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Cigna

How to Choose a Rehab that Accepts Cigna

Key Content Summary

Cigna Coverage Basics

Overview of how Cigna covers rehab.

Types of Cigna Plans and Network Rules

Breaks down PPO, HMO, EPO, and POS plans, highlighting differences in out-of-network coverage, referral requirements, and flexibility when choosing rehab.

Costs & What You’ll Pay

Breaks down deductibles, coinsurance, and why in-network care is usually the most affordable option.

How to Choose Rehab with Cigna

Step-by-step guidance to find the right level of care, confirm your plan, and verify benefits with facilities.

Finding the right treatment can be overwhelming, but your Cigna insurance can make it easier to choose care. Most Cigna plans cover life-saving addiction services. This page will help you understand how Cigna coverage typically works so you can maximize your benefits and minimize your costs.

Note: Cigna’s behavioral health and substance use benefits can be administered through Evernorth Behavioral Health, so you may see the Evernorth name on your member ID card or portal.

What does your specific Cigna plan cover for addiction treatment?

Most Cigna plans cover addiction treatment, but benefits vary. Knowing which type of plan you have can help you narrow your search for the right type of care. Coverage can come through your employer, the ACA marketplace, Medicare Advantage, or Medicaid, and most Cigna plans use one of the network types below. Network types determine which providers you can use and if you need a referral for specific services. 

Plan types and coverage
Plan Type Out-of-Network Coverage Referral Required? What This Means for Choosing Care
PPO (Preferred Provider Organization) Yes, but generally at a higher cost No Offers a lot of flexibility to choose programs outside your area but out-of-network care usually costs more and may include “balance billing” (you pay the difference between what the provider charges and what the plan will cover).
HMO (Health Maintenance Organization) No (except emergencies) Yes You must choose an in-network provider, and out-of-network is probably not covered at all, except for emergency care.
EPO (Exclusive Provider Organization) No (except emergencies) No Treatment is only covered if it is in-network (except for emergency care) and you usually don’t need a referral.
POS (Point of Service) Yes, but generally at a higher cost Yes Combines components of HMO and PPO plans. You might need a referral for out-of-network care, and you may need to submit out-of-network claims yourself.

High-Deductible Plans (HDHP): Some Cigna plans are high-deductible plans. HDHPs are not a separate plan type, and all the network rules for PPOs, HMOs, EPOs, and POS noted above still apply to HDHPs. HDHP plans generally impact how costs are handled and when you pay for care. Many HDHPs are often also paired with a Health Savings Account (HSA). With these plans, you could potentially pay more out of pocket before your coverage begins, but an HSA can help cover costs until you meet your deductible and once the deductible is met, your plan could cover a significant portion of treatment costs.

If you are not sure which plan you have, start with your ID card and log in to your myCigna portal. You can also call the number on your ID card for plan-specific details.

What if you didn’t purchase your Cigna plan through your employer?

The way you purchased your plan will also most likely impact your coverage. See details below on State Exchange (Marketplace), Medicare Advantage, and Medicaid plans, and the changes to coverage based on which programs you purchased your Cigna plan through.

State Exchange (Marketplace) Plans

You can get insurance coverage through the ACA marketplace via state or federal exchanges. Plans purchased through the marketplace use the same network types (HMO, PPO, EPO, or POS), but they often have some variations in coverage. Cigna only offers ACA marketplace plans in select states, including Florida, Texas, Tennessee, and North Carolina. Because coverage can differ by state and may change yearly, it’s important to check your specific plan details and provider network for updated information.

Coverage details
Coverage Rule What this means for choosing care
Out-of-network coverage Generally not covered
Referral requirements Depending on the plan type, a referral may be required for care.
Network size Generally smaller than employer-sponsored plans

Medicare Advantage Plans

Some people receive insurance through Cigna Medicare Advantage plans, but coverage rules can be different for these plans versus an employer-sponsored plan.

