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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 St. Louis. 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 $2300.00 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 medications, with the amount varying based on the drug tier and pharmacy type. For example, preferred generic drugs have a $4 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your covered drugs. This plan may have reduced premiums if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a wide range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services have copays between $0 and $295. Emergency services, primary care, and preventive services are covered with copays, and the plan also includes coverage for hearing, vision, and dental services, with maximum benefits for eyewear and dental. This plan provides coverage for ambulance services, with a copay for ground transport and coinsurance for air transport, as well as transportation to health-related locations. Additionally, it covers home health, skilled nursing facilities, and home infusion services, with specific copays or coinsurance for certain services. The plan also includes coverage for medical equipment, diagnostic and radiological services, and offers an over-the-counter (OTC) benefit.
Inpatient Hospital See details
Inpatient Hospital services are covered by Cigna Preferred Medicare (HMO), with prior authorization required. For Inpatient Hospital-Acute, you'll pay a $205 copay for days 1-7, and no copay for days 8-90; Inpatient Hospital Psychiatric has a $245 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, but 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, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $0 and $295, observation services have a copay of $295, and ambulatory surgical center services have no copay. Individual and group outpatient substance abuse sessions have a copay of $20.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $100 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Cigna Preferred Medicare (HMO) plan. Ground ambulance services have a $230 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, but transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $135 copay, while Urgently Needed Services have a $25 copay, and all services have no coinsurance.
Primary Care See details
Under the Cigna Preferred Medicare (HMO) plan, primary care physician services, occupational therapy services, physician specialist services, physical therapy, speech-language pathology services, and opioid treatment program services are covered with a $20 copay, while chiropractic services, mental health specialty services, and psychiatric services are partially covered. Additional telehealth benefits are covered with a copay between $0 and $20.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, health education, kidney disease education, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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, 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, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Hearing exams have a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids are each covered once per year. Prescription Hearing Aids (all types) have a copay between $399 and $1800, and are covered twice per year; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, as well as OTC hearing aids.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including routine eye exams with a copay of $0-$35, and eyewear. Eyewear has a combined maximum plan benefit of $300 every year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades.
Dental Services See details
Dental services are covered by the Cigna Preferred Medicare (HMO) plan, with a $20 copay for Medicare dental services. Other dental services, including oral exams, dental x-rays, and more, are covered. The plan has a maximum benefit coverage of $3,300 per year.
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 and a coinsurance between 0% and 20%, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred Medicare (HMO) plan. This benefit requires prior authorization and has a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the Cigna Preferred Medicare (HMO) plan. Durable Medical Equipment has a 20% coinsurance and no copay, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance and no copay. Diabetic Equipment benefits are covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests with a minimum copay of $0 and a maximum copay of $25, and lab services with no copay. Radiological Services include coverage for diagnostic radiological services with a maximum copay of $175, therapeutic radiological services with a coinsurance of at least 20%, and outpatient X-Ray services with no copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan, with no copay or coinsurance; however, 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 covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered. 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.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $135.00 every three months, including nicotine replacement therapy and Naloxone. The plan also covers a meal benefit for chronic illnesses or medical conditions requiring you to stay at home, but other services like acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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