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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 Baltimore. 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 $67.00. 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 $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 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 will pay nothing for your Part D covered drugs.
Additional Benefits
The Cigna Achieve Medicare (HMO C-SNP) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have a $350 copay per day for the first few days, while outpatient services have copays ranging from $0 to $400. Emergency, primary care, and preventive services often have copays, and the plan covers hearing, vision, and dental services, each with its own set of copays, coinsurance, and annual maximums. This plan provides coverage for home health, medical equipment, and home infusion services with copays and coinsurance, and also includes services like ambulance, diagnostic, and skilled nursing facility care. However, some services are not covered, such as cardiac rehabilitation, additional hours of care, and many "other services" like acupuncture and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For the first 6 days of an Inpatient Hospital-Acute stay, the copay is $350 per day, and there is no copay for days 7-90; for the first 5 days of an Inpatient Hospital Psychiatric stay, the copay is $350 per day, and there is no copay for days 6-90. Additional days and non-Medicare-covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $400, observation services have a $400 copay, and ambulatory surgical center (ASC) services have no copay. Individual and group sessions for outpatient substance abuse have a $45 copay. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Achieve Medicare (HMO C-SNP) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Achieve Medicare (HMO C-SNP). Ground ambulance services have a $215 copay, while air ambulance services have a 20% coinsurance; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Cigna Achieve Medicare (HMO C-SNP) plan. Emergency Services have a $110 copay, and Urgently Needed Services have a $45 copay, with no coinsurance for either. Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, with no coinsurance, and 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, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $35 copay, Physician Specialist Services with a $45 copay, Physical Therapy and Speech-Language Pathology Services with a $35 copay, Other Health Care Professional services with a copay between $0 and $45, and Opioid Treatment Program Services with a $45 copay. Mental Health Specialty Services 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 $45.
Preventive Services See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers preventive services with no copay, including health education, fitness benefits, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay, with routine hearing exams and fitting/evaluation for hearing aids covered once per year. Prescription hearing aids are covered with a copay between $399 and $1800 for all types, with two visits per year, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$45. This plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 every year, and includes upgrades.
Dental Services See details
Dental Services are covered, with a $5,000 annual maximum benefit. Medicare Dental Services require prior authorization and have a $45 copay. Other covered services include oral exams (4 visits per year), dental x-rays (complete series x-rays and panoramic x-rays are limited to once every three years, and four bitewing x-rays are covered every year), other diagnostic dental services, prophylaxis (cleaning) (2 visits per year), fluoride treatment (2 visits per year), other preventive dental services, adjunctive general services, and periodontics. Restorative Services, Endodontics, Prosthodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
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 coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance ranges from 0-20%.
Dialysis Services See details
Dialysis services are covered under the Cigna Achieve Medicare (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered by Cigna Achieve Medicare (HMO C-SNP), including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance with no copay, and 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, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $250, Therapeutic Radiological Services with a coinsurance of at least 20%, and Outpatient X-Ray Services with a $40 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan with no copay and no coinsurance, but require authorization. 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 Achieve Medicare (HMO C-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services with the Cigna Achieve Medicare (HMO C-SNP) plan are not covered, including acupuncture, over-the-counter items, 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. The plan does cover a Meal Benefit.
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