Does Cigna Cover Drug and Alcohol Rehab?

Last updated on March 16th, 2021

  • Cigna Plans and Coverage Levels
  • Does Cigna Cover Inpatient Rehab?
  • Does Cigna Insurance Cover Outpatient Rehab?
  • Does Cigna Cover Mental Health Services?
  • How Do I Check My Cigna Benefits?

There are hundreds of millions of patients who have health insurance through Cigna.1 For many, though, there is confusion about what exactly your insurance plan covers when it comes to substance abuse and mental health services.

So does Cigna cover the cost of addiction treatment? The short answer is yes, it will cover at least some of the cost, but this page is intended to help you figure out what your Cigna healthcare plan does and does not cover.

Please note: This page is a brief guide to how Cigna insurance plan benefits work with regard to mental health, substance abuse, and behavioral health treatment. This is not a comprehensive guide. Call one of our admissions navigators at +1 (888) 341-7785 or reach out to a Cigna representative to confirm your coverage benefits and with specific questions about your health plan.


Cigna Plans and Coverage Levels

Cigna health plans fall into several categories, and the features of those plans may vary based on your:

  • State of residence.
  • Employer (if you obtained insurance through your employer).
  • Qualification for healthcare funded by the state/federal government. Typically, government-funded healthcare includes:
    • Medicaid, which typically applies to low-income individuals.2
    • Medicare, which is mostly for seniors or people with certain health conditions.3
  • Decision to select your plan through the Affordable Care Act (ACA) marketplace (rather than your employer).

So what plans does Cigna offer? Cigna’s insurance plans fall into several main categories:4

  • Health maintenance organization (HMO): An HMO plan tends to be a good option for people who are ok with a limited number of providers within the Cigna network that they can see. HMO plans cover care provided by physicians and facilities contracted directly with the insurance company
  • Exclusive provider organization (EPO): An EPO plan allows patients to have more flexibility in selecting a doctor or facility for healthcare needs. However, there are services that Cigna may not cover if they are out of network.
  • Preferred provider organization (PPO): A PPO plan lets patients choose from a wider range of healthcare providers. Still, receiving care outside of the network often results in higher out-of-pocket costs.

In addition, Cigna also provides two other options:

  • LocalPlus: This plan is an affordable way that patients can receive healthcare services from a limited network. Your plan can either only include services from the network or you can include out-of-network services (for an additional cost).5
  • Open access plan (OAP): While similar to a PPO plan, an OAP plan has a larger network of providers. OAP plans also permit you to pay additional costs to go outside of the network.6

Does Cigna Cover Inpatient Rehab?

Cigna covers at least some of the cost of inpatient rehabilitation for substance abuse treatment. 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 has to pay the $6,500 annual deductible before Cigna starts covering costs.
  • After the deductible is paid, the patient is still required to pay 50% of the remaining costs (known as the co-insurance rate) before reaching their out-of-pocket limit of $8,150. After the patient has met all of those requirements, Cigna covers 100% of the remainder. The high cost of inpatient treatment makes it likely that this out-of-pocket maximum will be reached.

In this example, the 50% coinsurance rate also applies to any required prescription drugs (unless the out-of-pocket maximum has already been reached).7

Remember, since this is an EPO plan, obtaining treatment outside of the network would lead to no rehab coverage.7


Does Cigna Insurance Cover Outpatient Rehab?

In addition to inpatient treatment, Cigna health insurance plans cover at least some of the cost of outpatient rehab. For this example, we’ll look at an OAP plan for an individual living in Indiana. The breakdown of costs at an in-network outpatient facility includes the following:8

  • This plan does not have an overall deductible so the patient only has to pay a $50 co-payment when they visit the facility.
  • The maximum out-of-pocket limit is $2,000, which would only be reached if the outpatient services for 40 days or more or if costs for other services had also been incurred.

This plan also includes a deductible for prescription medicines ($175f). Depending on the drug brand, the co-payment for prescription treatments range between $20-70. 8

This plan does not cover any expenses if care is obtained outside of the Cigna OAP network.8


Verify Your Benefits at an American Addiction Centers Facility

The cost of alcohol or drug addiction treatment may appear to be an obstacle, but we are here to help. Insurance may cover all or some of your rehab.

Find out if your insurance covers long-term addiction rehabilitation.

Check Online Now

Does Cigna Cover Mental Health Services?

In addition to covering at least some of the costs of substance abuse treatment, Cigna plans also cover mental health and behavioral health. With the two examples provided above, Cigna coverage for mental health treatment, via either outpatient or inpatient rehab, would be equal to what is provide for substance abuse. 7, 8


How Do I Check My Cigna Benefits?

If you have Cigna but you are unsure about the plan you have or what coverage it provides, there are a few ways to check. You can contact Cigna via their website or app, call their customer service line, or verify coverage via your insurance paperwork.

In addition to those options, you can also contact one of our admissions navigators at +1 (888) 341-7785 or click here to verify your benefits.


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Sources

  1. Cigna. (2020). Company profile.
  2. Centers for Medicare & Medicaid Services. (2020). Medicaid.
  3. U.S. Department of Health & Human Services. (n.d.). What’s Medicare?
  4. Cigna. (2020). Cigna Open Access Plus medical plans.
  5. Cigna. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services.
  6. Cigna. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services.
  7. Cigna. (2020). Contact us.

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