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Cigna Preferred PA Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred PA 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 PA Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred PA 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 PA 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 PA 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 PA 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 $3900.00 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 PA Medicare (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you may have reduced costs.
Additional Benefits
The Cigna Preferred PA Medicare (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, while outpatient services have copays that vary by service. The plan also includes coverage for ambulance services, emergency care, primary care, preventive services, and home health services. Additional benefits include hearing and vision services with copays, dental services with varying copays, and coverage for medical equipment and diagnostic services. The plan also covers skilled nursing facility stays with copays after the first 20 days. There is a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you pay a $260 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you pay a $324 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered by the Cigna Preferred PA Medicare (HMO) 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 $325, observation services have a $325 copay, ambulatory surgical center services have no copay, and both individual and group outpatient substance abuse sessions have a $20 copay. Outpatient blood services include an enhanced benefit with three pints deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred PA Medicare (HMO) plan, with a copay of $85.00. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $220 copay, while air ambulance services have a 20% coinsurance; transportation services to a plan-approved health-related location are covered for 12 one-way trips per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Cigna Preferred PA Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay. Worldwide Emergency Services also covers Worldwide Urgent Coverage and Worldwide Emergency Transportation, each with a $125 copay and a maximum plan benefit of $50,000.
Primary Care See details
The Cigna Preferred PA Medicare (HMO) plan covers Primary Care Physician services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services, with a $20 copay for Chiropractic Services, Physician Specialist Services, Occupational Therapy Services, and Physical Therapy and Speech-Language Pathology Services. The plan's Mental Health Specialty Services and Psychiatric Services are not covered. The plan also covers Other Health Care Professional services, Opioid Treatment Program Services and Additional Telehealth Benefits with a copay ranging from $0 to $20.
Preventive Services See details
The Cigna Preferred PA Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, additional preventive services, health education, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and support for caregivers with personalized resources. Home and bathroom safety devices and modifications are covered with a maximum benefit of $1500 once per lifetime. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $20 copay. Fitting/Evaluation for Hearing Aid is covered and Prescription Hearing Aids (all types) are covered with a copay between $399 and $1800. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, as well as OTC Hearing Aids, are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0-$20, and eyewear benefits, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum plan benefit of $250 every year, and contact lenses are unlimited.
Dental Services See details
Dental services are covered, including oral exams with a $20 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Restorative services have a copay between $0 and $550, adjunctive general services have a copay between $0 and $285, endodontics have a copay between $0 and $675, periodontics have a copay between $0 and $595, prosthodontics (removable) have a copay between $25 and $615, prosthodontics (fixed) have a copay between $50 and $525, and oral and maxillofacial surgery is covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay and 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred PA Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by the Cigna Preferred PA Medicare (HMO) plan, with Durable Medical Equipment subject to 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts are covered, with Prosthetic Devices and Diabetic Therapeutic Shoes/Inserts subject to 20% coinsurance, and Medical Supplies subject to 20% coinsurance. Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna Preferred PA 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 $250, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred PA Medicare (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically 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 PA Medicare (HMO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
The Cigna Preferred PA Medicare (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $40.00 every three months, and also offers a meal benefit for chronic illnesses 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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