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Cigna TotalCare (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare (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 (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare (HMO D-SNP) is a HMO D-SNP plan offered by The Cigna Group available for enrollment in 2025 to people living in Southeast Florida. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna TotalCare (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 (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 (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 (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $17.40. 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 $3500.00 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 (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs associated with your drugs based on the tier and pharmacy you use, until your total drug costs reach $2,000. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D drugs will be $17.40.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a range of benefits with varying costs. Hospital stays have copays, with $650 for acute and $500 for psychiatric admissions. Outpatient services, emergency services, and primary care have no copays for many services, while some services, like ambulance and air ambulance, have coinsurance. The plan also includes coverage for vision, dental, and hearing services, each with specific limits and costs. Medical equipment, home health services, and skilled nursing facilities have no copays, but some services require prior authorization or doctor referrals. Additionally, the plan covers transportation to health-related locations, over-the-counter items, and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits with Cigna TotalCare (HMO D-SNP) include coverage for Inpatient Hospital-Acute with a copay of $650 per admission or stay, and Inpatient Hospital Psychiatric with a copay of $500 per admission or stay. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, but individual and group sessions are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna TotalCare (HMO D-SNP) plan, but requires prior authorization. The copay for this benefit is $100.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna TotalCare (HMO D-SNP), with no copay for all ambulance services, though Medicare-covered ground ambulance services have coinsurance. Air ambulance services have a 20% coinsurance. Transportation Services to plan-approved health-related locations are covered for up to 40 one-way trips per year, utilizing rideshare services, bus/subway, medical transport, and other methods. 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 TotalCare (HMO D-SNP) plan. Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay and no coinsurance, while Urgently Needed Services have no copay and no coinsurance.
Primary Care See details
Primary Care benefits include coverage for 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, with no copay and no coinsurance for Occupational Therapy and Physical Therapy and Speech-Language Pathology Services. Chiropractic Services, Mental Health Specialty Services (Individual and Group Sessions), and Psychiatric Services (Individual and Group Sessions) are partially covered, while Podiatry Services are not covered.
Preventive Services See details
The Cigna TotalCare (HMO D-SNP) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services like health education and fitness benefits. 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 include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams and fitting/evaluation for hearing aids are each covered once per year, and prescription hearing aids (all types) have a copay between $399 and $1800.
Vision Services See details
Cigna TotalCare (HMO D-SNP) covers vision services, including routine eye exams, eyewear, and upgrades. The plan covers one routine eye exam per year, and offers a combined maximum of $200 annually for eyewear, including contact lenses, eyeglasses, and eyeglass lenses and frames, with the option for one pair of each per year.
Dental Services See details
The Cigna TotalCare (HMO D-SNP) plan covers a range of dental services, including oral exams, x-rays, and cleanings, with an annual maximum of $2,500. Other services like orthodontics and implant services are also covered.
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 a coinsurance 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 under the Cigna TotalCare (HMO D-SNP) plan, but require prior authorization and a doctor's referral. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefits, both with no copay and no coinsurance, but Durable Medical Equipment for use outside the home is not covered. 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 are covered by the Cigna TotalCare (HMO D-SNP) plan. Lab services have no copay, while therapeutic radiological services have a coinsurance of at most 20%; however, diagnostic procedures/tests, diagnostic radiological services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare (HMO D-SNP) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization and a doctor referral are required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna TotalCare (HMO D-SNP) plan, with a $0 copay for days 1-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services with the Cigna TotalCare (HMO D-SNP) plan includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $150 every three months and a meal benefit for chronic illness or home-bound medical conditions. 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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