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 South Carolina. This plan received an overall rating of 4 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 $5050.00 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 your prescriptions, which varies depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies and $20 at standard pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your Part D costs will be $0.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan provides a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay, and outpatient services have copays from $0 to $285. Emergency services have a $125 copay, and primary care visits have a $20 copay. Preventive services and some hearing, vision, and dental services are covered, often with no copay. The plan also covers ambulance, home health, and skilled nursing facility services, but may require prior authorization and have copays or coinsurance. Other benefits include over-the-counter items and a meal benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $285 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you'll pay a $595 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered, while the "Non-Medicare-covered Stay for Inpatient Hospital-Acute" and "Upgrades for Inpatient Hospital-Acute" are not covered. Additional days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered by the Cigna Preferred Medicare (HMO) plan with copays ranging from $0 to $285. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $20.00. Outpatient Blood Services are also covered, with three pints deductible waived.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $105 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $270 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, using rideshare services, bus/subway, medical transport, and other modes of transportation; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, have a $125 copay, while Urgently Needed Services have a $55 copay; there is no coinsurance for any of these services. Worldwide Emergency Services have a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers Primary Care Physician, Chiropractic, Occupational Therapy, Physician Specialist, Other Health Care Professional, Psychiatric, Physical Therapy and Speech-Language Pathology, Additional Telehealth, and Opioid Treatment Program services. Chiropractic services have a $20 copay, while Routine Chiropractic Care is not covered. Occupational Therapy has a $20 copay, and Physician Specialist services have a $20 copay. Other Health Care Professional services have a copay between $0 and $20, and Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $20, and Opioid Treatment Program Services have a $20 copay. Individual and group sessions for Mental Health and Psychiatric Services are not covered, and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered preventive services, annual physical exams, and other preventive services are covered. Health Education, and Fitness Benefits are covered. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered. Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered.
Hearing Services See details
Hearing services are covered, including hearing exams with a $20 copay. Prescription hearing aids are partially covered, but inner ear, outer ear, and over the ear hearing aids are not covered, and prescription hearing aids have a copay between $399 and $1800.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$20, and a routine eye exam once per year. Eyewear benefits are covered, with a combined maximum benefit of $200 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
The Cigna Preferred Medicare (HMO) plan covers a range of dental services with an annual maximum of $1650, including oral exams, dental x-rays, and cleanings with no copay, but there is a $20 copay for Medicare Dental Services. Additionally, orthodontic services are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan and require prior authorization. Insulin has a $35 copay and 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 under the Cigna Preferred Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment (DME) and Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include diagnostic procedures/tests with a copay between $0 and $95, lab services with no copay, diagnostic radiological services with a copay up to $195, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with no copay. All radiological services require prior authorization.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay and no 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 not covered by the Cigna Preferred Medicare (HMO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
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 a $10 copay, for days 21-60 there is a $214 copay, and for days 61-100 there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Under the Cigna Preferred Medicare (HMO) plan, 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 $60 every three months, and the plan offers nicotine replacement therapy (NRT) and Naloxone coverage. The plan also covers a meal benefit for a chronic illness or medical condition, but there is no maximum benefit coverage amount.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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