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Cigna Preferred Plus Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred Plus 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 Plus Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred Plus Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Northeast Ohio. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Cigna Preferred Plus 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 Plus 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 Plus Medicare (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $4000.00 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 Plus Medicare (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy, also known as LIS or "Extra help."
Additional Benefits
The Cigna Preferred Plus Medicare (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. You'll find no copays for many preventive services, and also for home health services. This plan includes coverage for hearing, vision, and dental, with copays and annual maximums for some services. Emergency and urgent care services are covered with copays, while ambulance services have copays or coinsurance. The plan also covers some transportation, and offers an over-the-counter allowance, along with a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage under the Cigna Preferred Plus Medicare (HMO) plan includes both acute and psychiatric care. For days 1-6, there is a $325 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $0-$295, observation services with a $295 copay, ambulatory surgical center services with no copay, individual and group sessions for outpatient substance abuse with a copay of $35, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered with a $100 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the Cigna Preferred Plus Medicare (HMO) plan. Ground ambulance services have a $230 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, while transportation to any health-related location is 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 Plus Medicare (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $65 copay; both have no coinsurance. Worldwide services have a $140 copay and a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Plus Medicare (HMO) plan 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, other health care professional services with a copay between $0 and $35, and opioid treatment program services with a copay between $35. Mental health and psychiatric services do not cover individual or group sessions, and podiatry services are not covered. Additional telehealth benefits are covered with a copay between $0 and $35.
Preventive Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers preventive services, including annual physical exams, with no copay. Other preventive services like health education, glaucoma screenings, and diabetes self-management training are covered, while in-home safety assessments, personal emergency response systems, and several other services are not covered.
Hearing Services See details
Hearing services are covered by the Cigna Preferred Plus Medicare (HMO) plan. Hearing exams have a $25 copay, and Routine Hearing Exams and Fitting/Evaluation for Hearing Aid are covered annually. Prescription Hearing Aids are covered with a copay between $399 and $1800, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a copay of $0 - $25, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $250 per year. Routine eye exams are covered once per year.
Dental Services See details
Dental Services are covered by the Cigna Preferred Plus Medicare (HMO) plan, including Medicare dental services with a $35 copay, and other dental services with a maximum plan benefit coverage of $3,100 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, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna Preferred Plus Medicare (HMO) plan, with prior authorization required. There is a $35 copay for Medicare Part B Insulin Drugs, with coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Plus Medicare (HMO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Cigna Preferred Plus Medicare (HMO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit are covered with coinsurance, and Prosthetic Devices have a 20% coinsurance. Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but 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 $30, lab services with no copay, diagnostic radiological services with a copay up to $200, therapeutic radiological services with a copay of $60, and outpatient X-ray services with a $20 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by Cigna Preferred Plus Medicare (HMO) 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 Plus Medicare (HMO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Plus Medicare (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay per day 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 Plus Medicare (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $125.00 every three months, and it includes nicotine replacement therapy and Naloxone coverage. Acupuncture, Dual Eligible SNPs, 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 covers a meal benefit.
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