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Cigna TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna TotalCare (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in East Texas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Cigna TotalCare (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna TotalCare (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna TotalCare (HMO D-SNP).
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 TotalCare (HMO D-SNP), 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.
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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3400.00 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 TotalCare (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay a copay or coinsurance for your prescriptions, depending on the drug tier and pharmacy. In the initial coverage phase, you'll pay copays of $20 for preferred generic drugs, $47 for standard generic drugs, and $100 for preferred brand drugs. Non-preferred drugs have a 25% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a wide range of benefits. It covers inpatient hospital stays, outpatient services, and partial hospitalization, with varying copays for certain services. Emergency services, primary care, preventive services, and home health services are available with no copay, while other services like hearing, vision, and dental have defined coverage limits. The plan also provides coverage for ambulance services, with a $75 copay for ground transport and 20% coinsurance for air ambulance. Home infusion, dialysis, and medical equipment are included, with specific copays or coinsurance amounts. Additional benefits include over-the-counter items and meal benefits for those with chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered by the Cigna TotalCare (HMO D-SNP) plan. For Inpatient Hospital Psychiatric care, there is a $100 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare-covered stays for both acute and psychiatric care, as well as upgrades for acute care, are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, and Outpatient Blood Services. Outpatient Substance Abuse Services are partially covered, with Individual and Group Sessions for Outpatient Substance Abuse not covered.
Partial Hospitalization See details
Cigna TotalCare (HMO D-SNP) covers partial hospitalization with a $130 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna TotalCare (HMO D-SNP) plan, with both ground and air ambulance services included. Ground ambulance services have a $75 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 50 one-way trips per year, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Cigna TotalCare (HMO D-SNP) plan. Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $140 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered with no coinsurance and no copay. Chiropractic Services, Mental Health Specialty Services (Individual and Group Sessions), and Psychiatric Services (Individual and Group Sessions) are partially covered. Podiatry Services are not covered.
Preventive Services See details
The Cigna TotalCare (HMO D-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, with some services not covered, such as in-home safety assessments, personal emergency response systems, and several others. The plan also covers health education, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, fitness benefit, and in-home support services, with no copay or coinsurance.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year, and prescription hearing aids (all types) have a copay between $399 and $1800, and are covered twice per year. Prescription hearing aids for 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 routine eye exams, eyewear, and upgrades. Routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $400 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames.
Dental Services See details
The Cigna TotalCare (HMO D-SNP) plan covers dental services, with a maximum benefit of $4,000 per year. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, removable, maxillofacial prosthetics, implant services, prosthodontics, fixed, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance ranges from 0% to 15%. The coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 15%.
Dialysis Services See details
Dialysis Services are covered under the Cigna TotalCare (HMO D-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with no copay or coinsurance, and Prosthetics/Medical Supplies with no copay and 20% coinsurance. However, Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna TotalCare (HMO D-SNP) plan. Lab Services have no copay, while Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered 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 covered, but the specific services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
The Cigna TotalCare (HMO D-SNP) plan covers Skilled Nursing Facility (SNF) services with a prior authorization requirement. For days 1-20, the copay is $20, and for days 21-100, the copay is $214.
Other Services See details
The Cigna TotalCare (HMO D-SNP) plan's "Other Services" benefit includes Over-the-Counter (OTC) items with a maximum benefit of $240 every three months, and meal benefits for chronic illnesses or conditions requiring home care. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services are not covered.
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