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Cigna TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare (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 (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Baltimore/Delaware. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna TotalCare (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $23.20. 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 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After you meet your deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS). With LIS, you will pay $23.20 for Part D. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a range of benefits including coverage for inpatient and outpatient services, with varying copays and coinsurance depending on the service. You will have no copay for home health services, and skilled nursing facilities have no copay for the first 20 days. This plan also includes coverage for vision, dental, and hearing services, with specific limits and cost-sharing. Additionally, the plan provides coverage for emergency services, ambulance, and transportation services, with a $110 copay for emergency services and a 20% coinsurance for ambulance.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $360 per day for days 1-6 and no copay for days 7-90 for acute care, and a copay of $350 per day for days 1-5 and no copay for days 6-90 for psychiatric care. Additional days and non-Medicare-covered stays for both acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a coinsurance between 0% and 20%, and observation services with a 20% coinsurance. Ambulatory Surgical Center (ASC) Services are covered with a coinsurance between 0% and 20%, while Outpatient Substance Abuse Services, including individual and group sessions, have a 20% coinsurance. Outpatient Blood Services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna TotalCare (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 the Cigna TotalCare (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with no copay. 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 under the Cigna TotalCare (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, and Urgently Needed Services have a $45 copay, with no coinsurance for any of these services.
Primary Care See details
The Cigna TotalCare (HMO D-SNP) plan covers primary care physician services, chiropractic services with 20% coinsurance (prior authorization required), occupational therapy services with 20% coinsurance, physician specialist services with 20% coinsurance (prior authorization required), podiatry services with 20% coinsurance, other health care professional services with 0-20% coinsurance (prior authorization required), physical therapy and speech-language pathology services with 20% coinsurance, additional telehealth benefits with 0-20% coinsurance, and opioid treatment program services with 20% coinsurance (prior authorization required). Routine chiropractic care and individual and group sessions for mental health specialty services and psychiatric services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, an annual physical exam, health education, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered. However, in-home safety assessment, personal emergency response system (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers a fitness benefit.
Hearing Services See details
Hearing Services include Routine Hearing Exams, Fitting/Evaluation for Hearing Aids, and Prescription Hearing Aids. Routine Hearing Exams and Fitting/Evaluation for Hearing Aids are covered with no coinsurance, limited to one visit per year. Prescription Hearing Aids have a copay between $399 and $1800 per year, and Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered.
Vision Services See details
Vision services include coverage for eye exams with a coinsurance of 0% - 20%, eyewear with a combined maximum benefit of $150 every year, contact lenses, eyeglasses (lenses and frames), eyeglass lenses (1 pair every year), eyeglass frames (1 frame every year), and upgrades.
Dental Services See details
The Cigna TotalCare (HMO D-SNP) plan covers dental services, including Medicare dental services with 20% coinsurance and other dental services up to a $20,000 annual maximum. The plan covers oral exams (4 visits per year), dental X-rays (limited to 1 complete series or panoramic x-ray every three years and 4 bitewing x-rays per year), other diagnostic dental services, prophylaxis (cleaning) up to 2 visits per year, fluoride treatments (2 visits per year), and other preventive dental services. However, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered, and orthodontics is covered under the Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. 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 TotalCare (HMO D-SNP) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical equipment is covered by the Cigna TotalCare (HMO D-SNP) plan, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a coinsurance of up to 20%, while Lab Services have no copay. Diagnostic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20% and a minimum coinsurance of 20%, and Therapeutic Radiological Services have a coinsurance of up to 20% and a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare (HMO D-SNP) plan, with no copay or coinsurance. 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 TotalCare (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna TotalCare (HMO D-SNP) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Cigna TotalCare (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $50 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone, and a meal benefit, but 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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