does Aetna Cover Dental Surgery

Surgical dental extractions are typically included in an Aetna dental plan; however, there are exceptions. They recommend calling member services to ensure you are covered.

Does Aetna Cover Wisdom Teeth Removal

If your wisdom teeth are impacted, they are likely to be covered under your Aetna health insurance. 

Does Aetna Cover Dental Implants

Many of Aetna’s regular medical plans cover the replacement of teeth due to a non-biting injury.

Aetna Vision Insurance Overview

Aetna vision plans are very similar to their dental plans in which they offer Network Only Plans, Network Option Plans, and Indemnity Plans. 

Does Aetna Cover LASIK

No, a basic Aetna plan does not cover Lasik. For those who already have a basic Aetna plan, you could purchase an Aetna Vision Plan, which partially covers the cost of the procedure.

Does Aetna Cover Cataract Surgery

Aetna recognizes cataract-removal surgery as medically necessary according to the member’s level of visual impairment, based on specific Snellen Acuity results. However, if glasses or visual aids provide adequate functional vision, you will not be covered.

Aetna Prescription Drug Insurance Overview

Like all health insurance plans, there are specific prescription drugs that are covered. This information is located under your Summary of Benefits and Coverage (SBC), as it varies by policy. 

Does Aetna Cover Hearing Aids

Unfortunately, most Aetna benefit plans do not cover hearing aids. However, Aetna’s non-Medicare insurance plans comply with the mandate to provide hearing care for children in the state of Texas in all of its available packages. 

According to hearingwithclarity.com, “Coverage and benefit levels vary under selected copayment, deductible, and coinsurance options, along with attached riders for adults on other plans offered by Aetna. Member discounts and specialized programs available within and outside their membership network might also provide payment assistance.”

Does Aetna Cover a Blood Pressure Monitor

When prescribed by a physician, Aetna typically covers blood pressure monitors.

Does Aetna Cover Cialis

Aetna pharmacy benefit plans typically exclude erectile dysfunction medication. Cialis is covered only when required by state regulation. 

Does Aetna Cover Chantix

No, Aetna does not typically cover Chantix. However, the member or treating physician or health care professional can obtain a medical exception from Aetna for the medication to be eligible for coverage in some instances, such as:

  • AIDS-related pneumonia
  • Precancerous lesions (lesions of the throat or larynx)
  • Lung cancer
  • Chronic obstructive pulmonary disease (COPD)
  • Emphysema
  • Asthma
  • Bronchiectasis
  • Cardiac Disease

Does Aetna Cover the Shingles Vaccine

Yes, Aetna covers the shingles vaccine for those aged 50 and over. Please note that some pharmacies may require a prescription for the vaccine. 

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