A non-government entity
Cigna Achieve Medicare (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Achieve Medicare (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Achieve Medicare (HMO C-SNP) in 2025, please refer to our full plan details page.
Cigna Achieve Medicare (HMO C-SNP) is a HMO C-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Delaware. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna Achieve Medicare (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna Achieve Medicare (HMO C-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 Achieve Medicare (HMO C-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 Achieve Medicare (HMO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $68.00. 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 $5500.00 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 Achieve Medicare (HMO C-SNP)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Cigna Achieve Medicare (HMO C-SNP) 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 whether you use a preferred or standard pharmacy. For example, preferred generic drugs have a $4 copay, while preferred brand drugs have a $100 copay. 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 Achieve Medicare (HMO C-SNP) plan offers a range of benefits with varying costs. You'll find coverage for inpatient hospital stays, with copays depending on the type of care and length of stay, as well as outpatient services with copays ranging from $0 to $385. Emergency and urgent care services have copays, and ambulance services have either a copay or coinsurance. The plan provides coverage for primary care, preventive services, hearing, vision, and dental services, often with no copay or a low copay. You'll also find coverage for home health services, skilled nursing facilities, and other services like home infusion and dialysis. The plan also covers over-the-counter items with a quarterly allowance.
Inpatient Hospital See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers inpatient hospital stays, including acute and psychiatric care. For acute care, you'll pay a $385 copay for days 1-6, and no copay for days 7-90; for psychiatric care, you'll pay a $350 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, for the Cigna Achieve Medicare (HMO C-SNP) plan, includes coverage for all outpatient hospital services with a copay between $0 and $385, observation services with a $385 copay, and ambulatory surgical center services with no copay. Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $40. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Achieve Medicare (HMO C-SNP) plan. This benefit has a $100 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Achieve Medicare (HMO C-SNP). Ground ambulance services have a $245 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna Achieve Medicare (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay, and 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 Achieve Medicare (HMO C-SNP) plan covers Primary Care Physician Services with no copay, and Chiropractic Services with a $20 copay. Occupational Therapy Services have a $40 copay, while Physician Specialist Services and Physical Therapy and Speech-Language Pathology Services each have a $40 copay. Additional Telehealth Benefits have a copay between $0 and $40. The plan does not cover Podiatry Services, and does not cover Routine Chiropractic Care, Individual or Group Sessions for Mental Health Specialty Services, and Individual or Group Sessions for Psychiatric Services.
Preventive Services See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services include Health Education and Fitness Benefit, with services such as In-Home Safety Assessment, Personal Emergency Response System (PERS), and more not covered.
Hearing Services See details
Hearing exams and prescription hearing aids are covered, with routine hearing exams and fitting/evaluation for hearing aids covered once per year. Hearing exams have a coinsurance of 50%, and prescription hearing aids have a copay between $399 and $1800. OTC Hearing Aids, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, routine eye exams once per year, and eyewear with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers dental services, including oral exams, dental x-rays, and other diagnostic and preventive services with no copay. Medicare Dental Services have a $40 copay and require prior authorization, and the plan has an annual maximum benefit of $1,100.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with prior authorization, and the coinsurance is 20%.
Medical Equipment See details
Medical equipment benefits are covered by Cigna Achieve Medicare (HMO C-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Equipment requires prior authorization; however, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts 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 $50, and lab services with no copay. Therapeutic Radiological Services have a coinsurance up to 20%, while diagnostic radiological services have a copay up to $225, and outpatient X-ray services have a $20 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan, with a prior authorization requirement. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include coverage for over-the-counter (OTC) items and meal benefits. This plan offers a $45 allowance for OTC items every three months, and meal benefits for chronic or medical conditions. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved