A non-government entity
Cigna Premier Medicare (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Premier Medicare (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Premier Medicare (HMO-POS) in 2025, please refer to our full plan details page.
Cigna Premier Medicare (HMO-POS) is a HMO-POS 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 Premier Medicare (HMO-POS) 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 Premier Medicare (HMO-POS).
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 Premier Medicare (HMO-POS), 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 $4600.00 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 Premier Medicare (HMO-POS) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions. For preferred generic drugs, the copay is $4.00. For standard generic drugs, the copay is $45.00. For preferred brand drugs, the copay is $100.00. For non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for your covered drugs.
Additional Benefits
The Cigna Premier Medicare (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $285 copay for days 1-6, outpatient services with varying copays, and emergency services with a $125 copay. This plan also covers primary care, preventive, hearing, vision, and dental services, with specific copays and coverage limits for each. Additional benefits include ambulance and transportation services, home health services with no copay, and coverage for medical equipment with 20% coinsurance. However, certain services like cardiac rehabilitation, additional days in inpatient facilities, and some other services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both requiring prior authorization. For days 1-6 of an inpatient stay, the copay is $285 per day, and there is no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, nor are Non-Medicare-covered stays for either.
Outpatient Services See details
Outpatient services are covered, including outpatient hospital services with a copay between $0 and $285, observation services with a $285 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services. This plan also waives the deductible for three pints of blood.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Premier Medicare (HMO-POS) plan with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Premier Medicare (HMO-POS) plan. Ground ambulance services have a $255 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for 10 one-way trips per year, using rideshare services, bus/subway, medical transport, or other modes of transportation. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna Premier Medicare (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $25 copay, with no coinsurance for any of these services.
Primary Care See details
The Cigna Premier Medicare (HMO-POS) plan covers primary care physician services, occupational therapy services, physician specialist services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, occupational therapy services and physician specialist services have a $35 copay, physical therapy and speech-language pathology services have a $35 copay, and additional telehealth benefits have a copay between $0 and $35.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Additional benefits like Health Education, Support for Caregivers, and Fitness Benefits are covered, while others such as In-Home Safety Assessment, Medical Nutrition Therapy, and Remote Access Technologies are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $25 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $399 and $1800, while hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0 - $35. Eyewear is covered, with a combined maximum benefit of $250 per year for contact lenses, eyeglasses, eyeglass lenses, and frames.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a $35 copay, and other services such as oral exams, dental x-rays, and more, with a $1,400 maximum per year. Orthodontic services are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and 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 under the Cigna Premier Medicare (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Cigna Premier Medicare (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $250, Therapeutic Radiological Services have a coinsurance of up to 20%, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Cigna Premier Medicare (HMO-POS) plan with no copay and no 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 Premier Medicare (HMO-POS) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Premier Medicare (HMO-POS) plan, but require prior authorization. The copay for days 1-20 is $10, and the copay for days 21-100 is $214; this plan does not cover additional SNF days beyond what Medicare covers, nor does it cover non-Medicare-covered SNF stays.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items with a $75 benefit every three months, and Meal Benefit services. 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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