Does Cigna Cover Rehab? What Your Plan Pays For

Cigna is a global health services company covering approximately 18 million Americans through employer-sponsored plans, individual marketplace plans, and Medicare Advantage. Cigna is known for having one of the broadest national networks for addiction treatment, with over 1,900 contracted facilities. Under the Affordable Care Act and Mental Health Parity and Addiction Equity Act, all Cigna marketplace and employer plans must cover substance use disorder treatment at the same level as other medical conditions.

What Does Cigna Cover for Rehab?

Cigna covers the full continuum of addiction treatment services when medically necessary:

Covered Services

Medical Detoxification — Medically supervised withdrawal management in hospital-based or freestanding detox facilities. Covered at 60-80% after deductible for in-network facilities. Duration based on medical necessity, typically 3-14 days depending on substance and severity.

Inpatient/Residential Treatment — 24/7 residential treatment programs providing comprehensive care including therapy, medical monitoring, and life skills training. Cigna covers 60-80% after deductible for in-network facilities. Initial authorization typically 7-14 days with concurrent review for extended stays.

Partial Hospitalization Program (PHP) — Intensive day treatment providing 6+ hours of programming daily, 5-7 days per week. Covered at 70-90% after deductible.

Intensive Outpatient Program (IOP) — Structured outpatient treatment typically 3-5 days per week, 3-4 hours per day. Covered at 70-90% after deductible. Often used as step-down from residential treatment.

Outpatient Therapy — Individual, group, and family therapy sessions. Covered at 80-90% after deductible, with typical copays of $25-$60 per session depending on plan type and provider.

Medication-Assisted Treatment (MAT) — All FDA-approved medications for substance use disorder:

• Buprenorphine products (Suboxone brand, generic buprenorphine/naloxone, Sublocade injection, Zubsolv)
• Methadone (through certified opioid treatment programs)
• Naltrexone (Vivitrol monthly injection, ReVia daily tablets)
• Acamprosate (Campral) for alcohol use disorder
• Disulfiram (Antabuse) for alcohol use disorder

Coverage: 80-90% after deductible, depending on prescription drug tier. Generic medications typically have lower copays than brand-name options.

Cigna Plan Types and Rehab Coverage

Cigna Open Access Plus (OAP)

Best for: Maximum flexibility with broad network access

Network: Extensive nationwide network of 1,900+ addiction treatment facilities Out-of-network: Covers out-of-network at reduced rate (typically 50-60%) Referrals: Not required for most services (but preauthorization required for inpatient/residential treatment) Typical coverage: 60-80% in-network, 40-60% out-of-network after deductible Average out-of-pocket for 30-day inpatient: $6,000-$20,000

Cigna OAP is one of the most popular plan designs for addiction treatment due to its broad network and out-of-network benefits.

Cigna PPO (Preferred Provider Organization)

Best for: Traditional PPO flexibility

Network: Same extensive network as OAP Out-of-network: Covered at reduced rate (50-60%) Referrals: Not required Typical coverage: 60-80% in-network, 40-60% out-of-network after deductible Average out-of-pocket for 30-day inpatient: $6,000-$20,000

Similar to OAP but may have different cost-sharing structures depending on employer plan design.

Cigna HMO (Health Maintenance Organization)

Best for: Lower premiums with local network

Network: Regional network varies by location Out-of-network: Not covered except emergencies Referrals: Required from PCP for specialty care Typical coverage: 70-85% in-network after deductible Average out-of-pocket for 30-day inpatient: $5,000-$17,000

HMO plans have lower premiums but less flexibility in facility selection.

Cigna LocalPlus

Best for: Lower-cost option with regional network

Network: Smaller regional network focused on specific geographic areas Out-of-network: Limited or no coverage Referrals: May be required Typical coverage: 65-80% in-network after deductible Average out-of-pocket for 30-day inpatient: $5,500-$18,000

LocalPlus plans offer lower premiums but reduced network access compared to OAP or PPO plans.

