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Cigna Preferred Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred 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 Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Washington DC/Delaware. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna Preferred 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 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 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.
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:
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Drug Coverage
The Cigna Preferred Medicare (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies and mail order, and $15 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage with varying costs for different services. Inpatient hospital stays have a $285 copay for the first five days, with no copay for days 6-90. Outpatient services have copays ranging from $0 to $300. The plan also includes coverage for emergency services, primary care, preventive services, hearing, vision, dental, and other services. This plan provides coverage for ambulance services, with a $205 copay for ground transport and 20% coinsurance for air transport, as well as home health and skilled nursing services. Diagnostic and radiological services, medical equipment, and home infusion are covered, with specific copays or coinsurance amounts. Additional benefits include an OTC allowance and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Cigna Preferred Medicare (HMO) plan. For days 1-5, there is a $285 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and outpatient substance abuse services, are covered by the Cigna Preferred Medicare (HMO) plan. Outpatient hospital services have a copay between $0 and $300, observation services have a $300 copay, individual and group outpatient substance abuse sessions have a $40 copay, and Ambulatory Surgical Center (ASC) Services have no copay.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO). Ground ambulance services have a $205 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, including Worldwide Emergency Services, have a copay of $125.00, with no coinsurance. Urgently Needed Services have a copay of $55.00, with no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, physician specialist services with a $40 copay, other health care professional services with a copay of $0-$40, physical therapy and speech-language pathology services with a $40 copay, and additional telehealth benefits with a copay of $0-$40. Mental health specialty services and psychiatric services individual and group sessions are not covered, as are podiatry services.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services with no copay, an annual physical exam, health education, kidney disease education services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs after the Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing services with the Cigna Preferred Medicare (HMO) plan include hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a copay between $399 and $1800. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services, including eye exams, are covered. Eye exams have a copay of $0 - $40. Eyewear is covered, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames; this plan offers a combined maximum of $200 per year for eyewear.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $40 copay, Oral Exams (4 visits per year), Dental X-Rays (limited to one complete series of x-rays every three years and four bitewing x-rays per year), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (2 visits per year), Fluoride Treatment (2 visits per year), Other Preventive Dental Services, and Adjunctive General Services. Restorative Services, Endodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered. There is a $5,000 maximum plan benefit coverage per year for this benefit.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance; however, Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, 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 Medicare (HMO) plan with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.
Other Services See details
Other services include coverage for Over-the-Counter (OTC) items and a meal benefit, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. The OTC benefit provides up to $50 every three months and includes nicotine replacement therapy and Naloxone coverage.
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