If you need treatment for a substance use disorder but feel uncomfortable about costs, you are not alone. Thankfully, insurers must cover some basic aspects of substance abuse treatment and offer mental health services as part of their plans on the federal marketplace.
Cigna does cover drug rehab. The details of the coverage will vary greatly depending on the specific plan.
The federal health insurance marketplace allows individuals and small businesses to enroll in health insurance using exchanges. Many people receive Cigna insurance from their employer.
Insurance companies must cover several aspects of addiction treatment, such as:
Your care could be affected by something called parity protections. This means your insurer cannot provide more restrictions for your substance abuse coverage than for other health needs, such as surgery. Parity protections have the following limits:
Financial limitations: There may be co-pays, deductibles, coinsurance, and out-of-pocket expenses you have to pay.
Some of Cigna’s health plans help you cover the cost of addiction treatment, but the specific coverage will depend on your needs and your policy.
Inpatient and outpatient treatment are available, and some expenses associated with these treatments might be covered.
You live at the rehab facility and get all treatment there. You will most likely participate in groups or 12-step programs while also learning new skills and receiving medical treatment.
Inpatient treatment usually requires preapproval before insurance will cover it. You may also be required first to attempt outpatient treatment.
You live at home and can often keep your job. You will have to deal with more temptations and triggers to use substances since you are not in a full-time care facility. A strong support system is needed as well as a safe home environment.
Addiction treatment medications are sometimes covered by Cigna plans. Individuals recovering from opioid abuse may require maintenance treatment. Buprenorphine or methadone is often used. On average, one year of methadone treatment costs $4,700, according to the National Institute on Drug Abuse.
According to Cigna, the type of plan you choose will influence how much the insurance company will cover on your behalf.
It is rare that insurance will fully cover the cost of rehab. In addition to your monthly premiums, you can expect to have certain out-of-pocket costs associated with your addiction treatment.
These are fixed amounts you will pay when you receive a service. They are charged when you go to the doctor or get a prescription. You may pay a copay every time you see an addiction treatment physician or visit your therapist.
If you meet your deductible, you are still expected to pay these amounts. The cost depends on what you receive, and you are responsible for a percentage of the total cost. These payments do not go toward your deductible.
This is the amount you must pay before your insurance starts paying for the services you need. Once you hit your deductible, services will generally be covered fully at the agreed-upon percentage.
Cigna’s coverage for substance use disorder and mental health issues depends on the plan you have, but their Summary of Benefits and Coverage offers some information about what you can expect to pay out of pocket. Below are some examples of what you might expect with certain plans.
Cigna offers a variety of plans and enjoys a good reputation among consumers and facilities alike. They have plans that can cover many of your needs, and they comply with existing policies that expect insurance companies to cover treatment for mental health, substance abuse, and physical disorders.
The company seems to be a good option if you are willing to work with their in-network options. Family plans are also available that may be worth it for patients that have multiple family members who need coverage.
Many of the mental health benefits available can apply to people with substance use disorders, as do some of Cigna’s policies on prescription medication. Like other insurers, Cigna expects preauthorization for some services related to addiction treatment.
If you choose to work with them, speak with a Cigna representative about the specifics of prospective plans. Make sure you are clear on exactly how much you will be expected to pay out of pocket for rehab services.
Mental health & substance abuse coverage. HealthCare.gov Retrieved March 2019 from https://www.healthcare.gov/coverage/mental-health-substance-abuse-coverage/
Copays, Deductibles and Coinsurance. Cigna. Retrieved March 2019 from https://www.cigna.com/individuals-families/understanding-insurance/copays-deductibles-coinsurance
(October 2017) Inpatient and Outpatient Treatment for Substance Use Problems. Cigna. Retrieved March 2019 from https://www.cigna.com/individuals-families/health-wellness/hw/medical-topics/inpatient-and-outpatient-treatment-for-substance-ad1101
(May 2017) Summary of Benefits and Coverage. Cigna Health & Life Insurance Co. Retrieved March 2019 from https://www.cigna.com/static/www-cigna-com/docs/individuals-families/2019/medical/mo/907241-sbc-cigna-connect-3700-silver-kansas-city-mo.pdf
(January 2018) Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Is drug addiction treatment worth its cost? National Institute on Drug Abuse. Retrieved March 2019 from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/drug-addiction-treatment-worth-its-cost
(April 2016) Medicare Coverage of Substance Abuse Series. Department of Health and Human Services. Retrieved March 2019 from https://www.cms.gov/outreach-and-education/medicare-learning-network-mln/mlnmattersarticles/downloads/se1604.pdf
Health Insurance Marketplace. HealthCare.gov. Retrieved March 2019 from https://www.healthcare.gov/glossary/health-insurance-marketplace-glossary/