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 Denver. This plan received an overall rating of 2.5 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 $3550.00 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 your prescriptions. The copay amount depends on the drug tier and the pharmacy you use. For example, you'll pay a $4 copay for preferred generic drugs at a preferred pharmacy, and a $15 copay at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your prescriptions.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll find coverage for ambulance services with copays, and emergency services with a $140 copay. Primary care, hearing, vision, and dental services are also included, with specific copays for each. This plan provides additional coverage for home infusion, dialysis, and medical equipment, with coinsurance or copays applying. Diagnostic and radiological services, home health services, and skilled nursing facility stays are covered, with copays or coinsurance. Other services include acupuncture, over-the-counter items, and a meal benefit, with limitations on coverage amounts and specific services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered under the Cigna Preferred Medicare (HMO) plan, but require prior authorization. For days 1-6, there is a $195 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered under the Cigna Preferred Medicare (HMO) plan, with copays ranging from $0 to $195. Ambulatory Surgical Center (ASC) Services are covered with no copay, and outpatient substance abuse services are covered with a $25 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan with a $130 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a $205 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the Cigna Preferred Medicare (HMO) plan with a $140 copay, and no coinsurance. Urgently Needed Services have a $25 copay, and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, have a $140 copay and no coinsurance, with a maximum benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, physical therapy and speech-language pathology services with a $25 copay, other health care professional services with a $0 - $25 copay, and opioid treatment program services with a $25 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. Additionally, additional telehealth benefits are covered with a $0 - $25 copay.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including annual physical exams, and additional preventive services like health education, support for caregivers, and fitness benefits. However, it does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, additional sessions of smoking cessation, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services.
Hearing Services See details
Hearing Services include Hearing Exams with a $25 copay, Fitting/Evaluation for Hearing Aid, and Prescription Hearing Aids (all types) with a copay between $399 and $1800. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a copay of $0-$25, as well as coverage for eyewear, including contact lenses, eyeglasses, and upgrades. Eyewear has a combined maximum benefit of $350 every year.
Dental Services See details
Dental services are covered, with a $25 copay for Medicare dental services. Restorative services have a copay between $0 and $550, and adjunctive general services have a copay between $0 and $285. Endodontics has a copay between $0 and $675, periodontics has a copay between $0 and $595, and prosthodontics, removable has a copay between $25 and $615. Prosthodontics, fixed has a copay between $50 and $525. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna Preferred Medicare (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, both with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical Equipment benefits are covered under the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $20, lab services with no copay, diagnostic radiological services with a copay up to $195, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $10 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay or coinsurance, but prior 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. This includes Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, with a prior authorization requirement. You will pay a $20 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 are not covered.
Other Services See details
Other Services includes acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has a maximum plan benefit coverage amount of $300 per year. OTC items are covered up to $110 every three months, and the plan offers Nicotine Replacement Therapy and Naloxone as Part C OTC benefits. The meal benefit is available for chronic illnesses or medical conditions that require the enrollee to remain at home. The following services are not covered: 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.
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