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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 Pennsylvania. This plan received an overall rating of 3.5 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 $29.70. 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 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 $2,000. If you qualify for the low-income subsidy (LIS), you will pay $29.70 per month for Part D. Once your yearly out-of-pocket drug costs reach $2,000, you will pay nothing for your 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 covers outpatient services, including substance abuse and blood services, with a coinsurance of 0-20%, and also covers emergency services with a $110 copay. It also provides coverage for primary care, preventive services, hearing, vision, and dental services, with a mix of copays and coinsurance depending on the service. This plan includes coverage for medical equipment, diagnostic and radiological services, and home health services with no copay. In addition, the plan offers other services such as over-the-counter items, and a meal benefit. However, certain services like additional inpatient hospital days, personal care services, and some rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage, including acute and psychiatric, is covered by the Cigna TotalCare Plus (HMO D-SNP) plan; however, additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered. You must pay the Medicare-defined cost share for tier 1, and the copay information is available within the plan details.
Outpatient Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers outpatient services, including outpatient hospital services with a 0% to 20% coinsurance, observation services with a 20% coinsurance, and ambulatory surgical center (ASC) services with a coinsurance between 0% and 20%. This plan also covers outpatient substance abuse services, including individual and group sessions, each with a 20% coinsurance, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna TotalCare Plus (HMO D-SNP) plan with a 20% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna TotalCare Plus (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to plan-approved health-related locations are covered. 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. Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, and Urgently Needed Services has a $45 copay, all with no coinsurance.
Primary Care See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Other Health Care Professional, Opioid Treatment Program Services, and Additional Telehealth benefits. Chiropractic and Physician Specialist Services have a 20% coinsurance, and routine chiropractic care is not covered. Occupational Therapy, Other Health Care Professional, and Opioid Treatment Program Services have a 20% coinsurance. Mental Health Specialty Services and Psychiatric Services do not cover individual or group sessions. Physical Therapy and Speech-Language Pathology Services have a 20% coinsurance. Additional Telehealth benefits have a 0-20% coinsurance. Podiatry Services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as annual physical exams with 20% coinsurance. Additional preventive services include Health Education and Fitness Benefit, but the plan does not cover 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 (including Web/Phone-based technologies and Nursing Hotline), and Counseling Services.
Hearing Services See details
Hearing Services include routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $399 and $1800 for all types of prescription hearing aids, but not for inner ear, outer ear, or over the ear hearing aids. 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 0-20% coinsurance, and eyewear with a combined maximum of $500 per year. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered under the Cigna TotalCare Plus (HMO D-SNP) plan, with a 20% coinsurance for Medicare Dental Services, and other dental services are covered up to a $1200 annual maximum. 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, oral and maxillofacial surgery, and orthodontics are all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by 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%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna TotalCare Plus (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna TotalCare Plus (HMO D-SNP) plan. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of at most 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services also have a coinsurance of at most 20%.
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. Authorization is required for this benefit.
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) benefits are covered, but the plan does not cover additional days beyond Medicare-covered SNF or non-Medicare-covered SNF stays. Prior authorization is required, and you will have a copay, but the specific amount is not provided.
Other Services See details
Other Services include over-the-counter items with a maximum benefit of $260 every three months, and a meal benefit for chronic illness or medical conditions that require the enrollee to remain at home. 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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