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 $3200.00 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 will pay a copay depending on the drug tier and pharmacy. For example, you'll pay a $4 copay for preferred generic drugs at a preferred or mail-order pharmacy. For non-preferred drugs, you pay 33% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs, though you may still pay for excluded drugs under any enhanced benefit.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a wide range of benefits, including inpatient hospital stays with a $50 copay for the first five days and no copay for the following days, as well as outpatient services with varying copays. The plan covers emergency services with a $140 copay, and urgent care with a $25 copay. Additional benefits include primary care with a $20 copay, hearing exams with a $15 copay, and vision services with a $0-$15 copay for eye exams and up to $300 per year for eyewear. The plan also covers dental services with a $15 copay, home infusion services, and offers an over-the-counter allowance of $105 every three months.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a $50 copay 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 are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and ambulatory surgical center services are covered. Outpatient hospital services have a copay between $0 and $125, observation services have a $125 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services have a $15 copay for both individual and group sessions, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered by 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 Cigna Preferred Medicare (HMO), with a $150 copay for ground ambulance services and 20% coinsurance for air ambulance services. Transportation services to plan-approved health-related locations are covered for up to 50 one-way trips per year, but transportation 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 $140 copay, while Urgently Needed Services have a $25 copay, but all services have no coinsurance.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy with a $15 copay, physician specialist services with a $15 copay, physical therapy and speech-language pathology services with a $15 copay, and opioid treatment program services with a $15 copay. Mental health specialty services and psychiatric services do not cover individual or group sessions, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services. Health Education, In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefits are covered. The plan does not cover In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered.
Hearing Services See details
Hearing exams are covered with a $15 copay, and routine hearing exams are limited to one per year. Fitting/evaluation for hearing aids is covered, and is limited to one per year. Prescription hearing aids are covered, with a copay between $399 and $1800, and are limited to two per year; however, inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Routine eye exams have a copay of $0-$15, and eyewear has a combined maximum benefit of $300 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services, including Medicare Dental Services, Other Dental Services, Oral Exams, Dental X-Rays, Other Diagnostic Dental Services, Prophylaxis (Cleaning), Fluoride Treatment, Other Preventive Dental Services, Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics, are covered. Medicare Dental Services require prior authorization and have a $15 copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay, and coinsurance can range from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance can range from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan and require prior authorization and a doctor's referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. 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, including Diagnostic Procedures/Tests with a copay between $0 and $125, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $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 or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
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 benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, with a copay of $20 for days 1-20 and a copay of $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $105.00 every three months and offers a meal benefit for chronic illnesses or conditions requiring the enrollee to remain at home. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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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.
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