Cigna Insurance for Drug and Alcohol Rehab

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If you have Cigna health insurance, you are one of hundreds of millions of customers served worldwide.1 Like many others, you may be confused as to exactly what is covered when it comes to mental health or substance abuse services. This page should help you understand what is and what isn’t covered by Cigna insurance.

Please note: This page is simply a brief guide to how Cigna health plan benefits work with regard to substance abuse, mental health, and behavioral health treatment. This is not a comprehensive guide. Call 1-888-319-2606 Helpline Information or reach out to a Cigna representative to confirm your coverage benefits or with specific questions about your health plan.


About Cigna Health Insurance

Cigna is a “global health services company” that serves more than 180 million patients and customers worldwide. With a focus on addressing whole-person health, Cigna is “dedicated to improving the health, well-being, and peace of mind” for the people they serve.1

Cigna Insurance plans offer many different types of coverage that 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 use 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 Insurance Coverage Levels and Coverage Plans

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 a couple of 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 for 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 substance use treatment methods covered by Cigna insurance. Using the Cigna Connect 6500 EPO plan for an individual living in Wichita, Kansas, as an example, this is how costs of care at a Cigna network inpatient facility would be shared:7

  • The customer would be required to pay the $6,500 annual deductible before Cigna starts covering costs.
  • After the deductible is paid, the customer still has to cover 50% of the remaining costs (known as the coinsurance rate) before reaching their out-of-pocket limit of $8,150. Once this amount is paid, Cigna covers 100% of the remainder. Due to the high costs involved in inpatient care, it’s likely that this out-of-pocket maximum will be reached.

In this instance, the 50% coinsurance rate will also apply to any prescription drugs needed (unless the out-of-pocket maximum has already been reached).7

Remember, since this is an EPO plan, going outside the Cigna network for an inpatient treatment facility would 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. This time let’s use a different plan as an example—the OAP plan for an individual in Indiana. At one of the network outpatient facilities, this is how costs would break down:8

  • This plan has no overall deductible, so a patient will only have to pay the $50 copayment for each time they visit the inpatient facility.
  • The maximum out-of-pocket limit is $2,000. This would be only be reached if outpatient services lasted 40 days or longer (due to the $50 co-pay), or if outside costs for other services had been incurred.

This OAP plan has a separate deductible for prescription medication, which is $175. The copayment for prescription treatments are $20-$70, depending on the brand of drug (generic, preferred, or non-preferred).8

This plan would not cover any of the expenses if this patient went to a facility outside the Cigna OAP network.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
co-insurance.

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 use 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 substance use 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 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 in making sense of the health insurance coverage for addiction treatment; or fill out the form below.

Insurance Providers with Addiction Coverage


Sources

  1. Cigna. (2020). Company profile.
  2. Centers for Medicare & Medicaid Services. (2020). Medicaid.
  3. U.S. Department of Health & Human Services. What’s medicare?
  4. Cigna. (2020). Group health insurance plans.
  5. Cigna. (2020). Cigna Open Access Plus medical plans.
  6. Cigna. (2020). Cigna LocalPlus plans.
  7. Cigna. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services.
  8. Cigna. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services.
  9. Cigna. (2020). Contact us.
  10. Cigna. (2021). Substance Use Benefits.
  11. Cigna. (2019). What is an Out-of-Pocket Maximum and How Does It Work?
  12. Cigna. In-Network vs. Out-of-Network Providers.
  13. Cigna. (2018). Behavioral Health Providers.

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