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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 Delaware. This plan received an overall rating of 3 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 $25.20. 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 $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00. If you qualify for the low-income subsidy, you will pay $25.20 for Part D. Once your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna TotalCare Plus (HMO D-SNP) plan offers a wide range of benefits with varying cost-sharing. This plan includes coverage for inpatient and outpatient hospital services, with copays or coinsurance depending on the service. You'll also find coverage for emergency services, ambulance services, and transportation to health-related locations. This plan includes coverage for primary care, preventive services, hearing, vision, and dental services. You can expect to pay coinsurance for many services, while some preventive services have no copay. Additionally, the plan offers benefits like home health services with no copay, coverage for medical equipment, and other services like OTC items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital coverage, including Acute and Psychiatric, is covered by the Cigna TotalCare Plus (HMO D-SNP) plan. The plan requires prior authorization and has a copay, with additional details available in the plan documents.
Outpatient Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers outpatient services, including outpatient hospital services with a coinsurance of 0% - 20%, observation services with a 20% coinsurance, ambulatory surgical center (ASC) services with a coinsurance between 0% and 20%, individual and group outpatient substance abuse sessions with a 20% coinsurance, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna TotalCare Plus (HMO D-SNP) plan, with a copay of $80.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna TotalCare Plus (HMO D-SNP). Ground and air ambulance services have a 20% coinsurance, with no copay, and transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Cigna TotalCare Plus (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services have a $45 copay.
Primary Care See details
Cigna TotalCare Plus (HMO D-SNP) covers Primary Care, with a 20% coinsurance for Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services do not cover all sub-services, and Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, and Individual Sessions for Psychiatric Services are not covered. Occupational Therapy Services, Podiatry Services, Other Health Care Professional, Additional Telehealth Benefits, and Opioid Treatment Program Services are also covered with varying coinsurance amounts.
Preventive Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers a variety of preventive services, including Medicare-covered services with no copay, annual physical exams with a 20% coinsurance, health education, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and fitness benefits. However, services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered.
Hearing Services See details
Hearing services include hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a coinsurance of at most 20%, while prescription hearing aids have a copay between $399 and $1800. Inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers vision services, including routine eye exams with a coinsurance of 0% to 20% and one exam per year. Eyewear is covered, with a combined maximum benefit of $150.00 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with 20% coinsurance and other dental services with a maximum benefit of $2600 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, and oral and maxillofacial surgery are also covered. Orthodontic services are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna TotalCare Plus (HMO D-SNP) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Other Medicare Part B drugs have 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 coverage includes Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, are covered with a coinsurance of up to 20%, while lab services have no copay. Radiological services are also covered, with a coinsurance of up to 20% for diagnostic, therapeutic, and outpatient X-ray services.
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 the plan does not cover the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered. Prior authorization is required, and you will pay the Medicare-defined cost share for tier 1 with cost sharing on the day of discharge.
Other Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $135.00 every three months, and also offers a meal benefit for chronic illnesses and for medical conditions that require the enrollee to remain at home for a period of time. 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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