Preauthorization Requirements

Cigna requires preauthorization for all inpatient and residential substance abuse treatment. Here’s how the process works:

Before Treatment

1. Clinical assessment — You complete an intake assessment at the treatment facility
2. Facility submits authorization — The facility’s utilization review team submits preauthorization request to Cigna’s behavioral health division (Evernorth Behavioral Health)
3. Cigna reviews — Behavioral health clinicians review using ASAM (American Society of Addiction Medicine) criteria
4. Authorization decision — Typically 24-48 hours for urgent requests, up to 5 business days for standard requests

Medical Necessity Criteria

Cigna uses ASAM criteria to assess medical necessity across six dimensions:

1. Acute intoxication/withdrawal potential — Need for medical detox
2. Biomedical conditions — Co-occurring medical issues
3. Emotional/behavioral/cognitive conditions — Co-occurring mental health disorders
4. Readiness to change — Motivation and engagement in treatment
5. Relapse/continued use potential — Risk of relapse and severity of use
6. Recovery environment — Support systems and living situation

During Treatment

Concurrent review: Cigna conducts ongoing reviews every 3-7 days during your stay. The facility provides clinical updates demonstrating continued medical necessity and treatment progress.

Step-down planning: Cigna works with facilities to authorize appropriate step-down care (e.g., transitioning from residential to IOP).

Denial and appeals: If Cigna denies continued stay, the facility can request peer-to-peer review where a physician at the facility discusses the case with a Cigna physician reviewer.

Typical Out-of-Pocket Costs with Cigna

Your costs depend on your specific plan’s cost-sharing structure. Here’s a typical example:

Example: Cigna Open Access Plus (OAP)

Plan details:

• Deductible: $2,000 (individual)
• Coinsurance: 80/20 (Cigna pays 80%, you pay 20%)
• Out-of-pocket maximum: $8,550 (individual)

30-day inpatient program (in-network):

• Facility negotiated rate: $35,000
• You pay deductible: $2,000
• Remaining balance: $33,000
• You pay 20%: $6,600
• Total you pay: $8,600
• But: Capped at out-of-pocket max of $8,550

Medical detox (7 days, in-network):

• Facility cost: $4,900
• Applied to deductible and coinsurance
• If first service of year: $2,000 (deductible) + 20% of $2,900 ($580) = $2,580

MAT (monthly costs):

• Generic buprenorphine/naloxone: $20-$60 copay
• Suboxone brand: $80-$150 copay
• Sublocade injection: $50-$250 copay
• Vivitrol injection: $50-$250 copay

Cost Comparison by Plan Type

Verifying Your Cigna Coverage

Before entering treatment, verify your specific benefits:

Call Cigna Behavioral Health

Cigna Behavioral Health: 1-877-622-4327

Information to have ready:

• Member ID number (on your insurance card)
• Group number (if employer-sponsored)
• Name and location of facility you’re considering

Questions to ask:

• Is [facility name] in-network for my plan?
• What is my deductible, and how much have I met this year?
• What is my coinsurance for inpatient behavioral health services?
• What is my out-of-pocket maximum, and how much have I met?
• How does preauthorization work, and who initiates it?
• How many days will be initially authorized?
• Does my plan cover MAT medications, and what are my copays?
• Are there any plan-specific limitations I should know about?

Check Online

myCigna Portal: Log in at myCigna.com

• Find providers/facilities using behavioral health search
• View your benefits and coverage details
• Check deductible and out-of-pocket maximum progress
• Review claims and authorization status

Have the Facility Verify Benefits

Most treatment facilities have insurance verification specialists who will:

• Contact Cigna on your behalf
• Obtain detailed benefits breakdown
• Provide estimated out-of-pocket costs
• Initiate the preauthorization process
• Answer questions about payment options

This is often the easiest route, as facilities are familiar with Cigna’s processes and can navigate the system efficiently.

