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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 Salt Lake City. This plan received an overall rating of 2.5 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. Additionally, this plan comes with a Part B Premium reduction of $5.00. You must continue to pay paying your reduced 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 $4200.00 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. During the initial coverage phase, you'll pay a copay for each prescription, which varies 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 $2,000, you enter the catastrophic coverage phase, where you'll pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers coverage for inpatient and outpatient hospital services with varying copays, as well as emergency, urgent, and worldwide emergency services with copays ranging from $25 to $125. The plan includes coverage for primary care, hearing, vision, and dental services, with specific copays for each. Additionally, the plan provides benefits for ambulance and transportation, home infusion, dialysis, medical equipment, and home health services. This plan also covers a range of other services, including preventive care, diagnostic and radiological services, and skilled nursing facility care. The plan offers additional benefits such as over-the-counter items, nicotine replacement therapy, and a meal benefit. However, it's important to note that some services, like cardiac rehabilitation, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $295 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $295 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay between $0 and $295, observation services with a $295 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $20 copay for individual and group sessions, and outpatient blood services with a waived three-pint deductible.
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, with prior authorization required. Ground ambulance services have a $170 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, but other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $25 copay. Worldwide Emergency Services has a maximum plan benefit of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy with a $20 copay, physician specialist services with a $20 copay, other health care professional services with a $0-$20 copay, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a $0-$20 copay, and opioid treatment program services with a $20 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
The Cigna Preferred Medicare (HMO) plan covers preventive services, including annual physical exams, health education, In-Home Support Services, Support for Caregivers of Enrollees, and Fitness Benefits. This plan does not cover services such as In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, wigs, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing services include coverage for hearing exams with a $20 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids (all types) have a copay between $399 and $1800, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as are OTC hearing aids.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including eye exams with a copay of $0-$20, and eyewear with a combined maximum benefit of $400 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 dental services, including Medicare dental services with a $20 copay, oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. Restorative services have a copay from $0 to $550, adjunctive general services have a copay from $0 to $285, endodontics have a copay from $0 to $675, periodontics have a copay from $0 to $595, prosthodontics (removable) have a copay from $25 to $615, prosthodontics (fixed) have a copay from $50 to $525, and oral and maxillofacial surgery is covered. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
The Cigna Preferred Medicare (HMO) plan covers Home Infusion bundled Services, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by Cigna Preferred Medicare (HMO). You will pay a coinsurance of 20% for this benefit.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna Preferred Medicare (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $300, Therapeutic Radiological Services have a coinsurance of at least 20%, 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 or coinsurance, though prior authorization is required. However, 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. Prior authorization is required for these 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. You will have no copay for days 1-20, and a $214 copay per day for days 21-100.
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 items are covered with a maximum benefit of $105.00 every three months, and the plan offers nicotine replacement therapy and Naloxone coverage. The plan also provides a meal benefit for a chronic illness or for a medical condition that requires the enrollee to remain at home.
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