What Cigna is and who sells it
Cigna is a health insurance company that sells medical, dental, and vision coverage to individuals, families, and employers. You do not buy directly from Cigna in most cases — instead, you buy through your employer's benefits plan, through the federal marketplace at Healthcare.gov, through your state's marketplace, or through a licensed insurance broker. Cigna is one of several national insurers; others include Aetna, Blue Cross Blue Shield, UnitedHealthcare, and Humana.
Cigna operates in all 50 states, though the specific plans available to you depend on where you live and how you are buying. If you are uninsured and looking on your own, you would search Healthcare.gov or your state marketplace and filter for Cigna plans. If your employer offers health insurance, Cigna may be one of the options on your benefits menu. If you are on Medicare, Cigna sells Medicare Advantage and Medigap plans through Medicare.gov.
Key Takeaways
- Cigna sells health plans through employers, the federal marketplace, state marketplaces, and Medicare — the way you buy determines which plans you see and what subsidies you may receive.
- A Cigna plan includes a deductible (what you pay before insurance kicks in), copays or coinsurance (what you pay per visit), and an out-of-pocket maximum (the most you pay in a year).
- Cigna maintains a network of doctors and hospitals; using in-network providers costs less than using out-of-network ones, and some plans do not cover out-of-network care at all.
- If you buy through Healthcare.gov or a state marketplace, you may receive a tax credit or cost-sharing reduction that lowers your monthly premium or out-of-pocket costs.
- Cigna covers preventive care (like annual checkups and screenings) at no cost to you if you use in-network providers.
How to find and compare Cigna plans
Where you search depends on your situation. If you are uninsured and do not have an employer plan, go to Healthcare.gov (the federal marketplace) or your state's marketplace website. You can search by state and see all insurers available there, including Cigna. You will enter basic information about your household income and size, and the site will show you which plans may have access to for a tax credit and how much that credit is worth.
If your employer offers health insurance, Cigna plans will appear on your benefits enrollment form or in your company's benefits portal. You typically enroll during an open enrollment period (usually once a year in fall or winter) or within 30 days of hire. If you are on Medicare, visit Medicare.gov to see Cigna Medicare Advantage and Medigap plans available in your zip code.
When comparing Cigna plans, look at the monthly premium (what you pay each month), the deductible (what you pay before the plan starts paying), copays (fixed amounts per visit), and the out-of-pocket maximum (the most you will pay in a year for covered services). A plan with a lower premium often has a higher deductible and higher copays. A plan with a higher premium often has a lower deductible and lower copays. There is no single "best" plan — it depends on how often you see doctors and what you expect to spend.
Understanding Cigna's network and in-network versus out-of-network
Cigna contracts with doctors, hospitals, and other providers in your area. These are in-network providers. When you use an in-network provider, you pay less because Cigna has negotiated rates with them. When you use an out-of-network provider (one Cigna does not contract with), you pay more — sometimes much more — and you may have to pay the full bill upfront and file a claim yourself.
Before choosing a Cigna plan, check whether your current doctors are in the network. Cigna publishes a provider directory on its website and in the plan details on Healthcare.gov or your state marketplace. You can search by doctor name or specialty. If your doctor is not in the network, you have two choices: switch to an in-network doctor, or accept that you will pay out-of-network rates. Some Cigna plans do not cover out-of-network care at all except in emergencies.
If you need a specialist, ask your primary care doctor for a referral. Some Cigna plans require a referral before you see a specialist; others do not. Check your plan documents or call the number on your insurance card to confirm.
What Cigna covers and what it does not
All Cigna plans cover the same set of essential health benefits required by federal law: emergency services, hospitalization, doctor visits, prescription drugs, mental health and substance use treatment, maternity and newborn care, pediatric care, dental and vision care for children, and preventive care. However, the amount you pay out of pocket for each benefit varies by plan.
Preventive care — like annual checkups, blood pressure screening, cancer screenings, and vaccinations — is covered at no cost to you if you use an in-network provider. This is true for all Cigna plans. Prescription drugs are covered, but Cigna uses a formulary, a list of approved medications. Some drugs on the formulary cost less (lower tier), and others cost more (higher tier). If your doctor prescribes a drug not on the formulary, you may have to pay the full cost or ask your doctor to prescribe a different drug.
Cigna does not cover cosmetic procedures (like elective plastic surgery), most fertility treatments, or experimental treatments not yet approved by the FDA. Coverage for mental health and substance use treatment is the same as for physical health under federal law, but you should confirm the number of visits covered and whether you need a referral.
How to enroll in a Cigna plan
The enrollment process depends on where you are buying. If you are buying through Healthcare.gov or a state marketplace, create an account, enter your information, compare plans, and select the one you want. You will be asked to choose a start date (usually the first of the month). If you may have access to for a tax credit, it will be applied automatically to lower your monthly premium. You can pay your premium monthly by credit card, debit card, or bank account.
If you are enrolling through your employer, you will use your company's benefits portal or paper enrollment form during open enrollment. Your employer will deduct your premium from your paycheck. If you are enrolling in a Cigna Medicare plan, you enroll through Medicare.gov during Medicare's open enrollment period (October 15 to December 7 each year) or during a special enrollment period if you have a may have access to life event.
After you enroll, Cigna will send you an insurance card by mail. You can also view your card in the Cigna mobile app or on Cigna's website. Keep your card with you when you go to the doctor.
Common costs and how to estimate what you will pay
A typical Cigna plan includes these costs: a monthly premium (what you pay to have the plan), a deductible (what you pay before the plan starts paying — often $500 to $2,000 per person), copays (fixed amounts like $25 per doctor visit), and an out-of-pocket maximum (the most you pay in a year, often $5,000 to $10,000 per person). Once you reach your out-of-pocket maximum, the plan pays 100% of covered services for the rest of the year.
To estimate your costs, think about how many doctor visits you expect, what prescriptions you take, and whether you will need specialist care or hospitalization. Use the plan comparison tool on Healthcare.gov or your state marketplace — it shows estimated costs based on your expected use. If you buy through your employer, your benefits team can often run a cost estimate for you.
If you receive a tax credit when buying through Healthcare.gov or a state marketplace, that credit reduces your monthly premium. If you receive a cost-sharing reduction, that lowers your copays and deductibles. You must report changes in income or household size within 30 days, because receiving a credit you are not may have access to to means you will owe money back when you file your taxes.
What to do after you enroll
After your Cigna coverage starts, set up an account on Cigna's website or mobile app. You can view your coverage details, find in-network doctors, check claims, and refill prescriptions. read your insurance card or have it mailed to you. Choose a primary care doctor if your plan requires one — this is the doctor you see first for most health needs, and who refers you to specialists.
If you have questions about your coverage, call the customer service number on your insurance card. Cigna's customer service is available during business hours and sometimes 24/7 depending on your plan. If you need to change your plan or coverage (for example, if you lose your job or have a baby), you have 60 days to report the change and enroll in a new plan through a special enrollment period.
Frequently Asked Questions
Can I switch from Cigna to a different insurance company?
Yes, but only during open enrollment (usually November 1 to January 15 on Healthcare.gov) or if you have a may have access to life event like losing your job, getting married, or having a baby. If you buy through your employer, you can switch plans during your company's open enrollment period, usually once a year. If you are on Medicare, you can switch during Medicare's open enrollment period from October 15 to December 7.
What happens if I go to an out-of-network doctor by accident?
You will pay more out of pocket, and you may have to file a claim yourself. Call Cigna's customer service number on your card as soon as possible to report the visit. Ask whether the provider can be considered in-network retroactively. If not, ask Cigna to explain what you owe and whether you can appeal the out-of-network charge.
Do I need to pay my Cigna premium if I am not using the plan?
Yes. Your premium is due every month whether you use the plan or not. If you do not pay, Cigna will send you a notice and may cancel your coverage. If you cannot afford your premium, contact Cigna to ask about payment plans or hardship options.
How do I know if a prescription is covered by my Cigna plan?
Ask your doctor or pharmacist, or search the Cigna website using your plan name and the drug name. You can also call the customer service number on your insurance card. If the drug is not covered or is in a high-cost tier, ask your doctor whether a different drug on the formulary would work for you.
What if Cigna denies a claim?
Cigna will send you a letter explaining why. You have the right to appeal. Follow the instructions in the letter, which will tell you how to submit additional information or request a review. If you disagree with the appeal decision, you may have the right to an external review by an independent third party — Cigna will explain this in the letter.