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Cigna TotalCare Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare Plus (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna TotalCare Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare Plus (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in North Georgia. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Cigna TotalCare Plus (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
Cigna TotalCare Plus (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Cigna TotalCare Plus (HMO D-SNP).
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 TotalCare Plus (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. 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 a $590.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $9350.00 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 TotalCare Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. If you qualify for the low-income subsidy (LIS), your Part D premium will be $25. During the initial coverage phase, after you meet your deductible, you will pay the costs for your drugs. Once your total drug costs reach $2000, you will enter the next coverage phase. Once your yearly out-of-pocket drug costs reach $2000, you will pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna TotalCare Plus (HMO D-SNP) plan offers a wide range of benefits. It covers inpatient and outpatient services, including emergency care with copays and coinsurance. You'll also have access to primary care, preventive, vision, dental, and hearing services, with varying copays and coinsurance depending on the service. Additional benefits include ambulance and transportation services, home health, and medical equipment coverage. The plan also provides coverage for other services such as OTC items, with limits. Some services require prior authorization, and it's important to review the plan details for specific costs like copays and coinsurance for each service.
Inpatient Hospital See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay. Additional days, upgrades, and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered under the Cigna TotalCare Plus (HMO D-SNP) plan. Outpatient Hospital Services have a coinsurance between 0% and 20%, Observation Services have a 20% coinsurance, and Individual and Group Sessions for Outpatient Substance Abuse have a 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a coinsurance between 0% and 20%.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna TotalCare Plus (HMO D-SNP) plan, but requires prior authorization. You will pay 20% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a 20% coinsurance. Transportation Services to a plan-approved health-related location are also covered, with 40 one-way trips per year. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered by the Cigna TotalCare Plus (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $110 copay, while Urgently Needed Services has a $45 copay; all have no coinsurance.
Primary Care See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, Other Health Care Professional, Psychiatric Services, Additional Telehealth Benefits, and Opioid Treatment Program Services, but some services are not covered, including Routine Chiropractic Care, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Individual Sessions for Psychiatric Services, and Group Sessions for Psychiatric Services, and Podiatry Services. Primary Care Physician Services, Chiropractic Services, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services all have a 20% coinsurance, while Additional Telehealth Benefits have a coinsurance of 0% to 20%. Occupational Therapy Services, Other Health Care Professional, and Opioid Treatment Program Services have a coinsurance of 20%.
Preventive Services See details
Preventive services, including Medicare-covered services, are covered by Cigna TotalCare Plus (HMO D-SNP). Annual physical exams have a 20% coinsurance, while other services such as Health Education, Glaucoma Screening, and Diabetes Self-Management Training are covered with no copay or coinsurance.
Hearing Services See details
Hearing services include hearing exams with a coinsurance of up to 20% and prescription hearing aids with a copay between $399 and $1800. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
Vision services include coverage for eye exams with 0% to 20% coinsurance, and one routine eye exam per year. Eyewear is covered up to a combined maximum of $400 per year, and contact lenses, eyeglasses, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, and a $3,000 annual maximum for other dental services. 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 all covered.
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 is between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of up to 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare Plus (HMO D-SNP) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but the plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays. Prior authorization is required, and you will have a copay, with more details on the copay available in the plan documents.
Other Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers Over-the-Counter (OTC) items with a maximum benefit of $225 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. The plan does not cover 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.
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