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. 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 $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:
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Drug Coverage
The Cigna Preferred Medicare (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay based on the drug tier and pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan may also have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. You'll find coverage for ambulance services, emergency care, and a selection of primary care services like doctor visits and chiropractic care, all with associated copays. The plan also provides coverage for vision and dental services, hearing exams, and home health services with no copay, as well as medical equipment and diagnostic services. Additional benefits include coverage for preventive services, prescription hearing aids, and over-the-counter items. However, it's important to note that some services are not covered, such as certain mental health services, some cardiac rehabilitation services, and additional hours of home care. This plan requires prior authorization for certain services like home infusion, dialysis, and skilled nursing facilities.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $120 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you'll pay a $300 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, nor are Additional Days for Inpatient Hospital Psychiatric and Non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by Cigna Preferred Medicare (HMO). Outpatient Hospital Services have a copay between $0 and $125, Observation Services have a $100 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a copay between $15 and $15 for individual and group sessions.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $130 copay. Prior authorization is required for coverage.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO). Ground ambulance services have a copay of $225, and air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 40 one-way trips per year, while 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 by the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services has a $25 copay; all have no coinsurance.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $15 copay, other health care professional services with a copay between $0 and $15, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits with a copay between $0 and $15, and opioid treatment program services with a $15 copay. Mental health and psychiatric services are partially covered, but individual and group sessions for both are not covered, and routine chiropractic care is not covered. Podiatry services are not covered.
Preventive Services See details
Preventive Services, offered by Cigna Preferred Medicare (HMO), include coverage for Medicare-covered preventive services, annual physical exams, health education, in-home support services, support for caregivers, and fitness benefits. However, this plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss, 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 counseling services. Additionally, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits are covered.
Hearing Services See details
Hearing exams are covered with a $15 copay, and a doctor referral is required. Prescription hearing aids are partially covered, with a minimum copay of $399 and a maximum copay of $1800 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$15, eyewear with a combined maximum benefit of $300 per year, contact lenses, eyeglasses (lenses and frames) with one pair per year, eyeglass lenses with one pair per year, eyeglass frames with one frame per year, and upgrades. Routine eye exams are covered once per year.
Dental Services See details
Dental services are covered, including Medicare Dental Services with a $15 copay, and other services with a $3,500 annual maximum benefit. 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 covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna Preferred Medicare (HMO) plan, with prior authorization required. Insulin has a $35 copay, and coinsurance may apply for Medicare Part B drugs, with a minimum of 0% and a maximum of 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization and a doctor's referral. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetic Devices, Medical Supplies, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies and Durable Medical Equipment for use outside the home are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Cigna Preferred Medicare (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $150, and Therapeutic Radiological Services have a copay of $60. 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. However, Additional Hours of Care and Personal Care Services are not covered under this plan.
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 Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, with a prior authorization required. You will have a copay of $20 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit coverage amount of $95 every three months, and also covers meal benefits for a chronic illness or a medical condition requiring 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.
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