Cigna Healthcare Coverage for Addiction Treatment & Rehab

Cigna Healthcare is the health benefits provider of The Cigna Group, a worldwide company that serves individual customers, U.S. Government customers, and businesses/employers. They have 178 million customers and 2 million health care providers. Cigna health insurance is often accessed through an employer, but they do offer individual healthcare plans.

In addition to providing healthcare plans, Cigna supports many community programs to help youth, LGBTQ individuals, veterans, and others who may face health disparities. They also aid in disaster relief efforts.

Does Cigna Healthcare Cover Addiction Treatment?

Cigna Healthcare does cover mental health and substance abuse treatment, but because the company is so large and has so many different healthcare plans, the benefits offered in specific plans differ widely and the options for treatment vary.

So, it is important that you check with the insurance company to inquire about any specific plan that you may be considering. To comply with the 2008 Mental Health Parity Act and the Affordable Care Act (Obamacare), all mental health and substance abuse treatments offered by healthcare insurers must be made available to consumers at the same level of access as other medical treatments.

The Insurance Marketplace has 4 levels of healthcare plans, and each specifies a maximum percentage of out-of-pocket expenses that can be charged to consumers. You should be aware that pre-authorization may be required to access substance abuse treatment, and the level of care that is offered will likely be subject to the recommendation of your physician.

Does Cigna Cover Suboxone & Methadone?

Medication-assisted treatment (MAT) involves the use of FDA-approved medications for either medical detox or longer term treatment of opioid or alcohol use. Detoxification is the process of allowing substances to leave your body, and medication can be helpful in managing withdrawal symptoms.

For longer term treatment, providers combine prescription medications with other therapies to treat opioid or alcohol addictions. Suboxone and methadone are two of the FDA-approved medications for MAT. These prescriptions may be covered under your Cigna plan, depending on your medical needs and the type of plan you have.

What Levels of Care are Covered by Cigna Healthcare?

Insurance companies focus on covering medically necessary care that will help you achieve long term recovery. This may include both inpatient treatment and outpatient care, along with telehealth options.

Inpatient substance abuse treatment takes place in a hospital or clinic. Residential substance abuse treatment occurs in a non-hospital facility with a more home-like setting. Both options provide around-the-clock care and monitoring by professional staff and can last from a few weeks to 60 days or more. These programs may also offer detox services.

Outpatient care has several options based on your needs. Partial Hospitalization programs (PHPs)–or day programs–allow you to attend treatment during the day and return home at night. PHP programs often run for 4-8 hours a day, three or four days a week, and take place over 30-90 days total.

An intensive outpatient program generally offers 9-20 hours of treatment per week. These are usually spread over 3 to 5 days. The minimum duration of IOP treatment programs is usually 90 days.

A typical general outpatient program includes counseling sessions that take place once or twice a week, with group counseling and educational sessions on topics of addiction and relapse prevention education. Individual sessions are often provided on an as-needed basis.

Telehealth involves virtual services that may take place through a phone call or via the internet, using either video conferencing or chat messaging.

Types of Insurance Plans Offered by Cigna Healthcare

Cigna Healthcare provides a wide variety of insurance plans, including individual and family plans in the Insurance Marketplace, Medicare Advantage plans, and employer plans.

Individual and family plans in the Insurance Marketplace can be either preferred provider plans (PPOs) or Health maintenance organization plans (HMOs).

With PPOs, you get to choose your own doctor and treatment facilities; no referral is required. But out of pocket costs are generally higher with PPO plans. HMOs allow you to enjoy lower monthly fees but have higher deductibles than PPOs. You will need to designate a primary care provider to give you referrals to specialists and your care will be provided by the HMOs network of providers.

Cigna Healthcare offers Medicare Advantage (“Medicare part C”) plans. Medicare Advantage plans provide the same services as Medicare, but often with extra benefits, such as prescription drug coverage. Medicare coverage for drug rehab most often includes either inpatient or outpatient treatment, with detox, if needed. But you must have a diagnosis of a substance use disorder (SUD) from your doctor, and the doctor’s recommendation will usually determine which level of treatment you are offered. Co pays and deductibles may be required.

To learn more about Cigna Healthcare’s Medicare Advantage plans, go here.

Does Cigna Cover Mental Healthcare?

Yes most Cigna health insurance plans cover mental health care. Cigna health insurance mental health coverage can include therapy, psychiatric evaluations and medication. Two federal laws require health insurance providers to offer coverage for essential health benefits. These benefits include treatment for substance abuse disorders and mental health conditions. However there are exceptions to the laws and the extent of your coverage depends on your insurance plan.

Your coverage may limit the type of therapy you can receive and the duration of your treatment. Your plan may also limit coverage for out of network providers. Most people must pay a deductible before the insurance begins providing benefits and many plans include co payments and coinsurance. Cigna members also have access to virtual care or telehealth services including behavioral health therapists, psychiatrists and counselors.

You can speak with your doctor about getting access to mental health therapy or getting integrated treatment for co occurring mental health conditions alongside substance use disorders. Before receiving therapy you should verify your insurance benefits and coverage so you are not surprised by a bill. Your physician, therapist or treatment center can assist you.

Can I Travel Out of State for Treatment with Cigna?

Your Cigna plan generally provides care within the defined provider network. If the provider network includes centers outside your state or if your insurance plan allows you to receive coverage for out of network providers you may be able to go out of state for treatment. However most of the time the provider network will be local to where you live.

Even if you are able to get coverage outside the provider network keep in mind that the out of pocket costs may be significantly higher. For example the copayment may be significantly more for out of network care.

Before traveling out of state it’s important to check with your Cigna plan provider so you understand your benefits before you use them.

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

Your insurance plan determines your coverage for treatment. Even when your plan provides coverage you still have out of pocket costs that include a deductible, copay or coinsurance. You can reduce your costs by working with an in network provider. Your insurance plan typically offers lower out of pocket costs for in network providers than out of network providers.

Fortunately there are other options to help pay for the costs associated with rehab whether you have insurance or not. For example many mental health and addiction treatment centers offer payment plans or sliding scale fees when you qualify.

You can also find grants and scholarships which are helpful because they don’t have to be repaid. Some treatment centers may offer you partial or full scholarships for treatment. Many national organizations and state run organizations also offer scholarships for addiction treatment and mental health conditions.

If you do not qualify for private insurance you may qualify for Medicaid or Medicare. These programs help people who are lower income or older get the care they need.