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Cigna Preferred Plus Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred Plus 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 Plus Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred Plus Medicare (HMO) is a HMO 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 Preferred Plus 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 Plus 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 Plus Medicare (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $20.00. 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 $6750.00 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 Plus Medicare (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for each drug based on its tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies and a $15 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs.
Additional Benefits
The Cigna Preferred Plus Medicare (HMO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient services, with copays that vary depending on the specific service. Emergency, urgent, and worldwide emergency services are covered with copays, as are primary care, specialist visits, and therapies. This plan also includes coverage for preventive services, hearing, vision, and dental care. Additionally, it provides benefits for home health, medical equipment, and diagnostic services, with some services requiring copays or coinsurance. The plan also covers transportation, and offers additional benefits like over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Cigna Preferred Plus Medicare (HMO) plan, with a copay of $285 for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has a copay of $350 for days 1-5 and no copay for days 6-90, and additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered by Cigna Preferred Plus Medicare (HMO), with copays ranging from $0 to $325. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $35 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Plus Medicare (HMO) plan, requiring prior authorization, with an $85 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Preferred Plus Medicare (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location are covered for up to 12 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna Preferred Plus Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; there is no coinsurance for any of these services. Worldwide Emergency Transportation and Worldwide Urgent Coverage also have a $125 copay, and there is no coinsurance.
Primary Care See details
The Cigna Preferred Plus Medicare (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, physical therapy and speech-language pathology services with a $35 copay, and other health care professional services with a copay between $0 and $35. Mental health and psychiatric services are partially covered, and podiatry services are not covered. Additional telehealth benefits are covered with a copay between $0 and $35, and opioid treatment program services are covered with a copay between $35.
Preventive Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers preventive services, including annual physical exams, with no copay. The plan also covers health education, support for caregivers, home and bathroom safety devices and modifications with a maximum benefit of $1,500 once per lifetime, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit. Some services, like in-home safety assessments and counseling services, are not covered.
Hearing Services See details
Hearing services are covered by the Cigna Preferred Plus Medicare (HMO) plan, including hearing exams with a $30 copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers vision services including eye exams with a copay of $0-$35, and routine eye exams once per year. The plan also covers eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $250 every year.
Dental Services See details
Dental services include coverage for Medicare dental services with a $35 copay, and other dental services with a $4,000 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 under the Cigna Preferred Plus Medicare (HMO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Plus Medicare (HMO) plan, but require prior authorization. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Cigna Preferred Plus Medicare (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna Preferred Plus Medicare (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Plus Medicare (HMO) plan with no copay and no 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 generally covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Plus Medicare (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $40 every three months. Other services, including acupuncture, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more, are not covered.
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