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Cigna Achieve Medicare (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Achieve Medicare (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Achieve Medicare (HMO C-SNP) in 2025, please refer to our full plan details page.
Cigna Achieve Medicare (HMO C-SNP) is a HMO C-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Central Arizona. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Cigna Achieve Medicare (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna Achieve Medicare (HMO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna Achieve Medicare (HMO C-SNP).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Cigna Achieve Medicare (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Cigna Achieve Medicare (HMO C-SNP) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions based on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan may also have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Achieve Medicare (HMO C-SNP) plan offers a variety of benefits with varying costs. This plan covers inpatient hospital stays with a copay, outpatient services with copays ranging from $0 to $175, and ambulance services with either a copay or coinsurance. Additionally, the plan includes coverage for emergency services, primary care with copays as low as $0, preventive services, hearing and vision services, and dental services with a $20,000 annual maximum. Other covered services include home infusion, dialysis, medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility stays with copays. The plan also provides coverage for over-the-counter items and meal benefits. It is important to note that some services require prior authorization, and certain services like cardiac rehabilitation and some "Other Services" are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you will pay a $225 copay for days 1-7, and no copay for days 8-90; psychiatric care has the same cost structure.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $175, Observation Services with a $175 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $20 copay for both Individual and Group Sessions, and Outpatient Blood Services with waived deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Achieve Medicare (HMO C-SNP) plan, but requires prior authorization. You will have a $130 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Achieve Medicare (HMO C-SNP). Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Cigna Achieve Medicare (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $20 copay; all services have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care includes coverage for Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $20 copay, Physician Specialist Services with a $20 copay, Podiatry Services with a $20 copay, Other Health Care Professional services with a copay between $0 and $20, Physical Therapy and Speech-Language Pathology Services with a $20 copay, Additional Telehealth Benefits with a copay between $0 and $20, and Opioid Treatment Program Services with a $20 copay, but does not cover individual or group sessions for Mental Health Specialty Services or individual or group sessions for Psychiatric Services. Routine Chiropractic Care is limited to 12 visits per year.
Preventive Services See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers preventive services, including annual physical exams, health education, kidney disease education, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan also covers support for caregivers and fitness benefits, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services with Cigna Achieve Medicare (HMO C-SNP) include routine hearing exams with a $20 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, but prescription hearing aids for inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$20, and routine eye exams once per year. Eyewear is covered with a combined maximum of $300 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
Dental Services are covered, with a maximum benefit of $20,000 per year. Medicare Dental Services have a $20 copay, while Oral Exams have a $20 copay and are limited to 4 visits per year, and Dental X-Rays have a copay between $0 and $240, depending on the specific service. Other services like Restorative Services, Endodontics, and Implant Services have copays ranging from $0 to $950, depending on the service, while Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered under the Cigna Achieve Medicare (HMO C-SNP) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a coinsurance for Medicare-covered devices and supplies, and no copay. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for lab services with no copay, diagnostic radiological services with a copay up to $150, therapeutic radiological services with a coinsurance up to 20%, and outpatient X-ray services with a $10 copay. Diagnostic Procedures/Tests are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Cigna Achieve Medicare (HMO C-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan, but require prior authorization. For days 1-20, the copay is $20 per day, and for days 21-100, the copay is $214 per day. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services", acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Over-the-counter (OTC) items and meal benefits are covered, with a $65 maximum plan benefit coverage amount every three months for OTC items, and meal benefits offered for a chronic illness or medical condition that requires the enrollee to remain at home.
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