Coverage details
Coverage Rule What this means for choosing care
Out-of-network coverage Depending on plan type, out-of-network care may sometimes be covered.
Referral requirements Depending on the plan type, a referral may be required
Network size Depending on the plan’s provider options, the network size is potentially narrower than employee-purchased plans

Medicaid Plans

For people with limited income, Medicaid plans are a great route to receive health insurance coverage. Coverage rules for Medicaid plans vary widely by state.

Coverage details
Coverage Rule What this means for choosing care
Out-of-network coverage Except for emergencies, out-of-network care is generally not covered
Referral requirements Generally required depending on the care plan
Network size Most likely only includes providers contracted with the state Medicaid program
Prior authorization Quite common for detox, residential, and inpatient care

What does Cigna cover for rehab?

Cigna reviews your care needs and your plan to make insurance coverage decisions just like they would for other medical needs, such as a heart condition or diabetes. Because of federal parity law, coverage for addiction treatment cannot be more restrictive than coverage for other medical needs.

Coverage through Cigna is determined plan by plan and state by state. 

The following aspects of coverage usually vary by plan and state: 

  • Deductibles, copays, and coinsurance 

  • Prior authorization needs

  • How long treatment is approved for

  • Differences in coverage for levels of care 

  • Medication coverage for MAT (usually controlled by your plan’s prescription drug list and may involve prior authorization/therapy/quantity limits)

  • Out-of-pocket maximums that put a cap on how much you pay

Learn more about how insurance and out-of-pocket costs usually work for rehab.

Out-of-pocket costs for rehab

Choosing an in-network treatment facility is usually the best way to limit your out-of-pocket costs. We’ve provided the following illustrative example to show how Cigna could potentially handle coverage for a hypothetical residential treatment program using a PPO-style plan. 

Note: This example is hypothetical and actual costs depend on your specific plan and provider. Actual Cigna plans may use copays, different coinsurance rates, or vary by service.

Illustrative cost comparison
Cost Factor Hypothetical In-Network Facility Cost  Hypothetical Out-of-Network Facility (PPO example) Cost
Facility sticker price $50,000 $50,000
Cigna allowable amount ~$34,000 (negotiated rate) ~$28,000
Typical deductible Generally lower than out-of-network, varies widely by plan (often ~$1,500–$5,000) Generally higher, often ~$5,000
You share/co-insurance ~$6,500 (~20% of remaining ~$32,500) ~$9,200 (~40% of remaining ~$23,000)
Any unexpected costs $0 (not allowed) $20,000+ (the amount not covered by Cigna that you pay)
Estimated out-of-pocket cost ~$8,000–$9,000 ~$30,000–$35,000
Annual out-of-pocket maximum Varies by plan (often ~$8,000 - $9,000) Often much higher, and balance billing costs are not capped

How to choose the right treatment for you if you have Cigna

If you’re trying to pick the best treatment for you and you have Cigna coverage, the following steps can help you narrow your care options to make a final decision. 

Step 1: Decide the level of care you need

Cigna will typically cover treatment based on medical necessity. Before you try to decide on a specific facility, it helps to understand what level of care you actually need. To help you determine the level of care that is best for you, you can speak to a medical professional.

Common levels of care include:

