Aetna for Therapy

Aetna is part of CVS Health and one of the largest health insurance companies in the U.S., with coverage that includes mental health, behavioral health, and therapy services. This guide outlines the coverage that Aetna typically provides for therapy services.

Does Aetna Behavioral Health Cover Therapy?

Yes, nearly all Aetna Behavioral Health plans cover therapy for mental and behavioral health conditions.

The Affordable Care Act requires all health insurance offered through the Health Insurance Marketplace or small employers to cover mental health services. While not required by federal law, most large employers also cover mental health services.

While rare, your Aetna plan may not cover therapy services if:

You work for a large employer that does not include mental health benefits in its insurance coverage.
Your health insurance plan was created before 2014, when the ACA required health insurance plans to cover mental health services. There are other situations in which your Aetna plan may not cover the specific type of therapy service you seek, or your coverage may not apply until you spend a certain amount on medical services first. Learn more about these cases below.

How Do I Check if My Aetna Plan Covers Therapy?

To check whether your Aetna plan covers therapy, look for the “Outpatient Mental Health” line item on your Summary of Benefits.

Therapy is a type of outpatient mental health service. You can find your Summary of Benefits by logging into your Aetna Member Services portal (called “myAetna”), calling member services, or checking your employer’s benefits portal.

Here is an example of what your Aetna Summary of Benefits may look like and where to find the Outpatient Mental Health line item:

If the Outpatient Mental Health line item indicates these services are not covered, your health insurance plan does not cover therapy services.

If you cannot find coverage information for Outpatient Mental Health, contact Aetna for assistance. If you receive health insurance through your employer, contact your employer’s human resources department.

While your Aetna plan likely covers therapy, the extent of coverage, and requirements for coverage depends on your particular plan. Read on to learn more.

Here is an example of what your Aetna Summary of Benefits may look like, and where to find the Outpatient Mental Health line item:

How Much Does Therapy Cost With an Aetna Behavioral Health Plan?

The cost of therapy sessions with Aetna depends on your plan’s coverage. In the best-case scenario, your therapy sessions may qualify for full coverage, meaning you don’t pay anything at the time of the session. For most people, costs range from $15 to $50 per session. In the worst-case scenario, you must pay the full fee the therapist charges at the time of the session, which generally ranges from $80 to $200 per session. Find the scenario that applies to you below:

If you choose a therapist who is in-network with Aetna, your therapy sessions likely cost between $15 to $50 per session after you meet your deductible. The $15 to $50 amount is your copay or the fixed amount you owe at each therapy visit. The deductible is the total amount you must spend on medical costs in any given year before your health insurance begins to cover the cost of services.

Here are examples you may see on your Summary of Benefits under the “In-network Outpatient Mental Health” category and what they mean:

$15 copay, after $5,000 deductible → After you spend $5,000 in medical costs this year, your therapy sessions will cost $15 per session.
$15 copay, after $1,000 deductible → After you spend $1,000 in medical costs this year, your therapy sessions will cost $15 per session.
$15 copay, deductible does not apply → Your therapy sessions will cost $15 per session regardless of your deductible amount (even if this is your first medical visit of the year, you will only pay $15 at the time of your therapy session).

If you choose a therapist who is not in-network with Aetna and you have an Aetna PPO Plan, your therapy session will likely cost between $50 to $100 per session, or 20% to 50% of the full amount your therapist charges. This percentage is called a coinsurance: you pay the therapist’s full fee at the time of the session, send a claim to your health insurance company, and receive a check or direct deposit for the remaining percentage your plan covers.

PPO plans typically only cover out-of-network services after you meet your deductible. Here are examples you may see on your Summary of Benefits under the “Out-of-Network Outpatient Mental Health” category and what they mean:

20% coinsurance, after $5,000 deductible, therapist charges $100/session → After you spend $5,000 in medical costs this year, your plan will reimburse you $80 of your therapy session fee — your effective therapy cost is $20/session.
20% coinsurance, after $1,000 deductible, therapist charges $150/session → After you spend $1,000 in medical costs this year, your plan will reimburse you $120 of your therapy fee each time you submit a claim — your effective therapy cost is $24/session.

If you choose a therapist who is not in-network with Aetna and you have an Aetna HMO or EPO Plan, your plan will likely not reimburse you for sessions with a therapist who is not in-network with Aetna. You would owe the therapist’s full fee at the session time and not receive reimbursement from your plan. If cost is a barrier to seeking therapy, you can look for a therapist who offers a sliding scale or lower session fees based on financial need.

