Cigna Preferred Medicare (HMO)

Inpatient Hospital See details

Inpatient hospital services are covered, including acute and psychiatric care. For Inpatient Hospital-Acute, you'll pay a $270 copay for days 1-6, and no copay for days 7-90, while Inpatient Hospital Psychiatric has a $595 copay for days 1-3, and no copay for days 4-90; additional days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services, are covered. Outpatient hospital services have a copay between $0 and $295, and observation services have a $295 copay.

Ambulatory Surgical Center (ASC) Services are covered with no copay, while outpatient substance abuse services have a $20 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.

Partial Hospitalization See details

Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. The copay for this benefit is $105.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a $190 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location are covered for up to 20 one-way trips per year, and transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, including Worldwide Emergency Services, have a copay of $125.00, while Urgently Needed Services have a copay of $55.00; there is no coinsurance for any of these services. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.00.

Primary Care See details

The Cigna Preferred Medicare (HMO) plan covers primary care, chiropractic, occupational therapy, physician specialist, other health care professional, psychiatric services, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services. Chiropractic services have a $15 copay, physician specialist services have a $20 copay, occupational therapy and physical therapy/speech-language pathology services have a $30 copay, additional telehealth benefits have a $0-$20 copay, and opioid treatment program services have a $20 copay. However, routine chiropractic care, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and podiatry services are not covered.

Preventive Services See details

The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services with no copay. The plan also covers additional preventive services, such as health education, fitness benefits, kidney disease education services, and other preventive services like glaucoma screenings and diabetes self-management training. However, in-home safety assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, and other services are not covered.

Hearing Services See details

Hearing exams are covered with a $20 copay, including routine hearing exams and fitting/evaluation for hearing aids, each limited to one visit per year. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, limited to two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.

Vision Services See details

Vision services, including routine eye exams, eyewear, and upgrades, are covered. Routine eye exams have a copay of $0-$35, and you are allowed one exam every year. Eyewear has a combined maximum of $200 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses (one pair per year), and eyeglass frames (one pair per year).

Dental Services See details

Dental Services includes coverage for Medicare Dental Services with a $20 copay, and other dental services, with a maximum plan benefit of $1,400 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are all covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan and require prior authorization. You will pay 20% coinsurance.

Medical Equipment See details

The Cigna Preferred Medicare (HMO) plan covers durable medical equipment, prosthetics, medical supplies, and diabetic equipment, but durable medical equipment for use outside the home and diabetic supplies are not covered. For covered services, there is a 20% coinsurance, and there is no copay.

Diagnostic and Radiological Services See details

The Cigna Preferred Medicare (HMO) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.

Home Health Services See details

Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for this benefit.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) benefits are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. There is no copay for days 1-20, and the copay is $214 per day for days 21-100.

Other Services See details

The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $45.00 every three months, and it offers nicotine replacement therapy and Naloxone coverage. 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. The plan also provides a meal benefit for chronic illnesses or conditions requiring the member to stay at home.