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 Chicago. 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 $2350.00 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. In the initial coverage phase, you will pay a copay for each prescription based on the drug tier and pharmacy used. For example, preferred generic drugs have a $4 copay at preferred pharmacies and a $20 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a wide range of benefits. This plan covers inpatient hospital stays with a copay, and also covers outpatient services with varying copays, including services for substance abuse. You'll also find coverage for emergency services, primary care, preventive services, and vision and dental services, with varying costs for each. Additional benefits include hearing services, home infusion, dialysis services, medical equipment, and diagnostic services. The plan also covers home health services and skilled nursing facilities, as well as ambulance and transportation services. Some services, like cardiac rehabilitation and home health services, require prior authorization.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by Cigna Preferred Medicare (HMO), with a copay of $150 per day for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute, and a copay of $190 per day for days 1-7, and no copay for days 8-90 for Inpatient Hospital Psychiatric. Additional days, non-Medicare-covered stays, and upgrades are not covered for either Inpatient Hospital-Acute or Inpatient Hospital Psychiatric.
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. Outpatient Hospital Services have a copay between $0 and $175, and Observation Services have a $175 copay per stay. Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $25. Outpatient Blood Services are covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. This benefit has a $100 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a $260 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year; 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 $65 copay; all have no coinsurance.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services, and Podiatry Services are partially covered, but Routine Chiropractic Care is not covered. Mental Health Specialty Services and Psychiatric Services are partially covered, but individual and group sessions are not covered.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including annual physical exams, health education, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following a Welcome Visit, and a fitness benefit; however, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, 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, additional sessions of smoking cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices, and counseling services are not covered. Some services require a referral.
Hearing Services See details
Hearing Services include Routine Hearing Exams with a $25 copay, and Fitting/Evaluation for Hearing Aids with a $25 copay. Prescription Hearing Aids (all types) are covered with a copay between $399 and $1800, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services are covered, including eye exams with a copay of $0-$25, and eyewear with a combined maximum benefit of $350 per year. The plan also covers contact lenses, eyeglass lenses and frames, and upgrades.
Dental Services See details
The Cigna Preferred Medicare (HMO) plan offers dental services including Medicare Dental Services with a $25 copay, Oral Exams with a $0 copay, Dental X-Rays with a $0 copay, Other Diagnostic Dental Services with a $0 copay, Prophylaxis (Cleaning) with a $0 copay, Fluoride Treatment with a $0 copay, Other Preventive Dental Services with a $0 copay, Restorative Services with a copay ranging from $0 to $550, Adjunctive General Services with a copay ranging from $0 to $285, Endodontics with a copay ranging from $0 to $675, Periodontics with a copay ranging from $0 to $595, Prosthodontics, removable with a copay ranging from $25 to $615, Prosthodontics, fixed with a copay ranging from $50 to $525, and Oral and Maxillofacial Surgery with a $0 copay. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Cigna Preferred Medicare (HMO) plan, and prior authorization is required. You will pay a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance for all other drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization and a doctor referral. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, and Prosthetic Devices with 20% coinsurance and no copay. Diabetic Equipment is covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures, tests, lab services, and radiological services, are covered. Diagnostic procedures and tests have a copay of $0 to $25, and lab services have no copay. Diagnostic radiological services have a copay up to $175, while therapeutic radiological services have a 20% coinsurance, and outpatient X-rays have no copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization and a doctor referral are required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, with a copay of $20 for days 1-20, and a copay of $214 for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Under "Other Services", 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 (OTC) items are covered with a maximum benefit of $140 every three months, and nicotine replacement therapy is included. Meal benefits are also covered.
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