Cigna Insurance Coverage for Drug and Alcohol Addiction Rehab

Cigna Insurance Coverage Levels and Plans

Cigna insurance plans offer many different types of coverage, which include:

• Health insurance for individuals and families.
• Dental plans.
• Medicare plans.
• Supplemental Insurance.
• International health insurance.
• Behavioral health.

If you or a loved one are struggling with a substance use disorder (SUD), Cigna may cover various forms of treatment, therapy and support, depending on your plan. Substance addiction treatment services may include:¹⁰

• Inpatient treatment.
• Outpatient treatment.
• Partial hospitalization.
• Intensive outpatient.
• Personalized coaching and support services.
• Referrals for support groups, behavioral coaches and online resources.

Cigna health plans can be broken down into several different categories. However, the specifics of Cigna insurance plans may vary based on:

• Employer (if you opted for insurance through your employer).
• State of residence.
• Whether you qualified for government-funded healthcare. The two main types of government healthcare are:
  • Medicaid, which mostly applies to low-income individuals.²
  • Medicare, which is usually for seniors or people with certain specific health conditions.³
• Whether you chose your plan through the Affordable Care Act (ACA) marketplace (as opposed to your employer).

Like many other health insurance companies, Cigna insurance plans fit into several main categories:⁴

• Health Maintenance Organization (HMO). An HMO plan is an excellent option for people who don’t mind limiting themselves to providers within the Cigna network. HMO plans cover services exclusively provided by physicians and facilities that contract with the health insurance company directly.
• Exclusive Provider Organization (EPO). EPO plans give customers more flexibility when it comes to choosing a physician or facility for healthcare needs. However, many services may not be covered if they are outside the Cigna network.
• Preferred Provider Organization (PPO). PPO plans allow customers to choose from a much wider variety of healthcare providers. However, going outside the network typically results in a much higher out-of-pocket cost for services.

Cigna also provides other options:

• Open Access Plus (OAP). OAP plans are similar to PPO plans, except the network of providers contracted directly is larger. Like with a PPO plan, OAP plans allow you to go outside this network for a higher cost.⁵
  • This is an affordable route that allows you to choose from a limited network of healthcare services. You can opt to have your plan include out-of-network services (for a higher cost) or choose to limit yourself to the network for a lower premium.⁶

Does Cigna Insurance Cover Inpatient Rehab?

Inpatient rehabilitation is one of the addiction treatment methods covered by Cigna insurance. Coverage may vary depending on the state you live in and the types of services you require, so it’s important to contact a Cigna representative for more information.⁷

If you go outside the Cigna network for an inpatient treatment facility, it may result in no coverage.⁷

Does Cigna Insurance Cover Outpatient Rehab?

Another common form of addiction treatment covered by Cigna health insurance is outpatient rehabilitation in which a person visits a facility to receive treatment rather than stay overnight. Outpatient treatment can vary in intensity levels and include a range of services to help a person recover.

Like inpatient treatment, outpatient programs that are outside the Cigna OAP network may not be covered.⁸

Does Cigna Insurance Cover Mental Health Treatment?

Mental health, behavioral health, and substance abuse treatments are all categorized together within Cigna health plans. For both the examples outlined in the sections above, the coverage for mental health treatment in inpatient or outpatient treatment for mental health would be the same as it is for substance use.^{7, 8}

Cigna Out-of-Pocket Coverage

Out-of-pocket coverage means that after you meet your yearly out-of-pocket maximum, insurance will cover any costs above the maximum amount set by your plan. Out-of-pocket costs can include copayments, deductibles and coinsurance.

Some plans are required to meet standards set by the Affordable Care Act (ACA), which calls for out-of-pocket maximums. If you have a plan through the ACA, be sure to check your coverage for the specific out-of-pocket maximum.¹¹

Mental health and substance abuse coverage is a part of Cigna medical plans acquired through an employer and does not have a separate deductible to be met.¹⁰ If you buy your own health plan, there may be different premiums and rules regarding out-of-pocket maximums, such as not being able to apply your deductible to the out-of-pocket maximum.¹¹

It’s always important to check the details of your plan to confirm coverage. There may be some expenses that don’t count toward your out-of-pocket maximum, including:¹¹

• Cosmetic procedures and alternative medicine.
• Costs above the allowed amount. If your plan sets an amount for a specific service, and costs exceed that amount, your plan may not cover that cost or apply it to out-of-pocket maximum.
• Out-of-network care and services.
• Plan premiums for individual health plans (not through employer).
• Most preventative care like flu shots, well-visits, routine screenings etc.
• Plan deductibles for certain plans.

Cigna Out-of-State Rehab Coverage

Out-of-state rehab coverage may depend on your specific Cigna health plan and which treatment providers are considered in-network or out-of-network. Make sure to check your plan details for information about receiving addiction treatment that’s out of your plan’s local service area.

What Length of Treatment Does Cigna Cover?

The length of treatment for substance misuse covered by Cigna (e.g. 28-30 days or more long-term programs e.g. 60 days/ 90 days) will depend on what is deemed medically necessary. Cigna will work with treatment providers to assess and find the appropriate level of care for a person who needs treatment for substance misuse. This could include the length of treatment, types of treatment, services and level of care, in addition to milestones to be met during treatment.¹³

How to Check My Cigna Substance Abuse Coverage

If you have Cigna but you are unsure about which plan you have or what it covers, there are a few different ways to check your benefits. You can:

• Login to the myCigna website or mobile app. If you don’t have an account already, you will need to register. Creating an account is simple, though it will require your social security number (SSN) or Cigna membership ID number.
• Use the insurance paperwork that was provided by the ACA marketplace or your employer when you enrolled in Cigna health insurance.
• Call customer service.⁹

All the options above should be able to provide you with specific information about your Cigna plan. If you are considering treatment at an American Addiction Centers (AAC) facility and are unsure whether Cigna contracts with AAC directly, you can use the Verify Your Insurance portal, call one of our admissions navigators, who can assist you for free in making sense of the health insurance coverage for addiction treatment, or fill out the form below.