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Cigna Achieve Medicare (HMO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Achieve Medicare (HMO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Achieve Medicare (HMO C-SNP) in 2025, please refer to our full plan details page.
Cigna Achieve Medicare (HMO C-SNP) is a HMO C-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Philadelphia. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Cigna Achieve Medicare (HMO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna Achieve Medicare (HMO C-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 Achieve Medicare (HMO C-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 Achieve Medicare (HMO C-SNP), 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 $4400.00 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 Achieve Medicare (HMO C-SNP) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $4 copay at preferred pharmacies, while standard generic drugs have a $45 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Cigna Achieve Medicare (HMO C-SNP) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, while outpatient services and primary care physician visits may have no copay. This plan includes coverage for hearing, vision, and dental services, with copays for exams and specific procedures. It also covers ambulance services, emergency care, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the Cigna Achieve Medicare (HMO C-SNP) plan. For Inpatient Hospital-Acute, you'll pay a $290 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $230 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient Services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $290, and Observation Services have a $290 copay. Ambulatory Surgical Center Services have no copay, and both individual and group sessions for outpatient substance abuse have a copay of $20.
Partial Hospitalization See details
Partial hospitalization is covered by the Cigna Achieve Medicare (HMO C-SNP) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Achieve Medicare (HMO C-SNP). Ground ambulance services have a $200 copay, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all have no coinsurance. Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $125 copay and no coinsurance.
Primary Care See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $20 copay, and physical therapy services with a $20 copay. Physician specialist services, mental health specialty services, and psychiatric services are also covered, but individual and group sessions for these services are not covered. Additional telehealth benefits are available with a copay between $0 and $20, and opioid treatment program services are covered with a $20 copay.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Some services like In-Home Safety Assessment, Personal Emergency Response System, and others are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $20 copay. Prescription hearing aids are covered with a copay between $399 and $1800, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with a copay of $0-$20, and eyewear with a combined maximum of $200 every 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 Achieve Medicare (HMO C-SNP) plan, with a $20 copay for Medicare Dental Services. Other dental services include oral exams with a limit of 4 visits per year, dental x-rays limited to 1 series every 3 years, other diagnostic dental services, prophylaxis (cleaning) with a limit of 2 visits per year, fluoride treatments with a limit of 2 per year, and other preventive dental services. Restorative Services have a copay ranging from $0.00 to $550.00, Adjunctive General Services have a copay ranging from $0.00 to $285.00, Endodontics has a copay ranging from $0.00 to $675.00, Periodontics has a copay ranging from $0.00 to $595.00, Prosthodontics, removable has a copay ranging from $25.00 to $615.00, and Prosthodontics, fixed has a copay ranging from $50.00 to $525.00. Orthodontics and Maxillofacial Prosthetics 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 with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna Achieve Medicare (HMO C-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Cigna Achieve Medicare (HMO C-SNP) plan covers Durable Medical Equipment with a 20% coinsurance, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, 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 $25 copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Cigna Achieve Medicare (HMO C-SNP) plan with no copay and no coinsurance, but require authorization. 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 Achieve Medicare (HMO C-SNP) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Cigna Achieve Medicare (HMO C-SNP) plan. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefits, while Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered. The plan offers up to $30 every three months for OTC items.
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