Cigna Insurance Coverage for Drug and Alcohol Rehab

Cigna health insurance plans cover at least some of the costs of outpatient drug and alcohol rehab, including different therapies. In this example, we’ll look at the cost breakdown at an in-network outpatient facility under the Cigna OAP plan for a client residing in Indiana:

• Unlike inpatient coverage, you don’t have to pay an overall deductible. You only have to pay $50 as a co-payment when visiting the facility.​​

• The out-of-pocket limit is $2000, which can only be achieved if the outpatient service lasts 40 days or more. You could also reach the limit if the cost of other services is added to the total.  

The OAP plan includes a $175 deductible for prescription drugs depending on the type of medication. The co-payment will range between $20 and $70. However, the plan will not be effective if expenses are accrued outside the Cigna outpatient network. 

The coverage you receive depends on the state of your residence, the length of rehab, and your health insurance plan level. Additionally, the cost of rehab treatment will vary from person to person based on the program type attended and the services received.

The Cigna Group covers some of the costs for inpatient and residential rehab treatments for drug and alcohol abuse. For example, here is how the cost of treatment for a resident of Wichita, Kansas using the Cigna Connect 6500 EPO plan will be shared at the Cigna network inpatient facility:​

• You will have to pay the $6500 annual deductible before Cigna starts covering drug and alcohol rehab costs.

• ​Once you clear the annual deductible, you will still have to pay 50% of the remaining costs before reaching the out-pocket-limit of $8150.

• Cigna will cover the remaining treatment costs if you meet all these requirements.

In this example, 50% of the remaining costs apply to prescription drugs unless you have already reached your out-of-pocket limit. Since this is an EPO plan, seeking treatment outside the Cigna network could mean no rehab coverage.

40% to 60% of individuals who receive addiction treatment often fall back to substance abuse, which is why detox is vital to treatment. Drug and alcohol treatment usually involves detox services, which can be agonizing, uncomfortable, and sometimes life-threatening. On top of the two main treatment options, Cigna health insurance can also cover partial hospitalization, but it will vary depending on your coverage policy and location.

Cigna covers ambulatory detox, which is provided on an outpatient basis and is meant for individuals who are highly interested in recovery but require medical treatment to manage withdrawal symptoms. It also covers inpatient detox, primarily for individuals requiring 24-hour intensive medical care. Inpatient detox could also be used among people addicted to certain drugs such as sedatives, alcohol, and some opiates.