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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 pharmacy type. For example, standard generic drugs have a $20 copay at a standard pharmacy, while preferred brand drugs have a $100 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), also known as "Extra Help", your Part D costs will be $0.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a variety of benefits. This plan covers inpatient hospital stays with a copay of $190 per day for the first 5 days and no copay for days 6-90, outpatient services with varying coinsurance, and emergency services with a $140 copay. Other benefits include no copay for primary care, preventive services, and home health services, along with coverage for hearing, vision, and dental services. The plan also provides coverage for ambulance services with a 20% coinsurance, a $130 copay for partial hospitalization, and offers an OTC allowance of $300 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 5 days of an Inpatient Hospital-Acute stay, the copay is $190 per day, and there is no copay for days 6-90; Inpatient Hospital Psychiatric services have the same cost-sharing.
Outpatient Services See details
Outpatient Services, as offered by Cigna TotalCare (HMO D-SNP), includes coverage for Outpatient Hospital Services with a coinsurance between 0% and 20%, Observation Services with a 20% coinsurance, and Ambulatory Surgical Center (ASC) Services with a coinsurance between 0% and 20%. Outpatient Substance Abuse Services are not covered, but Outpatient Blood Services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna TotalCare (HMO D-SNP) plan. This benefit has a copay of $130.
Ambulance and Transportation Services See details
The Cigna TotalCare (HMO D-SNP) plan covers ambulance services with a 20% coinsurance for both ground and air ambulance services, and transportation services to a plan-approved health-related location. 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 TotalCare (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $20 copay, and 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. Chiropractic Services require a referral and prior authorization, but routine chiropractic care is not covered. Mental Health and Psychiatric Services do not cover individual or group sessions, and Podiatry Services are not covered.
Preventive Services See details
The Cigna TotalCare (HMO D-SNP) plan covers a variety of preventive services, including annual physical exams, health education, in-home support services, support for caregivers, and fitness benefits. However, the plan does not cover 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, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are covered for one visit per year, and prescription hearing aids (all types) are covered for two visits per year with a copay between $399 and $1800.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and eyewear, with a combined maximum benefit of $475.00 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses (1 pair per year), and eyeglass frames (1 pair per year); upgrades are also covered.
Dental Services See details
The Cigna TotalCare (HMO D-SNP) plan covers a range of dental services, including oral exams (up to 4 per year), dental x-rays (complete series and panoramic x-rays limited to once every three years, 4 bitewing x-rays covered every 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. There is a maximum plan benefit coverage of $20,000 per year. The plan does not cover maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna TotalCare (HMO D-SNP) plan, 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna TotalCare (HMO D-SNP) plan and require prior authorization and a doctor referral. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
The Cigna TotalCare (HMO D-SNP) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and requires prior authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetics, medical supplies, and diabetic therapeutic shoes/inserts are covered with a 20% coinsurance, and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the Cigna TotalCare (HMO D-SNP) plan. Lab Services are covered with no copay, but Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare (HMO D-SNP) plan with no copay and no coinsurance, but require prior authorization. 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 TotalCare (HMO D-SNP) plan, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and 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 Cigna TotalCare (HMO D-SNP), with a $20 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered SNF stays, are not covered.
Other Services See details
The Cigna TotalCare (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $300 every three months, and it also covers a meal benefit for chronic or home-bound medical conditions. 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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