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 Portland. 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.
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 $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. In the initial coverage phase, you'll pay a copay for your prescriptions based on the drug tier and pharmacy. For example, preferred generic drugs have a $4 copay at preferred pharmacies, and $20 at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. Be sure to check the plan's formulary for specific drugs covered.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits, including inpatient hospital stays with a $300 copay for the first five days and no copay thereafter, and outpatient services with varying copays. You can also expect coverage for primary care with no copay, along with preventive services and vision benefits, which include routine eye exams, and eyeglasses. Dental services are covered with a $20,000 annual maximum. This plan also covers emergency services, ambulance services, and home health services. Additional benefits include hearing services with a $25 copay for exams and coverage for hearing aids, as well as coverage for medical equipment and diagnostic services. However, the plan does not cover services like cardiac rehabilitation, maxillofacial prosthetics, or orthodontics.
Inpatient Hospital See details
The Cigna Preferred Medicare (HMO) plan covers inpatient hospital stays, including acute and psychiatric care, with a copay of $300 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.
Outpatient Services See details
Outpatient services are covered, including all outpatient hospital services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $350, observation services have a $350 copay, and ASC services have no copay. Individual and group outpatient substance abuse sessions have a copay of $25, and outpatient blood services have a waived 3-pint deductible.
Partial Hospitalization See details
Partial hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. You will have an $85 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO), with prior authorization required. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 10 one-way trips per year, using rideshare services, bus/subway, medical transport, or other modes of transportation. Transportation services to any other health-related location 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, and Urgently Needed Services has a $20 copay; all have no coinsurance. Worldwide Emergency Services also has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $25 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health Specialty Services, Podiatry Services, and Psychiatric Services are partially covered, with Individual and Group Sessions for Mental Health and Psychiatric Services not covered. The plan also covers Other Health Care Professional services and Opioid Treatment Program Services, with a copay between $0 and $25, and Additional Telehealth Benefits with a copay between $0 and $25.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, additional preventive services, health education, in-home support services, and fitness benefits. However, the plan does not cover in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing Services are covered, including hearing exams with a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year, and prescription hearing aids (all types) are covered with a copay between $399 and $1800, twice per year. 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
Vision services include eye exams with a copay of $0-$25, routine eye exams (1 per year), contact lenses, eyeglasses (lenses and frames) (1 per year), eyeglass lenses (1 per year), and eyeglass frames (1 per year). Eyewear has a combined maximum benefit of $400 per year. Upgrades are also covered.
Dental Services See details
The Cigna Preferred Medicare (HMO) plan covers dental services with a $20,000 annual maximum, and includes a $25 copay for Medicare dental services. The plan covers oral exams, dental x-rays, other diagnostic dental services, cleaning, fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with varying copays. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan and require prior authorization. With this plan, you will pay a $35 copay for Medicare Part B Insulin Drugs, and the coinsurance ranges from 0% to 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetic Devices, and Medical Supplies, are covered under the Cigna Preferred Medicare (HMO) plan. DME and Prosthetic Devices have a 20% coinsurance, and Medical Supplies also have a 20% coinsurance; there is no copay for these services. 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, with prior authorization required. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $35, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $195, Therapeutic Radiological Services have a coinsurance of at most 20%, and Outpatient X-Ray Services have a $15 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 not covered by the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture is covered with no copay, with a maximum plan benefit coverage amount of $300 per year. OTC items are covered, with a maximum plan benefit coverage amount of $115 every three months. The plan also provides a meal benefit for chronic or medical conditions requiring the enrollee to remain at home for a period of time, with no maximum plan benefit coverage amount. However, services like Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and others are not covered.
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