There are a lot of costs involved in providing care for an elderly loved one, or someone with elevated care needs. Even for individuals who provide care on a volunteer basis, it’s not entirely cost-free. And for those looking to bring in professional support, even on a limited basis, the out-of-pocket prices can be staggering. Insurance coverage can play a crucial role in offsetting these expenses.
But that doesn’t mean you’re out of options. A number of organizations, providers, agencies, and programs make resources available to those who qualify, reducing the burden and improving quality of life both for the patient, and those who are involved in their care. Many care coverage options are designed to support both the patient and caregiver’s well being.
Case in point: Cigna Healthcare has several offerings, depending on a few qualifying factors. If you’re covered by Cigna, or if your loved one is covered by them (such as through a Cigna-backed Medicaid Advantage plan), you may have some valuable resources at your disposal. Cigna provides comprehensive coverage options that can positively impact health outcomes for those in need of care.
Understanding Cigna Healthcare Insurance Eligibility and Coverage Details
Cigna Healthcare is a medical insurance provider. You might be familiar with them if you’ve worked for an employer that used them for employee health benefits. In addition to employer-sponsored plans, and offering benefits to their own employees, Cigna also provides the coverage for some Medicare Advantage plans.
What might be included in a Cigna plan (such as benefits related to caregiving and hospice) can vary, as will benefit amounts. The factors that have the biggest impact are things like:
- Location
- Plan type
- The insured’s relationship to the caregiver
Coverage and eligibility criteria must be met to qualify for caregiver benefits. Understanding coverage details is essential for making the most of Cigna’s offerings.
Other specifics aside, what’s available to you will depend heavily on who’s insured. If the caregiver is the one with Cigna coverage, such as if your employer offers medical benefits through Cigna, you’re likely eligible for wage replacement options. These are benefits included in many Cigna plans that can help alleviate the financial burden involved in taking a leave of absence from work to care for a family member.
For situations where it’s the care recipient that’s insured, such as if Cigna is their Medicare Advantage provider, there are still some assets you can make use of. As a prime example, the Cigna Caregiver Bridge Program connects you to a healthcare management service where you can access learning resources, helpful tools, and even one-on-one coaching with a professional who can provide expertise specific to caregiving. Family members and the primary care physician can play a key role in coordinating care and accessing resources.
When considering caregiver benefits, it is important to review coverage details and be aware of coverage limitations.
Will Cigna Help Pay for In-Home Care, Respite Care, Skilled Nursing Care, or Facility Services?
With the costs involved in hospice and caregiving being what they are, it’s no surprise when patients and caregivers are price-conscious. Most caregivers are family or friends of the patient, and don’t always come to the responsibility with a surplus of training and available resources.
Barring some kind of coverage, assistance, or support, caregivers may not have the means or the ability to facilitate the level of care their loved one needs. It’s an awful dilemma to be presented with, and you owe it to yourself and the person you look after to make use of what might be available.
So, does Cigna cover caregiver expenses? The short answer is “yes, possibly.”
Again, this will depend on the details of the coverage. If you, the caregiver, is the one who’s insured, you may be limited to the wage replacement benefits. In other words, yes, Cigna pays for in-home care, but the care they’re paying for is you.
When the care recipient is the one with coverage, things are a little different. Details vary, and they’re subject to eligibility requirements, but Cigna may help pay for one or more of the following home care services:
- In-home personal care services (non-medical assistance that helps the patient with daily needs and activities of daily living)
- Home health care services (in-home, healthcare-related services requiring proper training and certification)
- Skilled nursing care and other care provided by healthcare professionals
- Therapy services, including physical therapy, occupational therapy, and speech therapy, to support daily living skills and rehabilitation
- Medication management and monitoring vital signs as part of comprehensive medical care
- Hospice and end-of-life services
These essential services are provided by healthcare professionals, and the specific services and coverage limits may vary depending on your plan and eligibility criteria. Cigna’s home care coverage is designed to provide necessary support and promote recovery in the comfort of your own home or familiar surroundings.
Cigna may also cover other services, facility admissions, and treatments:
- Professional long-term care
- Services and/or facilities specific to the patient’s medical concerns (e.g. memory care)
- Respite care, temporary stays at long-term care facilities, etc.
- Additional services and emotional support, including support for emotional well being and bereavement support for caregivers and families
Finding in network providers is a key aspect of maximizing benefits and minimizing out of pocket costs. Understanding the authorization process, claims process, and coverage limitations is essential; maximum coverage and specific coverage details should be reviewed for each plan. Certain criteria must be met, and eligibility and coverage details can be obtained by contacting Cigna directly for up to date information.
Cigna’s commitment to comprehensive coverage and high-quality care is a vital component of their offerings, and their health insurance plans are designed to support the well being and daily living skills of individuals in their own homes.
Coverage Limitations and Exclusions to Cigna’s Caregiver Benefits
No insurance policy would be complete without clearly defined boundaries regarding what coverage will pay for, and what it won’t. It’s no different with caregiving services, so you’ll need to read the fine print, and perhaps even call and speak to a Cigna representative directly.
Even if coverage is available to you, there are a few caveats you’ll want to watch out for. Once you’ve established that a service is covered, you’ll probably need to prove medical necessity, up to and including getting a physician to file the proper paperwork for a prior authorization.
And, like other health insurance benefits, you’ll almost certainly have to contend with network affiliation; failing to choose an in-network provider can lead to a lot of extra headache for you and your loved one.
Finally, benefits may be subject to restrictions and limitations. For example, your plan may only allow for certain types of services, or certain formats of care. And there may be maximum benefit limits, beyond which you’ll be paying out-of-pocket.
Having a firm grasp of the related benefits—and what’s required to make use of them—will be critical if you want to make the most of the coverage while limiting the financial burden.
Additional Community Resources for Family Caregivers
In the event that Cigna healthcare does not cover the services you need, or the coverage won’t address the entirety of the need, you’re not out of options yet. Senior care is a major concern for communities across the country, and you’ll find a wealth of programs and organizations aimed at addressing that concern as a result.
With a little digging, it’s likely that you’ll discover resources at both the national and local level that can provide assistance of some kind. It’s worth looking into just about any support options you might qualify for. So keep searching for possible aid offerings until you find what you need.
Learn more at inhomecare.com where you’ll find diverse resources, practical solutions, and compassionate guidance tailored to the needs of seniors and caregivers.
