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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 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 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 $24.00. 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 $1500.00 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 an "Enhanced Alternative" drug benefit type with no deductible. In the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $4 copay for preferred generic drugs at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Cigna Preferred Plus Medicare (HMO) plan offers a range of benefits with varying costs. This plan includes coverage for inpatient and outpatient hospital services, with copays applicable. Additionally, it provides coverage for services like primary care, hearing, vision, dental, and home health, each with specific copays or coinsurance. The plan also covers ambulance services, emergency services, and offers coverage for prescription hearing aids, eyewear, and dental services. Preventive services, such as routine exams, are covered with no copay. However, certain services like cardiac rehabilitation and some home-based services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, there is a $240 copay per admission or stay, while Inpatient Hospital Psychiatric has a $1575 copay per admission or stay; additional days, and non-Medicare-covered stays are not covered for either.
Outpatient Services See details
Outpatient Services with the Cigna Preferred Plus Medicare (HMO) plan include coverage for all outpatient hospital services with a copay between $0 and $200, observation services with a $200 copay, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient substance abuse services, including individual and group sessions, are covered with a copay of $25. Outpatient blood services are covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Preferred Plus 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 Plus Medicare (HMO) plan. Ground ambulance services have a $230 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 are covered, with a $140 copay and no coinsurance. Urgently Needed Services are covered, with a $65 copay and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation, are covered, each with a $140 copay and no coinsurance, up to a maximum benefit of $50,000.
Primary Care See details
The Cigna Preferred Plus Medicare (HMO) plan covers primary care 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 opioid treatment program services with a $25 copay. Mental Health Specialty Services, including individual and group sessions, and routine chiropractic care are not covered.
Preventive Services See details
The Cigna Preferred Plus Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit, with no copay. However, the plan does not cover 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, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services are covered by the Cigna Preferred Plus Medicare (HMO) plan, including routine hearing exams with a $25 copay. Prescription hearing aids are covered with a copay between $399 and $1800, and Fitting/Evaluation for Hearing Aid is covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$25. Eyewear is covered, with a combined maximum plan benefit of $200 per year. Contact lenses and upgrades are also covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 copay, and other dental services. Oral exams are covered with a limit of 4 visits per year. Restorative Services have a copay between $0 and $550, Adjunctive General Services have a copay between $0 and $285, Endodontics have a copay between $0 and $675, Periodontics have a copay between $0 and $595, Prosthodontics, removable have a copay between $25 and $615, and Prosthodontics, fixed have a copay between $50 and $525. Maxillofacial Prosthetics, Orthodontics, and Implant Services are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Cigna Preferred Plus Medicare (HMO), but prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance is between 0% and 20%. Other Medicare Part B drugs also have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred Plus Medicare (HMO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered, with a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. Durable medical equipment for use outside the home and diabetic supplies are not covered, while diabetic therapeutic shoes/inserts have 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 $50, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $150, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services 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. 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. Prior authorization is required for these 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 SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Cigna Preferred Plus Medicare (HMO) plan does not cover 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, or Self-Directed Personal Assistance Services. The plan covers Over-the-Counter (OTC) Items with a maximum benefit of $165 every three months, and a meal benefit for chronic illnesses or medical conditions that require the enrollee to remain at home.
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