A non-government entity
Cigna Primary Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Primary Medicare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Primary Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Primary Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Chattanooga/Knoxville. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Cigna Primary 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 Primary 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 Primary Medicare (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.00. 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 $5100.00 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 Primary Medicare (HMO) plan has a $590.00 deductible for prescription drugs. After the deductible, you will pay the costs for drugs in each tier until your total drug costs reach $2000.00, at which point you enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you will pay $40.00 for Part D drugs. Once your yearly out-of-pocket drug costs reach $2000.00, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna Primary Medicare (HMO) plan offers a range of benefits with varying costs. For hospital stays, you'll pay a $250 copay for the first 6 days, and then no copay for the rest of the stay. Outpatient services have a copay between $0 and $250, while ambulance services start at a $270 copay. This plan includes coverage for primary care with a $10 copay for some services, preventive services with no copay, and hearing and vision services with some limitations. Dental services are covered up to $2,000 per year. The plan also covers home health services with no copay, and offers additional benefits such as over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Cigna Primary Medicare (HMO) plan. For days 1-6, there is a $250 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered by the Cigna Primary Medicare (HMO) plan, but require prior authorization. Outpatient hospital services have a copay between $0 and $250, and observation services have a $250 copay per stay. Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services are not covered, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Primary Medicare (HMO) plan, but requires prior authorization. You will pay a $105 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Primary Medicare (HMO) plan. Ground ambulance services have a $270 copay, while air ambulance services have 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 24 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 Primary Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay, while Urgently Needed Services has a $20 copay. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Primary Medicare (HMO) plan covers primary care physician services, occupational therapy services (with a $10 copay and no coinsurance), physician specialist services, mental health specialty services (excluding individual and group sessions), and physical therapy and speech-language pathology services (with a $10 copay and no coinsurance). The plan also covers additional telehealth benefits and opioid treatment program services. However, routine chiropractic care, individual and group sessions for psychiatric services, and podiatry services are not covered.
Preventive Services See details
The Cigna Primary Medicare (HMO) plan covers preventive services, including annual physical exams, health education, and fitness benefits, with no copay. Other services like in-home safety assessments, personal emergency response systems, and several others are not covered.
Hearing Services See details
The Cigna Primary Medicare (HMO) plan covers hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with one visit per year for each service. Prescription hearing aids are covered with a copay between $399 and $1800, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
The Cigna Primary Medicare (HMO) plan covers vision services including routine eye exams with 1 visit per year, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, with a maximum benefit of $2,000 per year. 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 and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna Primary Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical equipment benefits are covered under the Cigna Primary Medicare (HMO) plan, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Cigna Primary Medicare (HMO) plan. Lab Services have no copay, while Therapeutic Radiological Services have a coinsurance of at most 20%; Diagnostic Procedures/Tests, Diagnostic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna Primary Medicare (HMO) plan 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 Primary Medicare (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Primary Medicare (HMO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, the copay is $214.
Other Services See details
The Cigna Primary Medicare (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $110 every three months. The plan also offers a meal benefit for chronic illnesses or medical conditions that require the enrollee to remain at home for a period of time. However, acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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