How Does Cigna Rehab Coverage Work?

Cigna’s mental health and drug and alcohol treatment coverage works like any other coverage under your plan. In fact, the Affordable Care Act requires that insurance plans that include mental health benefits must ensure those benefits are similar in nature and scope to other medical benefits offered by the same plan. That means that if you’re seeking treatment for a mental health condition such as anxiety or depression or substance abuse issues such as drug and alcohol addiction, you can’t normally be hit with a separate deductible from the main one relevant to your insurance.

That doesn’t mean, however, that your insurance provider will foot the entire bill for the treatment. Whether mental health treatment or drug and alcohol rehab is covered at all depends on your plan and what treatment facility you choose. Your insurance provider might require you and your doctor to take certain steps before alcohol or drug rehab is approved and covered, and how much you pay out of pocket depends on the exact details of your Cigna health insurance coverage.

Like many commercial insurance providers, Cigna offers plans through employers and the Health Insurance Marketplace. It also offers some Medicare Advantage plans. You can get a Cigna insurance plan in the following ways:

• Via employer-sponsored benefits. If you work for a company that’s selected Cigna as its employer-sponsored insurance option, you can sign up for a plan during benefits enrollment periods. Most employers offer an enrollment period shortly after you start working and once a year for existing employees. With employer-sponsored benefits, you typically pay a portion of your insurance premiums via pretax deductions on your paycheck. Your employer covers the rest.
• Via the marketplace. Cigna insurance options are available in many states. During open enrollment periods at the end of each year, you can evaluate Cigna plans to see if any in your state match your private health insurance needs.
• As a Medicare Advantage plan.  You can opt for a Medicare Advantage plan if you’re eligible for regular Medicare. Private companies run these plans and must include all the benefits of a regular Medicare plan — though they sometimes include coverage for things original Medicare plans don’t.

Understanding Cigna Drug Rehab Copays, Deductibles and Out-of-Pocket Expenses

No matter how you get your Cigna coverage, it’s important to understand potential out-of-pocket expenses as you consider treatment, including drug addiction treatment. Your exact expenses depend on your plan, your treatment providers and the treatment options you choose. However, you do need to look for these common expenses and understand how they might apply:

• Deductible. This is how much you must pay before your insurance starts paying any claims. Your deductible is for the calendar year and includes any covered mental health or substance abuse treatment, medical treatment or any other services your plan would normally cover. So, if you had inpatient treatment in the hospital for appendicitis in January, for example, anything you paid for that treatment would go toward your deductible. If you then sought substance abuse treatment in July, you might have already met the deductible. However, if you’re wondering, ‘Does Cigna cover inpatient alcohol rehab?’ and haven’t met your deductible, you’ll have to meet it before insurance coverage pays for any charges.
• Copay or coinsurance. This is how much you pay once you hit your deductible. Every plan has different copay amounts. The copay amounts for outpatient services might also differ from those related to inpatient options. Typically, you may owe a percentage of covered charges (as coinsurance) or a flat fee (as a copay).
• In-network vs. out-of-network providers. Some insurance plans cover more of the charges if you choose in-network providers. When considering healthcare providers for rehab needs, keep this in mind and look for providers that are in the network with your plan. For example, a plan might cover 80% of approved charges after the deductible if addiction treatment providers are in the network, but it may only cover 50% of approved charges if you receive addiction treatment from a provider that’s out of network.

Other factors that can affect the cost of addiction treatment when you have a Cigna insurance plan include:

• The nature of the treatment. For example, inpatient recovery options might cost more than outpatient treatment services overall. That can increase your coinsurance amount.
• The location of the addiction treatment centers you choose. Insurance companies typically do not cover transportation to and from treatment facilities, so it’s important to consider this when selecting from different treatment centers.
• Whether preauthorization or other requirements were met. In some cases, your insurance plan might require preauthorization or prior approval. This means a doctor or another provider orders treatment and sends that information to the insurance company. The insurance company approves the treatment tentatively, and without this approval, it will deny future claims for that treatment. Some Cigna plans do require preauthorizations. If you agree to treatment without the appropriate preauthorization, you might end up owing more than you planned.