2024 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 39 million people are covered by Aetna health insurance plans.

From www.aetna.com: “Since our founding in 1853 in Hartford, CT, we’ve been committed to providing individuals, employers, health care professionals and producers with innovative benefits, products and services. Now that we are a subsidiary of CVS Health®, that mission has only gotten stronger.”

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Aetna Operating States

Aetna insurance is available in 21 states nationwide. These states include Arkansas, California, Colorado, Connecticut, Illinois, Indiana, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, New Jersey, New York, Rhode Island, South Carolina, Texas, Utah, Vermont, Washington, and West Virginia. 

Aetna Health Insurance Overview

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

  • 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. The insured have 24/7 online access to health plan information available through their online profile

There are several options for patients to choose from: network-only and network-option. 

Network-only plans limit the use of doctors to those in-network only; this plan can be limiting based on availability of practitioners but it is often more affordable. 

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

The Traditional Choice indemnity plan offers no restrictions as to whom a person can visit for medical care. This plan offers the most flexibility; however, services can 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.

Coverage limitations for acupuncture vary from state to state, so make sure to check with your provider to determine whether acupuncture will be covered for you. 

Please be weary of receiving acupuncture treatment if you are pregnant, have a pacemaker, or take blood thinners.

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. Common chiropractic treatments include therapeutic exercise and stretching, spinal traction, and transcutaneous electric nerve stimulation (TENS), among others.

In most cases the individual must have clinical symptoms of a condition that may be improved or resolved by standard chiropractic therapy. For full coverage, a treatment plan must be clearly documented, the chiropractic procedures must be clearly related to the patient’s condition, and the chiropractic care must be performed by a licensed chiropractor.

Does Aetna Cover Allergy Testing?

Aetna recognizes allergy testing as medically necessary for those with a clinically significant history of symptoms when particular criteria are met. These testing criteria include allergy testing as it relates to foods, hymenoptera venom allergy (stinging insects), inhalants, or specific drugs (penicillins and macromolecular agents).  

The amount and type of testing covered varies from condition to condition. Allergy testing and desensitization injections can be a great way to determine allergies and prevent bad reactions if determined to be medically necessary by the Primary Care Physician. Allergy testing and immunotherapy are covered if you are referred by your physician.

Does Aetna Cover Abortions?

Some job-based health plans cover elective abortions. Patients can search their plan documents or call their insurers directly to check.

However, due to the recent overturning of Roe v. Wade, no American insurance companies cover abortions or abortion-related treatments. 

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.

The general criteria you must meet to be eligible for gender reassignment surgery includes but is not limited to:

  • The candidate is at least 18 years of age.
  • The candidate has been diagnosed with gender dysphoria.

Does Aetna Cover Birth Control?

Aetna does provide birth control coverage. Patients need to obtain a prescription from a medical doctor; most plans cover the generic drug formulas. Most Aetna plans also cover IUDs, (hormonal and copper) as contraception or for the management of 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 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, 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.

Several criteria must be met, including a diagnosis of macromastia, the diagnosis of two or more symptoms of hypertrophy (backache, posture change, hygiene problems, or other), and the failure to relieve symptoms using nonsurgical treatment (including exercise, hot/cold treatment, and an appropriate support bra) for at least six weeks. Patients must also be at least 18-years-old  or must have reached breast maturity. 

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Does Aetna Cover InfertilityTreatment?

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

Basic Aetna plans do not cover in vitro fertilization (IVF) but will cover diagnostic tests to discover the reasons behind infertility. Higher-end plans do include coverage for 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 unprescribed at-home HIV test kits. 

Aetna-covered STD testing can include testing as part of a pregnancy screening, testing for individuals who are deemed high-risk, testing for victims of sexual assault, or routine testing for homosexual men. Testing for certain STDs — like HIV, syphilis, chlamydia, and gonorrhea — is one of most effective preventive health benefits that most health plans cover.

Aetna Mental Health Insurance Overview

Aetna Insurance values the importance of wellness and offers a variety of health and wellness benefits beyond basic health care plans, including: 

  • 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

In terms of basic mental health coverage, it is important to note that evidence-based treatment, like therapy and psychoanalysis, is covered, but services rendered outside of a therapy setting, such as systematic desensitization or exposure therapy for a specific phobia, are typically not covered. 

Does Aetna Cover Mental Health? 

Behavioral health, in many ways, is as important as physical health. Because of this, 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 licensed psychologist.

Most Aetna plans cover therapy, often focusing coverage on evidence-based therapeutic services, such as psychoanalysis. It’s best to clarify coverage with your provider directly by phone. 

Therefore, traditional therapy, like in-office cognitive behavioral therapy, hypnosis,or talk therapy will most likely be covered, but out-of-office therapy may not be.

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 Annual Dental Costs? 

The Aetna Dental Direct plan covers preventative care with no out-of-pocket cost. Persons can utilize the Dental Direct plan without utilizing other insurance plans through Aetna.

Covered dental treatments from Aetna can include:

  • Periodontal maintenance 
  • Periodontal scaling/root planing 
  • Periodontal and oral evaluations 
  • Palliative treatments 
  • Fluoride and sealants 
  • Extensive removal of plaque and tartar buildup (full mouth debridement)

Does Aetna Cover Braces?

It depends. Not all plans provide orthodontic coverage, which is why it’s important to understand the difference between various dental plan options. Policies with orthodontic coverage typically pay for 50% of the treatment costs for individuals under the age of 18.

Most plans will cover preventative treatments (like cleanings/check ups), basic treatments (like fillings), and around 75% of coverage for treatments like root canals. Cosmetic procedures, like whitening or tooth shaping, are rarely covered by dental insurance plans – and, unfortunately, braces can fall under the cosmetic category. It is best to check with your insurer to see if you will be covered for braces. 

Does Aetna Cover Braces for Adults?

Some Aetna plans 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 rules for braces coverage are the same for children as they are for adults – since braces or invisible liner treatments can be considered a cosmetic surgery instead of preventive or basic treatment, they may not be covered. Check your plan and your region’s policies to be sure.

Does Aetna Cover Dental Surgery?

Surgical dental extractions are typically included in an Aetna dental plan however, there are exceptions. It’s best to call member services to ensure the surgery is covered.

Most plans will cover preventative treatments (like cleanings/check ups), basic treatments (like fillings), and around 75% of coverage for treatments like root canals. Cosmetic procedures, like whitening or tooth shaping, are rarely covered by dental insurance plans

Does Aetna Cover Wisdom Teeth Removal?

If your wisdom teeth are impacted, the treatment will likely fall under the dental surgery category and will be covered by your Aetna dental plan. 

Does Aetna Cover Dental Implants?

Many of Aetna’s regular medical plans cover the replacement of teeth due to a non-biting injury. Dental implants can sometimes be sought out for purely cosmetic reasons, so you may have to check with your plan to see if they will cover your specific implants and the reason why you’re getting them. 

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Aetna Vision Insurance Overview

The Aetna Vision Preferred plan offers annual vision coverage for doctors in network; this typically includes a $0 annual vision test and other regular discounts on eyeglasses and contacts. Additional therapies and treatments are discounted through this insurance plan. 

Does Aetna Cover LASIK?

No, the Aetna Vision Preferred plan only covers 15% of LASIK treatment costs. Typically, no third party insurers or governmental insurers cover the surgery, but they can offer a discount or rebate.

Does Aetna Cover Cataract Surgery?

Aetna recognizes cataract-removal surgery medically necessary according to the member’s level of visual impairment, based on specific Snellen Acuity results. Coverage will be assumed under the vision plan if all criteria are met. More details regarding this classification and corresponding coverage are detailed here

Typically, if glasses or visual aids provide adequate functional vision, cataract-removal surgery is not covered.

Aetna Prescription Drug Insurance Overview

Like all health insurance plans, there are specific prescription drugs covered. The prescription drug coverage is detailed in the Summary of Benefits and Coverage (SBC) varying 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. 

Details regarding hearing aid coverage and policy related to the lack of Aetna coverage can be found here.

Does Aetna Cover a Blood Pressure Monitor?

When prescribed by a physician, Aetna typically covers blood pressure monitors. Check with your state’s coverage for more details. 

Does Aetna Cover Cialis?

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

A patient must have a diagnosis of erectile dysfunction or benign prostatic hyperplasia, among other criteria, in order for coverage to apply. 

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. 

Shingrix is a vaccine made of a shingles virus component. It’s given in two doses, with 2-6 months between doses. Because you have to repeat treatment, it is great that the cost is covered. 

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