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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 Lehigh Valley. 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 $25.00. 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 $4200.00 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. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, you will pay a $4 copay at preferred pharmacies and a $15 copay at standard pharmacies. For standard generic drugs, the copay is $45 at preferred pharmacies and $47 at standard pharmacies. For preferred brand drugs, the copay is $100 regardless of pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna Preferred Plus Medicare (HMO) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency, urgent, and worldwide emergency services have copays, and primary care, including specialist visits, has a $15-$30 copay. Preventive services are covered, and hearing and vision services are included with copays. Dental services are covered with copays, and other benefits include ambulance, home health, and skilled nursing facility services. This plan also includes coverage for home infusion, dialysis, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered with prior authorization. For acute inpatient hospital stays, you'll pay a $180 copay for days 1-6, and no copay for days 7-90; for psychiatric stays, the copay is $200 for days 1-6, and no copay for days 7-90. Additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $260, and Observation Services have a $260 copay, while Ambulatory Surgical Center Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a $30 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Plus Medicare (HMO) plan and requires prior authorization. The copay for this benefit is $85.
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; 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 Preferred Plus Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all have 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 $30 copay, specialist physician services with a $30 copay, physical therapy and speech-language pathology services with a $30 copay, telehealth services with a copay between $0 and $30, and opioid treatment program services with a $30 copay. However, routine chiropractic care, individual and group mental health sessions, podiatry services, and individual and group psychiatric sessions are not covered.
Preventive Services See details
Preventive Services are covered by the Cigna Preferred Plus Medicare (HMO) plan, including Medicare-covered zero dollar preventive services, annual physical exams, and additional preventive services. Some preventive services, like in-home safety assessments and counseling services, are not covered.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $30 copay. Fitting/evaluation for hearing aids is covered. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, but prescription hearing aids for the 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 between $0 and $35, and eyewear with a combined maximum benefit of $225 per year. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers dental services, including oral exams with a $30 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are also covered with varying copays. However, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance of 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Plus Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Cigna Preferred Plus Medicare (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. Diabetic Equipment is covered with coinsurance, but Diabetic Supplies are not covered, and Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services, are covered under 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 $225, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $35 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered by the Cigna Preferred Plus Medicare (HMO) plan, 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 for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Plus Medicare (HMO) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100.
Other Services See details
Other Services includes Over-the-Counter (OTC) Items with a maximum benefit of $30.00 every three months and a meal benefit for chronic illnesses or medical conditions requiring you to stay home, but 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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