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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 Arkansas. This plan received an overall rating of 4.5 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.
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 $5400.00 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. During the initial coverage phase, you will pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. Please note that the plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $315 copay for days 1-6, and then no copay for days 7-90, while outpatient services can have copays up to $350. You'll have access to primary care with copays as low as $0 for some services, and also preventive, hearing, vision, and dental coverage. This plan includes coverage for ambulance services, with a $300 copay for ground transport and 20% coinsurance for air ambulance, as well as emergency services with a $125 copay. Additional benefits include home health services with no copay, along with coverage for skilled nursing facilities. The plan also covers over-the-counter items up to $45 every three months.
Inpatient Hospital See details
Inpatient Hospital coverage includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, each with a $315 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay between $0 and $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services have no copay, while individual and group sessions for outpatient substance abuse have a copay of $20. Outpatient blood services are also covered.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground ambulance services with a $300 copay and air ambulance services with 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by Cigna Preferred Medicare (HMO), with a $125 copay and no coinsurance for emergency services, urgent care, and worldwide emergency transportation. Worldwide emergency coverage also has a $125 copay, and the plan has a maximum benefit coverage of $50,000 for worldwide services.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a $20 copay, other health care professional services with a $0-$20 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services with a $20 copay. Mental health specialty services, including individual and group sessions, and routine chiropractic care are not covered, nor is podiatry services.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, Annual Physical Exams, Health Education, Kidney Disease Education Services, and Other Preventive Services such as Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit. 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, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Fitness Benefits are also covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $399 and $1800; however, prescription hearing aids for the inner, outer, or over the ear are not covered, and OTC hearing aids are also not covered. Routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids (all types) are available once per year.
Vision Services See details
Vision services include coverage for eye exams with a copay between $0 and $20, and eyewear with a combined maximum benefit of $200 per year. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each limited to one per year. Contact lenses and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a $20 copay for Medicare Dental Services, and a maximum plan benefit of $1300 per year. Other services such as Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, and 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 are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
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 coverage includes durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable medical equipment has a 20% coinsurance with prior authorization required, while durable medical equipment for use outside the home is not covered. Prosthetic devices and medical supplies have a 20% coinsurance, and diabetic therapeutic shoes/inserts have a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for all diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $250, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $250, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred 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 under the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, with a $0 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
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $45.00 every three months, including nicotine replacement therapy and Naloxone. However, 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, and Self-Directed Personal Assistance Services are not covered.
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