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Cigna Preferred Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred 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 Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Central Pennsylvania. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Cigna Preferred 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 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 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 $5100.00 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 Medicare (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. These copays vary based on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies, while standard generic drugs have a $45 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays depending on the service. You'll find coverage for primary care, hearing, vision, and dental services, each with specific copayments. Additional benefits include ambulance services, emergency care, and home health services, and a range of diagnostic and therapeutic services. The plan also covers prescription hearing aids and has a $20,000 annual maximum for dental services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For Inpatient Hospital-Acute, you'll pay a $165 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $175 copay for days 1-8, and no copay for days 9-90.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $335, Observation Services with a $335 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with a $40 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 Medicare (HMO) plan, but requires prior authorization. You will have a $70 copay for this benefit.
Ambulance and Transportation Services See details
The Cigna Preferred Medicare (HMO) plan covers ambulance and transportation services, including both ground and air ambulance services, as well as transportation to plan-approved health-related locations. Ground ambulance services have a $195 copay, while air ambulance services have 20% coinsurance. 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 under the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Emergency Transportation each have a $125 copay, while Urgently Needed Services have a $55 copay; all services have no coinsurance.
Primary Care See details
The Cigna Preferred 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 $40 copay, and physical therapy and speech-language pathology services with a $35 copay. The plan also covers additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services with a $40 copay. However, routine chiropractic care, individual and group mental health sessions, podiatry services, and individual/group psychiatric sessions are not covered.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services including annual physical exams, health education, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. 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, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, a fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $25 copay, routine hearing exams and fitting/evaluation for hearing aids are each covered once per year, and prescription hearing aids have a copay between $399 and $1800 depending on the type of aid. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are OTC hearing aids.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including routine eye exams with a copay between $0 and $45, and eyewear with a combined maximum benefit of $200 every year. Contact lenses and upgrades are also covered.
Dental Services See details
Dental Services are covered by Cigna Preferred Medicare (HMO), including Medicare Dental Services with a $40 copay, and other services such as oral exams with a copay, dental x-rays, and other diagnostic services, prophylaxis (cleaning), fluoride treatments, other preventive services, restorative services with copays ranging from $0 to $550, adjunctive general services with copays ranging from $0 to $285, endodontics with copays ranging from $0 to $675, periodontics with copays ranging from $0 to $595, prosthodontics, removable with copays ranging from $25 to $615, and prosthodontics, fixed with copays ranging from $50 to $525, and oral and maxillofacial surgery; however, maxillofacial prosthetics, implants, and orthodontics are not covered. There is a maximum plan benefit of $20,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment coverage under the Cigna Preferred Medicare (HMO) plan includes Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 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 all diagnostic services, 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 $50 copay, and outpatient X-ray services with a $40 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred 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 not covered by the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan. There is no copay for days 1-20, and a $214 copay per day for days 21-100.
Other Services See details
Other Services benefits are covered by the Cigna Preferred Medicare (HMO) plan, with the exception of 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, which are not covered. The plan covers over-the-counter items up to $50 every three months, and offers a meal benefit for a chronic illness or medical condition requiring the enrollee to remain at home.
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