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Cigna Insurance for Addiction Treatment

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 does and does not cover.

American Addiction Centers (AAC) strives to provide you with the most updated information on each carriers’ addiction insurance coverage, but policy changes and errors do occur. Please check with your insurance carrier directly to confirm coverage levels.


Does Cigna Cover Addiction Treatment?

Yes, Cigna covers alcohol and drug abuse treatment for its members. Cigna has partnerships with drug and alcohol addiction centers throughout the country to provide a variety of detox and drug and alcohol addiction treatment services at discounted rates to members. The Affordable Care Act (ACA) requires that insurance companies provide some degree of coverage for mental health treatment, which includes substance use disorder (SUD) treatment (including coverage for drug and alcohol addiction).2

Examples of Cigna coverage:

Inpatient: 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:3

  • The customer must 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 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). Since this is an EPO plan, obtaining treatment outside of the network would lead to no rehab coverage.3

Outpatient: 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:4

  • 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. This plan does not cover any expenses if care is obtained outside of the Cigna OAP network.4


How to Check Your Insurance Benefits?

Before you decide which rehab center might be best for your needs, it’s important to check your insurance benefits to understand what costs are covered by your insurance provider, and which ones you are responsible for. Knowing exactly what your Cigna plan covers can give you peace of mind while you or your loved one is in rehab. You can do the work of getting and staying sober without worrying about unexpected costs or financial struggles. For more information on Cigna insurance plans and to check what your plan covers, call , click here, or fill out the form below.


What Are the Coverage Levels and Plans for Cigna?

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:5,6
    • Medicaid, which typically applies to low-income individuals.
    • Medicare, which is mostly for seniors or people with certain health conditions.
  • 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:7

  • 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:8,9

  • 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).
  • 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.

Do Treatment Centers Need to Be In-Network?

In-network providers have a contract with the insurance carrier to offer services at a set price. This means that your out-of-pocket expenses will typically be lower than if you choose an out-of-network facility. In some cases, you may even be responsible for the full cost of rehab if you choose an out-of-network facility.

Whenever possible, try to choose a facility that is in-network with Cigna. If you are unable to find an in-network provider or prefer a facility that is out-of-network, you may be able to work out a payment plan with the facility so you can pay back the cost of treatment over time.


What Different Types of Addiction Treatment Does Cigna Cover?

Your Cigna insurance plan may cover the following addiction treatment services:10,11

  • Detox services: In some cases, you may need assistance when detoxing from drugs and alcohol, which can potentially be uncomfortable, painful, or even life threatening. Medical detox helps you safely withdrawal from drugs and alcohol, as you’ll receive around-the-clock medical supervision. You might also be given medications to help minimize withdrawal symptoms.
  • Inpatient or residential care: Inpatient/residential live-in treatment centers provide drug and alcohol rehab while you live onsite at the facility. Most inpatient programs last anywhere from 15–90 days, depending on the program you’re in and your individual needs.
  • Partial hospitalization (PHP): Partial hospitalization programs give you the opportunity to live at home while attending treatment during the day.
  • Intensive outpatient: Intensive outpatient programs involve attending treatment programs a few evenings a week. In an intensive outpatient program, you can live at home and even go to work during the day.
  • Outpatient treatment: Individuals who have completed inpatient treatment often attend outpatient treatment for ongoing support on their journey to sobriety. You live at home and spend 10–12 hours a week at the treatment facility for therapy and support.

Your total out-of-pocket costs for treatment depend on the specific Cigna plan you have. Monthly premiums, copays, deductibles, and other potential costs all vary depending on the plan. But, with Cigna insurance, at least a portion of your costs should be covered under your plan.


How to Verify the Coverage of Your Cigna Plan?

The cost of drug and alcohol addiction treatment will vary from person to person. It will depend on the treatment center, the type of program attended, and specific services received.

Before deciding on a rehab center, check your Cigna policy benefits to determine which costs will be covered by your insurance plan and which will be out-of-pocket for you. Call the number on your insurance card or log in to your account on Cigna’s website to determine how much you may need to cover in terms of copays and any deductible that must be reached before coverage kicks in for the services you need.

American Addiction Centers can also verify your insurance coverage for you. Visit our insurance verification page, enter your information, and you will immediately be able to see if the center you are considering is in-network with Cigna. Or, call to speak to one of our admissions navigators to have them check your benefits and help you understand what is covered.


What Should I Do if Cigna Won’t Cover the Total Cost of Rehab?

Cigna may cover some, if not all, of your rehab costs, depending on the policy you have. In some cases, your policy may not cover all the expenses related to treatment at drug and alcohol rehab facilities and treatment centers. Speaking with an admissions specialist at the rehab center you are considering will help you get a deeper understanding of what is covered by your policy and what your financial commitment will be.

No matter the cost, it’s important not to let financial concerns hold you back from getting treatment. There are ways to help offset the cost, including payment plans, scholarships, and grants in some cases.

For more information on other ways to pay, visit these web pages:

Knowing what costs your Cigna health insurance plan covers for drug and alcohol addiction services can help you plan for any costs that you will be responsible for while you or your loved one are getting drug or alcohol addiction treatment. Knowing what costs you may be responsible for provides peace of mind, allowing you to focus on what truly matters—getting and staying sober. For more information on what your Cigna insurance plan covers for rehab, call the number on the back of your insurance card, or call one of our admissions navigators at . They can answer all your questions and provide you with the information and support that you need as you pursue treatment.


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Sources

  1. Cigna. (2020). Company profile.
  2. Healthcare.gov. (2021). Mental Health and Substance Abuse Coverage.
  3. Cigna. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services: Cigna Connect 6500.
  4. Cigna. (2020). Summary of benefits and coverage: what this plan covers & what you pay for covered services: Open Access Plus IN.
  5. Centers for Medicare & Medicaid Services. (2020). Medicaid.
  6. U.S. Department of Health & Human Services. (n.d.). What’s Medicare?
  7. Cigna. (2020). Cigna Open Access Plus medical plans.
  8. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Types of Treatment Programs.
  9. National Institute on Drug Abuse. (2014). Principles of Adolescent Substance Use Disorder Treatment: A Research-Based Guide: Treatment Settings.

More resources about Cigna Insurance for Addiction Treatment: