A non-government entity
Cigna Preferred DC Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred DC Medicare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Preferred DC Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred DC Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Washington DC. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna Preferred DC Medicare (HMO) 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 Preferred DC Medicare (HMO).
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 Preferred DC Medicare (HMO), 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $5200.00 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 Preferred DC Medicare (HMO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $4 at preferred pharmacies and mail order, and $15 at standard pharmacies. Standard generic drugs have a $45 copay at preferred pharmacies and mail order, and a $47 copay at standard pharmacies. Preferred brand drugs have a $100 copay at all pharmacies, and non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna Preferred DC Medicare (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. You can expect to pay a copay for primary care visits, specialist visits, and other services like hearing exams and vision care. Dental services are covered with a maximum annual benefit, and there's also coverage for home health services with no copay, as well as other services like ambulance, emergency, and skilled nursing facilities. This plan includes coverage for preventive services, hearing aids, and eyewear, along with some prescription hearing aids. Diagnostic and radiological services, as well as medical equipment, are covered with copays or coinsurance. The plan also provides an allowance for over-the-counter items, and additional services like cardiac rehabilitation.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, which require prior authorization. For the first 5 days, there is a $260 copay, and days 6-90 have no copay. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $245, observation services have a $245 copay, individual and group sessions for outpatient substance abuse have a $40 copay, and ambulatory surgical center services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred DC Medicare (HMO) plan, with a $105 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Preferred DC Medicare (HMO) plan. Ground ambulance services have a $205 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $55 copay, but there is no coinsurance for any of these services.
Primary Care See details
The Cigna Preferred DC Medicare (HMO) plan covers primary care, chiropractic services (with a $20 copay), occupational therapy (with a $40 copay), physician specialist services (with a $40 copay), physical therapy and speech-language pathology services (with a $40 copay), and opioid treatment program services (with a copay of $40). Mental health specialty services and psychiatric services do not cover individual or group sessions, while podiatry services are not covered. The plan also covers additional telehealth benefits with a copay between $0 and $40.
Preventive Services See details
Preventive services are covered, including Medicare-covered services, annual physical exams, and additional preventive services. Health education and fitness benefits are covered, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services include coverage for hearing exams with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$40. Eyewear is covered with a combined maximum benefit of $200 per year, and contact lenses are also covered.
Dental Services See details
The Cigna Preferred DC Medicare (HMO) plan covers dental services with a $20,000 maximum benefit per year. Medicare dental services have a $40 copay, while other dental services include oral exams with a copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services with a copay, adjunctive general services with a copay, endodontics with a copay, periodontics with a copay, prosthodontics (removable) with a copay, prosthodontics (fixed) with a copay, and oral and maxillofacial surgery with a copay. Maxillofacial prosthetics, implant services, and orthodontics are not 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 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 by the Cigna Preferred DC Medicare (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Cigna Preferred DC Medicare (HMO) plan, 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, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
The Cigna Preferred DC Medicare (HMO) plan covers diagnostic and radiological services, 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 $60 copay, and outpatient X-ray services with a $35 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred DC Medicare (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Cigna Preferred DC Medicare (HMO) plan, 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 this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred DC Medicare (HMO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214; additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
The Cigna Preferred DC Medicare (HMO) plan covers Over-the-Counter (OTC) items with a $45 allowance every three months, including nicotine replacement therapy and Naloxone. 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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