A non-government entity
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 Texas. 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 $3500.00 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:
Sign up for Cigna Preferred Medicare (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 $4 copay at preferred pharmacies and a $15 copay at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay, while outpatient services range from no copay to a $175 copay. Emergency services have a $140 copay, and primary care visits have no copay to a $25 copay depending on the service. This plan also includes coverage for preventive services, vision, and dental, with copays or limits on certain services. Hearing exams have a $20 copay, and eyewear is covered up to $200 per year. Dental services have a $25 copay for Medicare dental services and a $2450 annual maximum for other dental care.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, there is a $350 copay per admission or stay. For Inpatient Hospital Psychiatric, the copay is $350 for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay between $0 and $150 for outpatient hospital services and a $175 copay for observation services. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $25 copay per session. Outpatient blood services are covered, with three pints deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Preferred Medicare (HMO) plan, with a $130 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 50 one-way trips per year, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services and Worldwide Emergency Coverage have a $140 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Services has a maximum benefit coverage of $50,000.
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 $25 copay), Physician Specialist Services (with a $25 copay), Other Health Care Professional (with a $0-$25 copay), Physical Therapy and Speech-Language Pathology Services (with a $25 copay), Additional Telehealth Benefits (with a $0-$25 copay), and Opioid Treatment Program Services (with a $25 copay). This plan does not cover Routine Chiropractic Care, Individual and Group Sessions for Mental Health Specialty Services, Podiatry Services, and Individual and Group Sessions for Psychiatric Services.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, and fitness benefits. In-Home Support Services and Kidney Disease Education Services are covered, as well as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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 are covered with a $20 copay, and routine hearing exams are covered once per year. Fitting/evaluation for hearing aids are also covered once per year. Prescription hearing aids are covered, with a copay between $399 and $1800, but prescription hearing aids for the inner, outer, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a copay of $0-$20. The plan also covers eyewear, including contact lenses, eyeglasses, eyeglass lenses, and frames, with a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered, with a $25 copay for Medicare Dental Services; the plan has a maximum benefit of $2450 per year for other dental services. 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 also covered. Orthodontic Services are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, you will pay a $35 copay, and between 0% and 20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred Medicare (HMO) 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 by the Cigna Preferred Medicare (HMO) plan, with a 20% coinsurance for Medicare-covered prosthetic devices, medical supplies, and diabetic therapeutic shoes/inserts. Durable medical equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Cigna Preferred Medicare (HMO) plan, with a doctor referral and prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $150, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $5 copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay or coinsurance, but prior 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 and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Cigna Preferred Medicare (HMO) plan. The copay is $20 for days 1-20, and $214 for days 21-100.
Other Services See details
Under "Other Services," the Cigna Preferred Medicare (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $90 every three months, and a meal benefit for chronic illnesses or medical conditions that require 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved