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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 Albuquerque. 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 $4400.00 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. During 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, preferred generic drugs have a $4 copay at preferred pharmacies and $20 at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage with varying cost-sharing. For inpatient hospital stays, you'll pay a $270 copay for days 1-5, and no copay for days 6-90. Outpatient services have varying copays, and you'll have no copay for many services, including outpatient blood services, ambulatory surgical centers, and lab services. The plan also includes coverage for emergency services, primary care with copays between $0 and $30, preventive services, hearing and vision services, and dental services with a $1,200 annual maximum. Additional benefits include ambulance services, home health services, and home infusion services. Other services such as Over-the-Counter (OTC) Items are covered with a maximum benefit of $95.00 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by Cigna Preferred Medicare (HMO). For Inpatient Hospital-Acute, you will pay a $270 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $270 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are 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 not covered.
Outpatient Services See details
Outpatient Services are covered by the Cigna Preferred Medicare (HMO) plan. Outpatient Hospital Services have a copay between $0 and $270, while Observation Services have a $270 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30. Outpatient Blood Services are covered, with a waived three-pint deductible.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a copay of $225, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 30 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $30 copay; all have no coinsurance.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, other health care professional services with a copay between $0 and $30, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $30 copay. The plan does not cover routine chiropractic care, individual or group sessions for mental health specialty services, podiatry services, or individual or group sessions for psychiatric services.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, support for caregivers, and fitness benefits. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include hearing exams, with a $25 copay, as well as fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered; OTC hearing aids are also not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$30, and eyewear, including contact lenses, eyeglasses, eyeglass lenses and frames, and upgrades. Eyewear has a combined maximum benefit of $350 every year.
Dental Services See details
Dental Services are covered, with a $1,200 maximum benefit per year. Medicare Dental Services have a $30 copay, while 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 covered with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna Preferred Medicare (HMO) plan and require prior authorization. The cost sharing includes a $35 copay for Medicare Part B Insulin Drugs, while other services have a coinsurance between 0% and 20%.
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 these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment, Prosthetics, and Diabetic Equipment, are covered under the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment has a 20% coinsurance with prior authorization required, while Durable Medical Equipment for use outside of the home is not covered; Prosthetics and Medical Supplies have a 20% coinsurance and also require prior authorization, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services and Outpatient X-Ray Services have no copay, and Diagnostic Radiological Services have a maximum copay of $225. Therapeutic Radiological Services have a coinsurance of at least 20%.
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 these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $95.00 every three months, and includes nicotine replacement therapy and Naloxone coverage. Other services such as acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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