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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 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 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 $1250.00 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 your prescriptions, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies, while standard generic drugs have a $45 copay. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Cigna Preferred Plus Medicare (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays depending on the service. The plan also includes coverage for emergency services, ambulance services, and a variety of primary care services. This plan provides coverage for vision, hearing, and dental services, with copays for exams and specific services. It also covers home health services and skilled nursing facilities, but with copays and prior authorization required for some services. Additionally, the plan offers an over-the-counter (OTC) benefit, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered by the Cigna Preferred Plus Medicare (HMO) plan. For Inpatient Hospital-Acute, there is a $250 copay per admission or stay. For Inpatient Hospital Psychiatric, there is a $225 copay for days 1-7, and no copay for days 8-90. Additional days, non-Medicare covered stays, and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $175, observation services with a $175 copay, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services are covered with a $25 copay for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Cigna Preferred Plus Medicare (HMO) covers partial hospitalization with an $85 copay. Prior authorization is required for this benefit.
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 $230 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. 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 Plus Medicare (HMO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $65 copay, while Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay.
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 $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 and Opioid Treatment Program Services with a copay between $0 and $25. The plan does not cover Routine Chiropractic Care, individual or group sessions for Mental Health Specialty Services, individual or group sessions for Psychiatric Services, or Podiatry Services.
Preventive Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers a variety of preventive services, including annual physical exams, health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit; however, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered. Some services are covered, but the following are not covered: In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing services with the Cigna Preferred Plus Medicare (HMO) plan include hearing exams with a $25 copay, routine hearing exams, and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids (all types) are covered with a copay between $399 and $1800 per year; however, 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
Vision Services include coverage for eye exams with a copay of $0-$25, and eyewear with a combined maximum benefit of $250 every year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental services are covered under the Cigna Preferred Plus Medicare (HMO) plan, with a $25 copay for Medicare dental services. Other services include oral exams with a limit of 4 per year, dental x-rays, other diagnostic dental services, prophylaxis (cleaning) with a limit of 2 per year, fluoride treatment with a limit of 2 per year, other preventative dental services, restorative services with copays from $0-$550, adjunctive general services with copays from $0-$285, endodontics with copays from $0-$675, periodontics with copays from $0-$595, prosthodontics, removable with copays from $25-$615, and prosthodontics, fixed with copays from $50-$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, but prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
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, including Durable Medical Equipment (DME), prosthetics, medical supplies, and diabetic equipment, are covered by the Cigna Preferred Plus Medicare (HMO) plan. DME has a 20% coinsurance, while prosthetic devices and medical supplies have a 20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, are covered with a copay between $0 and $50. Lab services have no copay, while diagnostic radiological services have a copay up to $220, therapeutic radiological services have a $60 copay, and outpatient X-rays have a $20 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 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 not covered by the Cigna Preferred Plus Medicare (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation 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 and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and a meal benefit, but acupuncture, Dual Eligible SNPs, 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. The OTC benefit offers up to $50 every three months, including Nicotine Replacement Therapy and Naloxone coverage.
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