Cigna Preferred Medicare (HMO)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are also not covered.

Outpatient Services See details

Outpatient services include coverage for Outpatient Hospital Services with a copay between $0 and $275, Observation Services with a $295 copay, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Substance Abuse Services with $20 copays for both individual and group sessions. Outpatient Blood Services are also covered.

Partial Hospitalization See details

Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay. Prior authorization is required for coverage.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO). Ground ambulance services have a $235 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $95 copay, Urgently Needed Services has a $55 copay, and Worldwide Urgent Coverage and Worldwide Emergency Transportation also have a $95 copay.

Primary Care See details

The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a $20 copay, physical therapy and speech-language pathology services with a $20 copay, and other health care professional services with a copay between $0 and $20. The plan does not cover routine chiropractic care, individual or group sessions for mental health or psychiatric services, or podiatry services.

Preventive Services See details

Preventive Services are covered, including Medicare-covered services, Annual Physical Exams, and additional preventive services. Some services like In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and others are not covered.

Hearing Services See details

Hearing services include routine hearing exams with a $20 copay and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.

Vision Services See details

The Cigna Preferred Medicare (HMO) plan covers vision services, including routine eye exams with a copay of $0-$20, and eyewear with a combined maximum benefit of $200 per year, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses (1 pair per year), and eyeglass frames (1 frame per year).

Dental Services See details

The Cigna Preferred Medicare (HMO) plan covers dental services, with a $20 copay for Medicare Dental Services. Other services, including oral exams, dental x-rays, cleanings, and more are covered with a yearly maximum of $1500.

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 with a coinsurance between 0% and 20%, while 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 by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. There is a 20% coinsurance for this benefit.

Medical Equipment See details

Medical Equipment benefits are covered under the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered.

Prosthetics and Medical Supplies have no copay, with coinsurance of 20% for Medicare-covered prosthetic devices and medical supplies.

Diabetic Equipment is covered, but Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $95, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $200, Therapeutic Radiological Services have a copay of $80 or more, 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 for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Cigna Preferred Medicare (HMO) plan. This includes 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.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $178. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.

Other Services See details

Other Services for Cigna Preferred Medicare (HMO) include a meal benefit, but acupuncture, over-the-counter items, 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.