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.
Rehab Is Covered to Some Degree
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:
- Substance use disorder treatment
- Mental and behavioral health treatment
- Counseling and psychotherapy
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:
- Care management: Preapprovals are often necessary to ensure specific items are covered.
- Treatment length: There may be limits to your overall length of treatment or number of sessions. These limits are similar to those place on some other types of medical care.
Financial limitations: There may be co-pays, deductibles, coinsurance, and out-of-pocket expenses you have to pay.
Type of Treatment
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.
Benefits Vary According To Plan
According to Cigna, the type of plan you choose will influence how much the insurance company will cover on your behalf.
- Plans with a high deductible and low monthly premiums are better for people who are healthy and know they might not require too many services for a given year. You will pay more out of pocket for rehab with this type of plan.
- Plans with a low deductible and high monthly premiums are better for people with previous health issues who know they might incur medical costs over a year. You will generally have more of your rehab costs covered with this type of plan.
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.
- You may have a deductible of $3,700 per individual or $7,400 per family. This is the amount you are expected to pay before your plan starts to pay for benefits. The limits on out-of-pocket payments for some plans are $7,900 per individual or $15,800 per family.
- Your plan might not cover certain things if you do not get authorization first.
- Some Cigna plans may pay up to 70 percent of fees for inpatient or outpatient services if you need substance abuse or mental health services and use an in-network provider. This means you are responsible for up to 30 percent of the bill.
- Cigna also covers some prescription drugs. You must confirm if methadone, buprenorphine, or other addiction treatment medication is covered by your plan.
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.