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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 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $3400.00 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. In the initial coverage phase, you'll pay a copay for your prescriptions based on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy, also known as "Extra Help".
Additional Benefits
The Cigna Preferred Medicare (HMO) plan provides coverage for a wide range of healthcare services. Hospital stays require prior authorization and have a copay, with the amount varying depending on the type of stay. Outpatient services, including emergency care, have copays, while some services like home health and lab services have no copay. The plan also offers benefits for vision, dental, and hearing services. Vision services include eye exams and eyewear, while dental services have a $3,000 annual maximum. Hearing exams and hearing aids are covered, with copays for exams and prescription hearing aids. The plan also covers ambulance services, some transportation, and provides an over-the-counter items benefit.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization required. For Inpatient Hospital-Acute, you will have a $350 copay per stay for Medicare-covered stays, and additional days are covered. For Inpatient Hospital Psychiatric, there is a $300 copay for days 1-5 and no copay for days 6-90.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered by the Cigna Preferred Medicare (HMO) plan. Outpatient hospital services have a copay between $0 and $150, while observation services have a $150 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a copay of $20 for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. You will have a $65 copay 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 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 60 one-way trips per year. 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 under the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $25 copay; all services have no coinsurance.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services and occupational therapy services, but routine chiropractic care, individual and group sessions for mental health specialty services, podiatry services, and individual and group sessions for psychiatric services are not covered. Chiropractic services and physician specialist services have a $20 copay, while physical therapy and speech-language pathology services have a $30 copay. Other health care professionals and opioid treatment program services have a copay between $0 and $20. Additional telehealth benefits have a copay between $0 and $20.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services. Some services, such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and others are not covered. The plan also covers kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit.
Hearing Services See details
Hearing exams, including routine hearing exams, and fitting/evaluation for hearing aids are covered under the Cigna Preferred Medicare (HMO) plan, with a $20 copay for hearing exams and one visit per year for both routine exams and fitting/evaluation. 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
Vision Services includes coverage for eye exams with a copay between $0 and $20, and also covers eyewear with a combined maximum benefit of $300 per year. The plan also covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental Services are covered, with a $3,000 annual maximum. Medicare Dental Services have a $20 copay and require prior authorization, while other services include 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Cigna Preferred Medicare (HMO). The plan has a $35 copay for Medicare Part B Insulin Drugs, with coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
The Cigna Preferred Medicare (HMO) plan covers Durable Medical Equipment with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while 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 by the Cigna Preferred Medicare (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $150, and Therapeutic Radiological Services have a $60 copay, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay and no 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 and a doctor's referral are required for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) 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 coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for Cigna Preferred Medicare (HMO) includes an Over-the-Counter (OTC) Items benefit, with a maximum coverage amount of $120 every three months. Acupuncture and Dual Eligible SNPs with Highly Integrated Services are not covered.
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