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 Memphis/Nashville/West Tennessee. 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 $28.60. 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 $5000.00 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 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs based on your specific drug tier. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have a reduced premium of $28.60.
Additional Benefits
The Cigna Primary Medicare (HMO) plan offers a variety of benefits beyond standard Medicare coverage. This plan covers inpatient hospital stays with a copay for the first few days, and outpatient services with varying copays. You'll also find coverage for emergency services, ambulance, and transportation services, as well as preventive, hearing, vision, and dental services, all with specific copays, coinsurance, and annual limits. Additional benefits include home health services with no copay, and skilled nursing facility stays with a copay after the first 20 days. The plan also covers home infusion, dialysis, and medical equipment with coinsurance, and offers coverage for over-the-counter items and a meal benefit. Note that some services like Cardiac Rehabilitation Services, and some specific types of hearing aids are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. 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. Outpatient hospital services have a copay between $0 and $250, while observation services have a $250 copay. Ambulatory Surgical Center (ASC) Services have no copay. Outpatient substance abuse services are not covered. Outpatient blood services are also covered.
Partial Hospitalization See details
Cigna Primary 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 and air ambulance services, and transportation services to plan-approved health-related locations. Ground and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are limited to 24 one-way trips per year and have no copay or coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Cigna Primary Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $125 copay, while Urgently Needed Services has a $25 copay.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Occupational Therapy Services have a $10 copay and no coinsurance. Physical Therapy and Speech-Language Pathology Services have a $10 copay and no coinsurance. Chiropractic Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services are not covered. Podiatry Services are also not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, an annual physical exam, kidney disease education services, and other preventive services like glaucoma screening, are covered. Additional services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered. Fitness benefit is covered, including physical fitness and memory fitness.
Hearing Services See details
Cigna Primary Medicare (HMO) covers hearing exams, including routine exams and evaluations for hearing aids, each limited to one visit per year. Prescription hearing aids are covered with a copay between $399 and $1800, but hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams, and eyewear. Routine eye exams are covered once per year. Eyewear has a combined maximum plan benefit coverage of $100 per year.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $1,200 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. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Primary Medicare (HMO) plan, but require prior authorization. The coinsurance for this benefit is 20%.
Medical Equipment See details
Medical Equipment is covered by Cigna Primary Medicare (HMO), with no copay for Durable Medical Equipment (DME), and a 20% coinsurance. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance, and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Diagnostic Procedures/Tests, and Outpatient X-Ray Services are not covered. Lab Services have no copay, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the Cigna Primary Medicare (HMO) plan 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 not covered by the Cigna Primary Medicare (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Cigna Primary Medicare (HMO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Cigna Primary Medicare (HMO) plan's "Other Services" benefit covers over-the-counter items, with a maximum benefit of $120.00 every three months, and also offers a meal benefit for chronic illnesses or medical conditions that require the enrollee to remain at home, while acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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