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 Alabama. 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 $4900.00 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 will pay a copay depending 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 $2,000, you enter the catastrophic coverage phase where you will pay nothing for Medicare Part D covered drugs. If you qualify for the low-income subsidy, you will pay $0.00 for Part D drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. The plan also covers emergency services, primary care, preventive services, and home health services, often with no copay or low copays. Additionally, this plan includes coverage for hearing, vision, and dental services, with copays and annual maximums applying to some of these services. This plan provides coverage for ambulance and transportation services, along with partial hospitalization, and skilled nursing facility services with copays. It also includes benefits like home infusion, dialysis, medical equipment, and diagnostic services, with coinsurance or copays applying to certain services. The plan also offers over-the-counter items and meal benefits, but it's important to note that some services, such as certain hearing aids, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a copay of $295 for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a copay of $290 for days 1-7, and no copay for days 8-90. 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 include coverage for all outpatient hospital services, with a copay ranging from $0 to $299, observation services with a $299 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services with no copay.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 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 copay of $285, and air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 30 one-way trips per year.
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, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $125 copay, while Urgently Needed Services have a $55 copay; there is no coinsurance for any of these services.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan's primary care benefit covers primary care physician services, occupational therapy services, physician specialist services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while occupational therapy services, physical therapy and speech-language pathology services have a $25 copay. Physician specialist services have a $10 copay, and additional telehealth benefits have a copay between $0 and $10. Psychiatric services and mental health specialty services do not cover individual or group sessions, and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, annual physical exams, health education, kidney disease education, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following welcome visits. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing services with Cigna Preferred Medicare (HMO) include hearing exams with a $20 copay, and prescription hearing aids with a copay between $399 and $1800. Routine hearing exams and fitting/evaluation for hearing aids are covered, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered by the Cigna Preferred Medicare (HMO) plan. Eye exams have a copay between $0 and $25, and eyewear has a combined maximum benefit of $300 every year.
Dental Services See details
Dental Services are covered, with a $25 copay for Medicare Dental Services, with prior authorization required, and a $1,300 annual maximum. Other services like oral exams, dental x-rays, and orthodontics are covered with no copay or coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. The plan has a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment is covered under the Cigna Preferred Medicare (HMO) plan, with 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. 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. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $100, Therapeutic Radiological Services have a copay of at least $80, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay and no 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 covered, but the plan does not cover any of the sub-services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered SNF 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 $70.00 every three months, and also covers meal benefits for chronic illnesses or conditions requiring the enrollee to stay 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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