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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 Tri-cities. 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 $5200.00 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'll pay a copay for your prescriptions depending on the drug tier and pharmacy. The copays range from $10 to $100 for generic and brand name drugs, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. This plan also offers a Part D premium reduction for those who qualify for the low-income subsidy.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. Emergency, urgently needed, and worldwide emergency services are covered, with copays ranging from $30 to $125. Primary care visits have no copay, and the plan includes coverage for hearing, vision, and dental services, with a yearly maximum for dental. Additional benefits include ambulance services with a $290 copay for ground transport, and 20% coinsurance for air ambulance. The plan also covers home health services with no copay, skilled nursing facility stays, and offers an over-the-counter item benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the Cigna Preferred Medicare (HMO) plan. For days 1-6, there is a $315 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Cigna Preferred Medicare (HMO). Outpatient hospital services have a copay between $0 and $350, observation services have a $350 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services are covered with a $20 copay for both individual and group sessions, and Outpatient Blood Services are covered.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO), with a $290 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation Services to a Plan Approved Health-related Location are covered for up to 30 one-way trips every year, but Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $30 copay; all have no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $20 copay, and physical therapy and speech-language pathology services with a $25 copay. Mental health and psychiatric services, and routine chiropractic care are not covered, and podiatry services are not covered. Additional telehealth benefits are available with a copay between $0 and $20, and opioid treatment program services are covered with a copay of $20.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Health education and fitness benefits are covered, while 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. 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 are also covered.
Hearing Services See details
Hearing exams are covered with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered with a copay between $399 and $1800 for all types, but prescription 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, including routine eye exams, are covered by this plan. Routine eye exams have a copay between $0 and $10, and you are covered for one exam every year. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, are covered, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental services are covered, with a $20 copay for Medicare dental services, and a $2,250 annual maximum. Other services like oral exams, dental x-rays, and cleanings are covered with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis services are covered under the Cigna Preferred Medicare (HMO) plan and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered by Cigna Preferred Medicare (HMO), including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, and Medicare-covered Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $200, Lab Services have no copay, Diagnostic Radiological Services have a copay of up to $200, Therapeutic Radiological Services have a $60 copay, 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 authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Cigna Preferred 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 Medicare (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services include an Over-the-Counter (OTC) Items benefit, with a $60 maximum benefit every three months, and a meal benefit for chronic illness or conditions requiring the enrollee to remain at home. 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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