What Conditions Does Aetna Cover?

Aetna covers a wide range of mental health conditions including:

What Types of Therapy Does Aetna Cover?

The modalities that Aetna Behavioral Health covers may include, but are not limited to, the following:

Any therapy type that is evidence-based and utilized for diagnosis and treatment of mental health conditions should qualify for coverage under Aetna plans.

What Kinds of Therapy Does Aetna Not Cover?

Like most insurances, it is not typical for Aetna to cover services unrelated to a diagnosable mental health condition, like:

Couples counseling: Couples counseling is typically not covered by insurance because relationship issues, while a significant source of stress, are not considered a diagnosable mental health condition.
Life coaching: Life coaching is not covered by insurance because it focuses on achieving personal goals, rather than treating a diagnosable mental health condition.
Career coaching: Career coaching is not covered by insurance because it focuses on achieving professional goals, rather than treating a diagnosable mental health condition.

Aetna is also unlikely to cover therapy sessions occurring outside the therapy office because of the greater potential for risk involved.

While clients may sometimes benefit from services rendered outside of the therapy office, such as a client with an eating disorder needing support in the grocery store, or a client with a phobia of driving needing support in the car, these services are not likely to be covered by insurance.

Does Aetna Behavioral Health Cover Couples Therapy?

No. While it depends on your specific plan, it is unlikely Aetna will cover couples counseling.

That said, even if your insurance doesn't directly cover it, you still have options for getting affordable couples counseling.

Do I Need To See My Doctor Before Visiting an Aetna Therapist?

Your insurance plan type will determine if you need to see your primary care doctor before visiting a therapist:

HMO or POS plan: Yes, you are typically required to see your primary care physician for a referral to therapy before Aetna will pay for services
PPO or EPO plan: No, you typically don’t need to see your primary care physician for a referral to therapy before Aetna will pay for services.

This referral requirement is called pre-authorization (or prior authorization). Pre-authorization is a process where a health provider, in this case, your therapist, must get approval from your insurance company before providing care for the services to be covered.

Your Summary of Benefits should indicate whether your insurance plan requires pre-authorization for outpatient mental health services.

Does Aetna Behavioral Health Cover Online Therapy?

Yes, Aetna usually covers video therapy sessions, which you can use instead of an in-person visit to your therapist’s office.

Video sessions are also an option for managing medications without an office visit.

Why Use Zencare?

Navigating therapy and health insurance can be challenging, especially because this process has many misconceptions, like that all therapists take insurance or that only severe mental health issues require therapy. Working with Zencare makes the process of finding the right therapist for you easy through services and benefits such as:

Educational Resources

Our site is a wealth of information and provides informative articles clearly explaining what therapy coverage includes and the nuances of various health plans. By breaking down terminology and coverage details, we allow users to feel empowered while demystifying their insurance coverage options so you can make more informed decisions about your mental health needs.

Insurance Provider Information

We streamline the process of finding covered services with our searchable list of therapists. This transparency dispels any myths about therapy availability and insurance coverage and reduces anxiety around finding a qualified therapist in your network.

Cost Guidance

We go beyond just listing therapists and offer insights such as potential out-of-pocket costs and how to navigate any insurance reimbursements. Our goal is to help users understand what they can expect financially including copays, deductibles, and the reimbursement process, to make it easier to plan their mental health journey without worrying about unexpected financial burdens.

Answers to Your Most Common Questions

Our blog addresses common questions like therapy coverage, what to do if a therapist is out of network, and the denial process. By providing clear answers to these questions, we can alleviate fears and any uncertainties stopping you from trying therapy.

Personalized Matching

We have a personalized therapist matching service, allowing us to connect providers with users based on their specific needs and preferences. Our customized approach lets us find the best fit for you while ensuring all users find a provider that accepts their insurance. Choosing us gives you the space to focus on your mental health journey instead of navigating the complexities of insurance coverage.

Choose Zencare to Find Vetted Therapists Who Are In-Network With Aetna

Finding the right therapist for you is easy with Zencare. We remove the guesswork and offer amazing benefits like free consultations so you can see how you fit with a therapist without worrying about financial obligations. Take our matching quiz or find an in-network therapist with Aetna CVS Health by selecting your state below: