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Cigna TotalCare Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna TotalCare Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare Plus (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Ohio. This plan received an overall rating of 2.5 out of 5 stars in 2025.
It's important to know that Cigna TotalCare Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna TotalCare Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna TotalCare Plus (HMO D-SNP).
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 TotalCare Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $31.20. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 TotalCare Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After meeting the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), your Part D premium is $31.20. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna TotalCare Plus (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. You'll find coverage for outpatient services, including mental health, with a coinsurance of 0% to 20%, and dental services with a maximum annual benefit of $3,500. Emergency services come with a $110 copay, and primary care has a 20% coinsurance. This plan includes additional benefits such as hearing and vision services, with coverage for hearing exams and eyewear, and vision exams with a 0-20% coinsurance. You'll also have access to home health services with no copay or coinsurance, and ambulance services with a 20% coinsurance. The plan also covers prescription hearing aids with a copay between $399 and $1800.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered, but additional days for acute and psychiatric care, and non-Medicare-covered stays and upgrades for acute and psychiatric care, are not covered. You will need to pay the Medicare-defined cost share for tier 1 and the copay will vary.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services and Observation Services, are covered with a coinsurance of 0% to 20%. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 0% and 20%, and Outpatient Substance Abuse Services are covered with a 20% coinsurance for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna TotalCare Plus (HMO D-SNP) plan with a $80 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Cigna TotalCare Plus (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, with no copay. Transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year, with no copay or coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Cigna TotalCare Plus (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage each have a $110 copay, and Urgent Care services have a $45 copay, while there is no coinsurance for these services.
Primary Care See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, have a 20% coinsurance, and Occupational Therapy Services have a 20% coinsurance.
Preventive Services See details
Preventive Services for Cigna TotalCare Plus (HMO D-SNP) include Medicare-covered zero-dollar services, annual physical exams with 20% coinsurance, health education, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and a fitness benefit; however, in-home safety assessment, personal emergency response system, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a coinsurance of at most 20% and routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription Hearing Aids are partially covered, with coverage for all types of hearing aids with a copay between $399.00 and $1800.00, but not for inner ear, outer ear, and over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a 0-20% coinsurance, and eyewear coverage, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $400 every year.
Dental Services See details
Cigna TotalCare Plus (HMO D-SNP) offers dental services, including Medicare Dental Services with a 20% coinsurance and other dental services with a maximum benefit of $3,500 per year, as well as coverage for 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B insulin drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the Cigna TotalCare Plus (HMO D-SNP) plan, with Durable Medical Equipment (DME) subject to a 20% coinsurance and Prosthetic Devices also subject to a 20% coinsurance, while Medical Supplies have a 20% coinsurance. 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. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%, with a minimum of 20%. Lab Services have no copay.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare Plus (HMO D-SNP) 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 covered, but all of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization, and the plan does not provide Skilled Nursing Facility Services as a supplemental benefit under Part C. The plan charges the Medicare-defined cost share for tier 1, and additional days beyond Medicare-covered for Skilled Nursing Facility (SNF) and Non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, with a maximum of $175 for OTC items every three months. 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 are not covered.
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