A non-government entity
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 Western 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. 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 $2200.00 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:
Sign up for Cigna Preferred Medicare (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Cigna Preferred Medicare (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and where you fill your prescription. 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 your covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), where you will pay $0.00.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find coverage for ambulance, emergency, primary care, and preventive services, many with no copay. The plan also includes benefits for hearing, vision, dental, and home health services, as well as other services such as medical equipment, diagnostic services, and skilled nursing facilities. Additional benefits include coverage for partial hospitalization, home infusion, and dialysis services. The plan provides coverage for eyewear, and dental services with varying copays. The plan offers coverage for home safety devices up to $1500 once per lifetime, and over-the-counter items with a maximum benefit of $30 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $115 for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric benefits are also covered, with a copay of $175 for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered, 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 $175, observation services have a $175 copay, ambulatory surgical center services have no copay, and outpatient substance abuse services have a $25 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. You will have a copay of $85 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Preferred Medicare (HMO) plan. Ground Ambulance Services have a $230 copay, and Air Ambulance Services have a 20% coinsurance, while Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $65 copay. Worldwide Emergency Services have a maximum benefit of $50,000.
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 $25 copay), physician specialist services (with a $25 copay), physical therapy and speech-language pathology services (with a $25 copay), and other health care professional services (with a copay ranging from $0 to $25). Mental health specialty services and psychiatric services are not covered for individual or group sessions. This plan also offers additional telehealth benefits with a copay ranging from $0 to $25.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan also covers home and bathroom safety devices and modifications up to $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, support for caregivers of enrollees, 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 hearing exams with a $25 copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, while hearing aids for the inner ear, outer ear, and over-the-ear are not covered, along with OTC hearing aids.
Vision Services See details
Vision Services include eye exams with a copay of $0-$30, as well as coverage for eyewear. Eyewear includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Eyewear has a combined maximum benefit of $250 every year.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a $25 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services with a copay between $0 and $550, adjunctive general services with a copay between $0 and $285, endodontics with a copay between $0 and $675, periodontics with a copay between $0 and $595, prosthodontics (removable) with a copay between $25 and $615, prosthodontics (fixed) with a copay between $50 and $525, and oral and maxillofacial surgery. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and 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 by the Cigna Preferred Medicare (HMO) plan. You will pay 20% coinsurance for this benefit, and prior authorization is required.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but 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 $100, Lab Services with no copay, Diagnostic Radiological Services with a copay up to $195, Therapeutic Radiological Services with a $60 copay, and Outpatient X-Ray Services with a $35 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by Cigna Preferred Medicare (HMO) with no copay or coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Cigna Preferred Medicare (HMO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan with prior authorization. You will have no copay for days 1-20, and 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 every three months, as well as a Meal Benefit. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved