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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 Western Colorado. 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 $4650.00 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 an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $4 at a preferred pharmacy or preferred mail order, and $15 at a standard pharmacy or standard mail order. For standard generic drugs, the copay is $45 at a preferred pharmacy or preferred mail order, and $47 at a standard pharmacy or standard mail order. For preferred brand drugs, the copay is $100 at any pharmacy. For non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits with varying costs. You'll pay a copay for inpatient hospital stays, outpatient services, and some specialist visits, with costs ranging from $0 to $295 depending on the service. Emergency services have a $125 copay. This plan includes coverage for vision, dental, and hearing services, including routine eye exams with no copay, eyewear with a combined maximum benefit of $350 per year, hearing exams with a $25 copay, and hearing aids. It also covers home health services with no copay, and offers an over-the-counter (OTC) allowance of $85 every three months.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $295 copay for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, you'll pay a $285 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 also not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $280, observation services with a $280 copay, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient substance abuse services have a $35 copay for both individual and group sessions, and 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.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a $170 copay, while air ambulance services have a 20% coinsurance. 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 under the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services have a $35 copay; there is no coinsurance for any of these services. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
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 $35 copay), Physician Specialist Services (with a $35 copay), and Physical Therapy and Speech-Language Pathology Services (with a $35 copay). Mental Health Specialty Services, Podiatry Services, and Psychiatric Services are partially covered, as individual and group sessions are not covered. Other Health Care Professional services have a copay between $0 and $35, while Additional Telehealth Benefits have a copay between $0 and $35. Opioid Treatment Program Services also have a copay between $35 and $35.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers a variety of preventive services, including Health Education, Support for Caregivers of Enrollees, Fitness Benefit, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. The plan does not cover In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, or Counseling Services.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, and fitting/evaluation for hearing aids are covered. Prescription hearing aids for the inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including routine eye exams with a copay of $0-$35, and eyewear with a combined maximum benefit of $350 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Cigna Preferred Medicare (HMO) plan covers dental services, including oral exams, x-rays, and cleanings, with a $35 copay for Medicare dental services. Other dental services have a maximum benefit of $500 per year, and orthodontic services are covered under diagnostic and preventive dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay, with 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 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 is covered by the Cigna Preferred Medicare (HMO) plan, with a 20% coinsurance for durable medical equipment (DME), prosthetic devices, and medical supplies, and no copay. Durable medical equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $25, and Lab Services with no copay. Radiological Services are covered, with a copay of at most $200 for Diagnostic Radiological Services and a 20% coinsurance for Therapeutic Radiological Services. Outpatient X-Ray Services have a $10 copay.
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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan with prior authorization required. There is no copay for days 1-20, and a $214 copay 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 $85 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone. This plan does not cover 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.
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