A non-government entity
Cigna Alliance Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Alliance Medicare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Alliance Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Alliance Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in Houston. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Cigna Alliance 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 Alliance 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 Alliance 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 Alliance 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 whether you use a preferred or standard pharmacy. For example, preferred generic drugs have a $4 copay, while standard generic drugs have a $45 copay. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. This plan also offers a Part D premium reduction if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Alliance Medicare (HMO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $225 copay per admission, while outpatient services have copays ranging from $0 to $140. Emergency services and urgent care have a $140 copay, and primary care visits have a $10 copay. This plan also includes coverage for hearing, vision, and dental services. Hearing exams have a $10 copay, and eyewear has a combined maximum of $400 per year. Dental services have a $10 copay for Medicare-covered services, with a $2,600 annual maximum benefit for other services. Additionally, the plan covers medical equipment, home health services, and offers over-the-counter items with a maximum benefit of $170 every three months.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute with a $225 copay per admission, and Inpatient Hospital Psychiatric with a $125 copay for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $125, observation services have a $140 copay, and outpatient substance abuse services have a $10 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $130 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Alliance Medicare (HMO), with prior authorization required. 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, but 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 Alliance Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $10 copay; all services have no coinsurance.
Primary Care See details
The Cigna Alliance Medicare (HMO) plan covers primary care physician services, chiropractic services with a $10 copay, occupational therapy services with a $25 copay, physician specialist services with a $10 copay, other health care professional services with a copay between $0 and $10, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $10, and opioid treatment program services with a $10 copay. The plan does not cover routine chiropractic care, individual or group sessions for mental health specialty services, individual or group sessions for psychiatric services, or podiatry services.
Preventive Services See details
The Cigna Alliance Medicare (HMO) plan covers preventive services, including annual physical exams, health education, fitness benefits, and support for caregivers. In-home support services, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are also covered. 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 $10 copay, with routine hearing exams and fitting/evaluation for hearing aids each covered once per year. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, limited to two visits per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered. OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$10, and coverage for eyewear, including contact lenses, eyeglasses, and upgrades. The plan offers a combined maximum of $400 per year for eyewear.
Dental Services See details
Dental Services offers coverage for a variety of dental services. Medicare Dental Services require a $10 copay, and other services are covered with a maximum plan benefit of $2,600 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, and the coinsurance ranges from 0% to 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Alliance 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 under the Cigna Alliance Medicare (HMO) plan, with no copay for Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, but a 20% coinsurance for DME, Prosthetic Devices, and Medical Supplies. Diabetic Equipment and Durable Medical Equipment for use outside the home are partially covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Cigna Alliance Medicare (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, Lab Services have no copay, Diagnostic Radiological Services have a maximum copay of $125, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Cigna Alliance Medicare (HMO) plan with no copay and no coinsurance, but require authorization. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required for coverage. The plan has a copay, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Alliance 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-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under the Cigna Alliance Medicare (HMO) plan, 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. Over-the-counter items are covered with a maximum benefit of $170 every three months. Meal benefits are available for a chronic illness or a medical condition, with no maximum coverage amount.
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