A non-government entity
Cigna Preferred Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred Medicare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Preferred Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Metro Atlanta. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Cigna Preferred Medicare (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna Preferred Medicare (HMO).
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 Preferred Medicare (HMO), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 $5100.00 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 Preferred Medicare (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for each prescription, which varies based on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $8 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), you may have reduced premium costs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage with a focus on outpatient and preventive services. This plan includes coverage for primary care with varying copays, hearing and vision services, and dental with a $1,350 annual maximum. You'll also have access to emergency and ambulance services, along with home health services and skilled nursing facility care, though some services may require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $295 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll pay a $595 copay for days 1-3, and no copay for days 4-90. Additional Days for Inpatient Hospital-Acute is covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $399, observation services with a $295 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $35 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO), including ground and air ambulance services, as well as transportation to health-related locations. Ground ambulance services have a copay of $270, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered, and transportation to plan-approved health-related locations has a limit of 50 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna Preferred Medicare (HMO) plan. For Emergency Services and Worldwide Emergency Coverage, you will pay a $125 copay, and a $55 copay for Urgently Needed Services; all services have no coinsurance.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan's primary care benefit covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, and other health care professional services with a copay ranging from $0-$35. However, routine chiropractic care, individual and group sessions for mental health and psychiatric services, and podiatry services are not covered. The plan also covers additional telehealth benefits with a copay ranging from $0-$35, and opioid treatment program services with a $35 copay.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including annual physical exams, health education, kidney disease education services, and other preventive services with no copay. Additional services such as in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $25 copay, and routine hearing exams, and fitting/evaluation for hearing aids, each once per year. Prescription hearing aids are covered with a copay between $399 and $1800 for all types of hearing aids, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Cigna Preferred Medicare (HMO) covers vision services, including routine eye exams with a copay of $0-$35, and eyewear with a combined maximum benefit of $250 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services, as well as coverage for 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. There is a $1,350 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Insulin has a $35 copay, with a coinsurance between 0-20%. 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 with a coinsurance between 20% and 20%, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits are covered under the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $95, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $250, and Therapeutic Radiological Services have up to 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) 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 Preferred Medicare (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Cigna Preferred Medicare (HMO), but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) items, with a maximum benefit of $55.00 every three months and includes nicotine replacement therapy and Naloxone. However, 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.
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