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Cigna Premier Medicare (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Premier Medicare (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Premier Medicare (HMO-POS) in 2025, please refer to our full plan details page.
Cigna Premier Medicare (HMO-POS) is a HMO-POS plan offered by The Cigna Group available for enrollment in 2025 to people living in Chicago. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Cigna Premier Medicare (HMO-POS) 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 Premier Medicare (HMO-POS).
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 Premier Medicare (HMO-POS), 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 $3250.00 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 Premier Medicare (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies, while standard generic drugs have a $45 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Cigna Premier Medicare (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. It also covers primary care, preventive services, hearing, vision, and dental services, with specific copays and annual maximums for certain services like dental. This plan provides coverage for ambulance services, emergency services, and skilled nursing facilities, with some services requiring copays or coinsurance. Additionally, it includes benefits for medical equipment, home health services, and home infusion, with coverage for over-the-counter items and meal benefits. However, certain services like cardiac rehabilitation, additional hours of care, and specific therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered. For days 1-7, the copay is $200, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $240, observation services have a $240 copay, ambulatory surgical center services have no copay, and both individual and group outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Premier Medicare (HMO-POS) plan with a $85 copay, and prior authorization is required. There is no coinsurance.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Premier Medicare (HMO-POS), with prior authorization required. Ground ambulance services have a $260 copay, while 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, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the Cigna Premier Medicare (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all three services have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Premier Medicare (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. The plan also covers additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay. However, routine chiropractic care, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, including an annual physical exam, additional preventive services, kidney disease education services, and other preventive services. Health education and fitness benefits are covered, but in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered. Glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are covered as other preventive services, but a referral is required for Medicare-covered barium enemas.
Hearing Services See details
Hearing Services are covered, including hearing exams and prescription hearing aids. Routine hearing exams have a $25 copay, and prescription hearing aids have a copay between $399 and $1800.
Vision Services See details
Vision services are covered, including eye exams with a copay between $0 and $35, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames with a combined maximum benefit of $225 per year. Routine eye exams are covered once per year.
Dental Services See details
Dental services are covered, with a $35 copay for Medicare Dental Services and an annual maximum of $20,000. Oral exams have a $35 copay, with up to 4 visits per year, while dental x-rays are limited to 1 series of complete or panoramic x-rays every 3 years and 4 bitewing x-rays per year. Other services like restorative, endodontics, periodontics, prosthodontics, fixed, and oral surgery have varying copays, and maxillofacial prosthetics, implant services, and orthodontics are not 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 a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna Premier Medicare (HMO-POS) plan, but require prior authorization and a doctor referral. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered by the Cigna Premier Medicare (HMO-POS) plan, with Durable Medical Equipment requiring a 20% coinsurance and no copay, and Prosthetic Devices, and Medical Supplies also requiring a 20% coinsurance with no copay. Diabetic Equipment coverage includes a 20% coinsurance for Medicare-covered diabetic supplies, and Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance. However, 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 all diagnostic services, diagnostic procedures/tests, and lab services. For diagnostic procedures/tests, there is a copay between $0 and $50, and for lab services, there is no copay. Diagnostic Radiological Services have a copay of at most $200, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna Premier Medicare (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Cigna Premier Medicare (HMO-POS) plan. Specifically, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Premier Medicare (HMO-POS) plan, with a copay of $20 for days 1-20 and $214 for days 21-100. Additional days beyond Medicare coverage and non-Medicare covered stays for SNF are not covered.
Other Services See details
The Cigna Premier Medicare (HMO-POS) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $70.00 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. Meal benefits are also covered for chronic illnesses or medical conditions requiring home care. Acupuncture, Dual Eligible SNPs, 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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