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 Northwest 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 $2000.00 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. In the initial coverage phase, you will pay a copay for each drug tier, with the copay varying depending on the drug and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, and you will pay nothing for your Part D covered drugs. This plan may have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage for a variety of medical services. Inpatient hospital stays have a copay, and outpatient services like doctor visits and outpatient hospital services have copays that vary. The plan also provides coverage for preventive services, hearing and vision services, and dental services. Additionally, the plan covers home health services, skilled nursing facility stays, and offers an over-the-counter item benefit.
Inpatient Hospital See details
Inpatient Hospital coverage is provided, with a copay of $140 per day for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute. Inpatient Hospital Psychiatric has a copay of $100 for days 1-5, and no copay for days 6-90. Additional days and non-Medicare-covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $170, Observation Services with a $170 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. The plan has an $85 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO), with prior authorization required for all ambulance services. Ground ambulance services have a $230 copay, while air ambulance services have a 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 by the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $65 copay. Worldwide Emergency Services has a maximum benefit coverage 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 $30 copay, physician specialist services with a $30 copay, physical therapy and speech-language pathology services with a $30 copay, other health care professional services with a copay between $0 and $30, and opioid treatment program services with a $30 copay. 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. Additional telehealth benefits are covered with a copay between $0 and $30.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including annual physical exams and kidney disease education services. Additional preventive services such as Health Education, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered, while in-home safety assessments, personal emergency response systems, and other services are not covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $25 copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services including eye exams, with a copay of $0-$35. Eyewear is covered up to a combined maximum of $200 every year. Contact lenses are also covered, and so are eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a limit of one pair per year for each.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $30 copay, along with other services such as oral exams, dental x-rays, and prophylaxis (cleaning). Restorative services have a copay between $0 and $550, and prosthodontics, removable have a copay between $25 and $615. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna Preferred Medicare (HMO) plan and require prior authorization. Insulin has a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered under the Cigna Preferred Medicare (HMO) plan, with no copay and a 20% coinsurance for durable medical equipment and prosthetic devices, while durable medical equipment for use outside the home and diabetic supplies are not covered. Diabetic therapeutic shoes/inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $195, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $30 copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay or 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. No copay or coinsurance information is available, as none of the services are covered.
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 for days 21-100.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $35 every three months. The plan also offers a meal benefit for chronic illnesses and conditions that require the enrollee to remain at home. Other services, including acupuncture, are not covered.
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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.
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