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Cigna Insurance Coverage for Rehab

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Two adults discussing an insurance coverage for addiction treatment

Knowing what kind of health insurance benefits you have in terms of drug and alcohol addiction treatment is an important step in seeking help for a substance use disorder. Here we will explore the common health insurance plans offered by Cigna and the treatment coverage you may be eligible for as a Cigna health insurance member. Rehabs that accept Cigna insurance vary from state to state and rehabilitation modality.

Will Cigna Insurance Cover Drug and Alcohol Rehab Program?

Making the decision to seek treatment for a substance use disorder can be life-changing. However, many people also find this choice to be overwhelming due to the many decisions that often must be made. A primary decision individuals must address is how they will pay for drug and alcohol addiction treatment. While addiction programs can be expensive, it’s important to know that there are several ways to offset this cost, with one of the most common being healthcare insurance.

As one of the largest insurance providers in the world, Cigna offers health insurance plans that often cover some or even all of drug and alcohol addiction treatment programs. Thanks to the Mental Health Parity and Addiction Equity Act of 2008, if your Cigna insurance plan offers coverage for medical services, it is also required to provide equal coverage for mental health services which include addiction treatment. This means that you likely have coverage options under your Cigna healthcare plan that can help you counteract the cost of a treatment program.

Let’s take a look at common healthcare insurance plans offered by Cigna and the types of coverage that may be provided by these plans for addiction treatment.

Health Insurance Plans Commonly Offered by Cigna

The healthcare insurance plans offered by Cigna will vary depending on the state and county in which a person resides. Additionally, whether the insurance is obtained individually or through an employer can also affect the plans available to you. The following are a few common Cigna insurance plan categories that may be offered in your area:

  • Bronze: Bronze Cigna insurance plans are typically the most affordable in terms of monthly premium costs. However, Bronze plans often have the highest out-of-pocket costs for healthcare services including drug and alcohol addiction treatment. This type of plan is recommended for those who don’t go to the doctor frequently and who want to keep their premium payments as low as possible.
  • Silver: A Silver Cigna plan provides moderate premium costs as well as moderate out-of-pocket expenses when it comes to medical services.
  • Gold: The Gold-level plan has the highest premium costs but the lowest out-of-pocket expenses. People with Gold-level Cigna insurance plans will likely pay the least for drug and alcohol addiction treatment.

Additional types of plans that you may be able to get through Cigna include the following:

  • HMO (Health Maintenance Organization): An HMO plan is one that provides a local selection of top-quality medical providers whom you can choose from when seeking treatment. HMO plans require you to have a primary care physician (PCP) who refers you to specialists. Most if not all healthcare must be coordinated through the PCP.
  • PPO (Preferred Provider Organization): This type of insurance plan typically provides a larger variety of doctors and other healthcare providers to choose from. This gives individuals flexibility when it comes to seeking treatment. However, many PCP plans require higher out-of-pocket costs and monthly premiums.
  • EPO (Exclusive Provider Organization): This type of plan offers coverage for a select few local medical providers and often requires individuals to have a primary care physician who coordinates their medical care. Most EPO plans will not provide any coverage for out-of-network medical care.

These are the basic levels and types of insurance offered through Cigna. Each plan will vary as to how much coverage it offers for substance use disorder treatment.

What You Need to Know about In-network and Out-of-network Cigna Insurance Coverage

Knowing the difference between in-network and out-of-network medical services is an important part of understanding your insurance coverage. In-network medical providers are those that have been sourced directly by Cigna. These providers often work with Cigna to agree on a lowered payment requirement for Cigna customers. As a result, seeking in-network treatment is typically much less expensive than out-of-network treatment due to coverage levels provided by Cigna.

Out-of-network medical providers are any doctors or health facilities that do not work directly with Cigna. As a result, most medical services that are considered out of Cigna’s network will cost more money out-of-pocket for Cigna insurance clients. However, some Cigna plans offer coverage for out-of-network providers. While it is often not as much as in-network medical services, this is important to know when deciding where you will seek treatment for drug and alcohol addiction.

Will Cigna Insurance Provide Coverage for a Drug and Alcohol Detox Program?

Most people who pursue an inpatient treatment program and even an outpatient addiction program will be recommended or required to complete a medically-supervised detox program first. A detox program is often completed in a medical facility and is when a person detoxes from drugs and/or alcohol under the supervision of medical professionals. This is the safest way to rid the body of substances, as some substances can cause highly uncomfortable and even dangerous withdrawal symptoms. Some of these drugs include heroinprescription drugs, and alcohol. Many detox programs will also provide patients with medication and other methods of support to help ease withdrawal symptoms and reduce overall discomfort throughout the detox process.

Many Cigna plans cover some or all of a detox program as long as it is in Cigna’s network of medical providers. Some plans may offer partial coverage for out-of-network medically supervised detox programs. Additionally, your plan may require you to obtain prior authorization before it will cover a detox program for substance use disorders.

Will Cigna Cover an Inpatient Alcohol and Drug Rehab Center?

Depending on the severity of your substance use disorder as well as your ability to take several weeks or months off from work or other responsibilities, your physician may recommend that you consider inpatient treatment. Inpatient drug rehabs are the most intensive form of treatment for substance use disorders and require patients to live at a residential facility for weeks at a time. During this period, patients undergo daily intensive treatment that may include therapy, medication-assisted treatment and other research-proven approaches to addiction recovery.

The following is a break down of how some Cigna plans offer coverage for inpatient addiction treatment:

  • Bronze: A Bronze-level plan often requires individuals to meet their yearly deductible before Cigna will provide coverage for inpatient treatment. However, once this deductible has been met, Cigna may cover most or all of the costs for inpatient programs that are in-network.
  • Silver: Silver Cigna plans may require people to pay anywhere from 30 to 50 percent of the cost of inpatient treatment after their deductible has been met.
  • Gold: Gold plans may require patients to pay 20 to 50 percent coinsurance for inpatient addiction treatment.

Each plan will vary so be sure to speak with a Cigna representative to get the specific requirements and inpatient coverage options for your insurance plan.

Will Cigna Cover Outpatient Addiction Treatment?

Another common form of drug and alcohol addiction treatment is an outpatient program. There several different types of outpatient treatment, with the most popular being the following:

  • Partial hospitalization programs (PHP): PHPs are considered the most intensive form of outpatient treatment. This type of outpatient program is typically held in a hospital or other medical facility and requires patients to attend treatment daily for several hours each day. However, unlike inpatient treatment, patients can return home each evening once treatment is completed.
  • Intensive outpatient programs (IOP): IOP is less intensive than partial hospitalization programs and only requires individuals to go to outpatient treatment several times a week for a few hours each day.
    Standard outpatient programs: This is the least intensive form of outpatient treatment. Most standard outpatient programs require patients to attend treatment a few times a week, often in the afternoon or evenings to best fit their work or school schedules.

Most if not all Cigna healthcare plans offer some level of coverage for outpatient treatment. The specific coverage options will depend on the type of plan as well as the type of outpatient treatment a person chooses to pursue. For example, some Cigna plans may require individuals to pay a copay every time they attend an outpatient treatment session, whereas other plans may ask for a coinsurance percentage to be paid for the entire outpatient program.

Are There Other Addiction Services That Cigna Will Cover

In addition to detox, inpatient and outpatient programs, there are several other addiction treatment services that may be provided separately or in conjunction with inpatient or outpatient treatment. The following are the most commonly implemented addiction treatment services that you should be aware of before entering into a treatment program:

  • Medication-assisted treatment (MAT): MAT is when a person is prescribed a medication to help ease withdrawal symptoms and reduce cravings of certain substances. MAT is most commonly used in the treatment of alcohol and opioid addiction. Frequently used medications for these addictions include Acamprosate, Disulfiram, methadone, Vivitrol, buprenorphine and Suboxone. Many Cigna plans will cover some or all of the costs for these prescriptions.
  • Therapy: There are several forms of therapy that may be used to treat substance use disorders. These include behavioral therapies such as cognitive-behavioral therapy and individual, group and family counseling. Most Cigna plans provide coverage for therapy.
  • Sober aftercare: Sober aftercare, which also may be referred to as sober living, is sometimes recommended once a person has completed an inpatient treatment program. Not all Cigna plans offer coverage for sober aftercare. Other plans may offer coverage for sober living on a case-by-case basis.
    Additional services: Other addiction services that may be covered by Cigna include drug testing, interventions, experiential therapies and other medications such as those for co-occurring mental health disorders.

What Should I Ask My Cigna Representative About My Addiction Coverage Benefits?

There are several questions you should ask a Cigna representative before deciding where you will seek treatment for a substance use disorder. It’s best to speak with a representative before you choose a facility and program to pursue, as they can ensure you fully understand your coverage and what you will be required to pay out-of-pocket.

Here are some questions to consider when talking with your insurance representative:

  • Will my Cigna insurance plan cover medically-supervised detox programs? If so, is there a limit on the number of days that will be covered in a detox program?
  • Does my Cigna plan offer coverage for inpatient addiction programs? Do the rehab facilities need to be in-network?
  • How many days of inpatient treatment am I eligible to receive coverage for?
  • Will my Cigna healthcare plan cover outpatient drug rehab? What types of outpatient programs are covered under my plan?
  • What copays, coinsurance and/or deductibles will be required of me for each type of addiction rehabilitation program?
  • Does my Cigna plan cover additional addiction services such as medication-assisted treatment and therapies?
  • Do any drug and alcohol addiction treatment services require me to obtain prior authorization before they will be covered under my Cigna insurance plan?
  • Are there any treatment services that are not covered under my plan?

You can find the number to contact a Cigna representative on the back of your health insurance card or on the Cigna members’ website.

How to Find an Addiction Program that Accept My Cigna Insurance Plans

Seeking treatment for a drug or alcohol addiction can be daunting, but you don’t have to do it alone. There are people who can help you every step of the way, including throughout the process of selecting the right treatment program for you. If you want to learn more about what your Cigna insurance covers as well as which treatment programs accept your Cigna plan, contact one of our caring treatment specialists today.