Cigna’s Behavioral Health Network

Cigna maintains one of the largest addiction treatment networks in the industry:

Network size: 1,900+ contracted facilities nationwide

Types of facilities:

• Hospital-based detox and inpatient programs
• Freestanding residential treatment centers
• Luxury and executive rehab programs
• Intensive outpatient programs (IOP)
• Partial hospitalization programs (PHP)
• Medication-assisted treatment providers
• Opioid treatment programs (methadone clinics)

Geographic coverage:

• Strong nationwide presence
• Particularly robust in major metropolitan areas
• Growing network in rural areas
• Extensive options in all 50 states

Network strengths:

• Many high-quality, accredited facilities accept Cigna
• Includes CARF-accredited and Joint Commission-accredited programs
• Good mix of mainstream and specialized treatment programs

What Makes Cigna Different

Evernorth Behavioral Health

Cigna’s behavioral health services are managed through Evernorth Behavioral Health (formerly Cigna Behavioral Health), which specializes in mental health and substance use disorder care management.

Benefits:

• Specialized behavioral health expertise
• Dedicated utilization review for addiction treatment
• Care management support during and after treatment
• Care coordinators who help navigate step-down care

Integrated Health Management

Cigna emphasizes integrated physical and behavioral health care:

• Coordination between medical and behavioral health providers
• Support for co-occurring medical conditions
• Medication management across specialties
• Holistic approach to recovery

Cigna Healthy Rewards

Some Cigna plans include Healthy Rewards programs offering discounts on wellness services, gym memberships, and complementary therapies that support recovery.

Out-of-Network Coverage with Cigna

If you need to use an out-of-network facility (perhaps due to specialized programming or geographic location):

How Out-of-Network Works

Coverage: Cigna PPO and OAP plans typically cover 50-60% of out-of-network costs after a higher deductible

Balance billing: Out-of-network facilities can “balance bill” you for the difference between their charges and what Cigna reimburses

Example:

• Facility charges: $50,000
• Cigna’s “reasonable and customary” reimbursement: $35,000
• Cigna pays 50% of $35,000 = $17,500
• You pay: Deductible + 50% of $35,000 ($17,500) + balance bill of $15,000 = potentially $32,500+

Better option: Negotiate with Cigna for single-case agreement if no suitable in-network facility exists. Facilities and Cigna can sometimes agree to in-network rates for your specific case.

What If Cigna Denies Coverage?

You have appeal rights under federal law:

Internal Appeals

1. File appeal within 180 days of denial
2. Submit additional documentation — Include letters from treating physicians, clinical assessments, evidence of medical necessity
3. Peer-to-peer review — Request physician-to-physician review
4. Timeline — Cigna must respond within 30 days (72 hours for urgent appeals)

External Review

If internal appeal is denied:

1. Request external review — Independent review organization assesses your case
2. Timeline — Decision within 60 days (72 hours for urgent)
3. Binding decision — Cigna must comply with external reviewer’s determination

State Insurance Department

File complaints with your state insurance department if you believe Cigna violated mental health parity laws or your plan terms.

Don’t Have Cigna (or Any Insurance)?

If you’re currently uninsured, obtaining coverage is often the most cost-effective path to treatment. A 30-day inpatient program costs $15,000-$50,000 without insurance, while monthly premiums for a PPO plan with comprehensive addiction coverage typically range from $400-$750 — a fraction of out-of-pocket treatment costs.

All ACA marketplace plans must cover substance use disorder treatment as an essential health benefit. A licensed insurance specialist can help you:

• Compare Cigna and other carriers during open enrollment
• Identify qualifying life events that allow special enrollment
• Navigate income-based subsidies and cost-sharing reductions
• Understand network differences and coverage levels

Sources

• Cigna. “Behavioral Health Benefits and Coverage.” Member Resources. 2026.
• Evernorth Behavioral Health. “Treatment Authorization Guidelines.” 2026.
• Centers for Medicare & Medicaid Services. “Mental Health Parity and Addiction Equity Act.” 2024.
• Healthcare.gov. “Substance Use Disorder Services Coverage.” 2026.