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.