A non-government entity
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 Southwest Ohio/North Kentucky. 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 $3500.00 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:
Sign up for Cigna Preferred Plus Medicare (HMO)
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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 will 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. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Medicare Part D covered drugs. If you qualify for the low-income subsidy, your Part D premium will be $27.00.
Additional Benefits
The Cigna Preferred Plus Medicare (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays, and no copays for ambulatory surgical center services. You'll also find coverage for emergency and primary care services, along with preventive, hearing, vision, and dental services. The plan includes coverage for ambulance, home health, and skilled nursing facility services, and covers durable medical equipment, with associated copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by the Cigna Preferred Plus Medicare (HMO) plan. For days 1-5, there is a $275 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Cigna Preferred Plus Medicare (HMO) plan with a copay of $0-$275 for outpatient hospital services and a $275 copay for observation services. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $35 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Preferred Plus Medicare (HMO) plan with a $100 copay. Prior authorization is required for this benefit.
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 copay of $245, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year, but other transportation services are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Cigna Preferred Plus Medicare (HMO) plan. Emergency Services have a $140 copay and no coinsurance, while Urgently Needed Services have a $35 copay and no coinsurance.
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), podiatry services (with a $35 copay), other health care professional services (with a copay between $0 and $35), physical therapy and speech-language pathology services (with a $35 copay), additional telehealth benefits (with a copay between $0 and $35), and opioid treatment program services (with a $35 copay). The plan does not cover routine chiropractic care, individual or group mental health specialty services, or individual or group psychiatric services.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered under the Cigna Preferred Plus Medicare (HMO) plan. The plan also covers Health Education and Fitness Benefits, while services such as In-Home Safety Assessment and Weight Management Programs are not covered.
Hearing Services See details
Hearing Services are covered by the Cigna Preferred Plus Medicare (HMO) plan, including routine hearing exams with a $30 copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers vision services, including eye exams with a copay of $0-$35, eyewear with a combined maximum benefit of $400 per year, and contact lenses. The plan covers one routine eye exam, and one pair of eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames per year.
Dental Services See details
Cigna Preferred Plus Medicare (HMO) covers dental services, including Medicare dental services with a $35 copay, and other dental services, with a maximum plan benefit of $3,700 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 and fixed), maxillofacial prosthetics, implant services, 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, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Plus Medicare (HMO) plan, but 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, but does not cover DME for use outside the home. Prosthetics and medical supplies are covered with a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $250, lab services with no copay, diagnostic radiological services with a copay up to $225, therapeutic radiological services with a $60 copay, and outpatient X-ray services with a $20 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Plus Medicare (HMO) plan with no copay or 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. 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 Plus Medicare (HMO) plan, 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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a maximum benefit of $125 every three months, and a Meal Benefit for chronic illnesses or medical conditions, but 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.
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