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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 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 $3450.00 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'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For generic drugs, you'll pay a $20 copay at standard and mail-order pharmacies. For preferred brand drugs, the copay is $100. Non-preferred drugs have a 25% coinsurance. Once your total yearly drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have a copay, and outpatient services often involve coinsurance. Emergency services have a copay, and ambulance services have a 20% coinsurance. The plan covers primary care, preventive services, and offers hearing, vision, and dental benefits. Hearing exams and hearing aid fittings have no copay, and vision includes routine eye exams and eyewear. Dental services include oral exams and other services. The plan also includes benefits for home infusion, dialysis, and medical equipment with coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services with a copay of $190 per day for days 1-5, and no copay for days 6-90. Additional days for inpatient hospital-acute are covered, while non-Medicare-covered stays and upgrades for inpatient hospital-acute, and additional days and non-Medicare-covered stays for inpatient hospital psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered under the Cigna TotalCare (HMO D-SNP) plan, including all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services. Outpatient hospital services have a coinsurance of 0% to 20%, observation services have a 20% coinsurance, and ASC services have a coinsurance between 0% and 20%; however, individual and group sessions for outpatient substance abuse are 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 Cigna TotalCare (HMO D-SNP), with a 20% coinsurance for both ground and air ambulance services. Transportation Services to a plan-approved health-related location are covered for up to 50 one-way trips per year, with various modes of transportation available; transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the Cigna TotalCare (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services have a $20 copay; all have 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, while 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 annual physical exams, health education, and fitness benefits. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing exams and hearing aid fittings/evaluations are covered with no deductible, 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, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Cigna TotalCare (HMO D-SNP) plan covers vision services, including routine eye exams with one visit per year, and eyewear with a combined maximum benefit of $275 every year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Cigna TotalCare (HMO D-SNP) plan covers a variety of dental services, including oral exams (up to 4 per year), dental x-rays (limited to 1 complete series or panoramic every 3 years, and 4 bitewing x-rays per year), other diagnostic dental services, prophylaxis (cleaning) (up to 2 per year), fluoride treatments (up to 2 per year), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery. Orthodontic services are covered under Diagnostic and Preventive Dental, and there is a maximum benefit of $20,000 per year. Maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna TotalCare (HMO D-SNP) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna TotalCare (HMO D-SNP) plan, but require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, with Durable Medical Equipment (DME) requiring prior authorization and a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered and requires prior authorization, but Diabetic Supplies are not covered, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include lab services with no copay, but diagnostic procedures, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services are not covered. All services require prior authorization and a doctor referral.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare (HMO D-SNP) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna TotalCare (HMO D-SNP) plan, but require prior authorization. For days 1-20, the copay is $20, and for days 21-100, the copay is $214; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) items and a meal benefit, but 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. The OTC benefit includes a maximum of $250 every three months.
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