  • Withdrawal management (detox): You receive short-term, medically supervised care to help you safely stop using alcohol or other drugs and manage withdrawal symptoms. Withdrawal management may take place in a hospital, residential, or outpatient setting, depending on your withdrawal symptoms and risk of complications, and is often the first step before ongoing treatment. Withdrawal management should always be directly linked to longer-term treatment. Some programs may be connected to longer-term inpatient treatment or a residential program. In other cases, outpatient treatment may be appropriate after completion of withdrawal management.
  • Inpatient: You stay overnight and receive 24/7 care in a structured setting. This can be in a hospital or a nonhospital residential program, and can be especially helpful if you need intensive support for substance use and other health concerns. Inpatient care often follows withdrawal management when additional stabilization or intensive treatment is needed.
  • Hospital: You stay in a hospital and receive medically managed, highly structured care, including 24/7 nursing for substance use and other serious biomedical or mental health conditions. Hospital care often focuses on stabilization and may be short term.
  • Outpatient: You live at home and go to a clinic or facility regularly for individual, group, or family sessions with addiction treatment professionals. Outpatient care can range from an hour or less per week to several days per week. Depending on your needs, outpatient treatment may include a partial hospitalization program (PHP), an intensive outpatient program (IOP), or standard outpatient therapy. Typically, higher intensity treatment is advised initially, and once you’ve achieved recovery, sessions can be shorter and/or more spaced out. Some people may also complete withdrawal management on an outpatient basis before continuing treatment.
  • Telehealth: You meet with addiction treatment professionals by phone or secure video instead of in person. Outpatient care may be delivered exclusively via telehealth or through a combination of virtual and in-person visits. Telehealth can also supplement  residential or hospital-based care.

Step 2: Confirm your Cigna plan type

Your specific Cigna plan will greatly impact the level of coverage you’ll receive for different facilities. You can review your insurance card or member portal to confirm your plan type. Review the table above for details on each plan type and how the different plans impact coverage at facilities both in-network and out-of-network as well as referral requirements and cost structures.

Step 3: Finalize your list of top in-network rehab centers

Before reaching out to specific facilities to confirm coverage details for your plan type, it is a good idea to narrow your choices to only a few facilities that will meet your care needs and are most likely in-network with Cigna. You can filter facilities by treatment needs and location and see whether a facility commonly works with Cigna plans. Review the filtered results to compare programs based on your specific treatment needs. 

Some rehabs may be noted as “Platinum” providers, which designate a certain quality or performance level is met. This can also be used as a deciding factor when making your short list of potential facilities. 

Ghost networks

It’s important to know that some people may run into what is called a ghost network, which is when providers listed as in network are not actually available, no longer accept the plan, or have extended wait times. If you run into a ghost network, you can do the following: 

  • Request your Evidence of Coverage: This will outline Cigna’s contractual obligations to you. If in-network options aren’t available, your plan may be required to cover out-of-network care at in-network rates.

  • Ask about who manages your behavioral health benefits: Cigna often uses Evernorth Behavioral Health to handle mental health and substance use coverage. Reaching out to Evernorth directly can help provide clarity on ghost networks and the next steps you can take to find care.

Step 4: Verify your insurance benefits (VOB)

It is also important to determine how your Cigna plan would apply to the facilities you are interested in. If you reach out, a majority of rehabs will verify benefits for you for no cost and they can tell you whether the program is in network, what your potential costs could be, and if there are any limitations on length of stay for treatment. 

Step 5: Confirm prior authorization requirements

Cigna will often require prior authorization for certain levels of care, like detox, inpatient, or residential treatment. When you reach out, consider asking the facilities on your shortlist the following questions 

  • Is this program in network with my specific Cigna plan?  

  • Do you handle prior authorization and ongoing insurance reviews?  

  • What costs, if any, should I expect after my deductible is met? 

  • If coverage changes, will you help plan next steps in care? If so, how?

Step 6: Choose the program that is the best fit for you  

After you create a narrow list of options with clear coverage details, you’ll most likely be deciding between just a few programs. To make a final decision, try to focus on whether the program is the best fit for you and where you are. There are many factors to consider, such as: 

  • The facility’s experience with treating your specific needs

  • Family involvement in treatment and aftercare options

  • How the program supports care if insurance coverage changes

Learn how different treatment levels work and how clinicians determine the right level of care.

Rehab options that accept Cigna

See below for treatment facilities that report accepting Cigna. Before you make a final decision about treatment, ensure you follow the steps above to confirm network status, coverage, and out-of-pocket costs.

Acceptance of Cigna does not guarantee coverage. A facility may say they accept Cigna, but coverage will still depend on your specific plan and your medical needs. If coverage is denied, ask about options for appealing the decision.

Find Cigna Providers

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