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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 St. Louis. This plan received an overall rating of 2.5 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 $31.80. 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 $9350.00 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 you meet your deductible, you will pay the costs for your drugs. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy (LIS), you may have a reduced premium. The LIS monthly premium is $31.80.
Additional Benefits
The Cigna TotalCare (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. The plan covers inpatient and outpatient hospital services, including emergency and urgent care, with copays or coinsurance. Preventive services, home health, and lab services are available with no copay or coinsurance. This plan provides coverage for primary care, hearing, vision, and dental services with coinsurance or copays. Additional benefits include ambulance services, medical equipment, and home infusion, each with their own cost-sharing structure. The plan also includes an over-the-counter allowance and meal benefits.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but additional days, non-Medicare-covered stays, and upgrades for these services are not covered. The plan requires prior authorization, and the cost sharing includes a copay, with more information available.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the Cigna TotalCare (HMO D-SNP) plan. Observation Services have a 20% coinsurance, while outpatient hospital services have a coinsurance between 0% and 20%. Ambulatory Surgical Center (ASC) Services and Outpatient Substance Abuse Services are covered with a coinsurance between 0% and 20% for ASC services and 20% for individual and group sessions for Outpatient Substance Abuse. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay 35% coinsurance for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna TotalCare (HMO D-SNP) plan, which includes coverage for ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna TotalCare (HMO D-SNP) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, while Urgently Needed Services has a $45 copay; all have no coinsurance.
Primary Care See details
The Cigna TotalCare (HMO D-SNP) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, other health care professional services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services, physician specialist services, and other health care professional services have a 20% coinsurance. Occupational therapy services have a 20% coinsurance, while physical therapy and speech-language pathology services also have a 20% coinsurance. Some services are covered under mental health and psychiatric services, but individual and group sessions are not covered. Additional telehealth benefits have a coinsurance between 0% and 20%.
Preventive Services See details
The Cigna TotalCare (HMO D-SNP) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, health education, kidney disease education services, and other preventive services, with no copay or coinsurance. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a 20% coinsurance, and fitting/evaluation for hearing aids; prescription hearing aids have a copay between $399 and $1800, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered. You are allowed 1 routine hearing exam and 1 fitting/evaluation per year, and 2 prescription hearing aids per year.
Vision Services See details
Vision services include coverage for eye exams with 0-20% coinsurance. Eyewear is covered with a combined maximum benefit of $400 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services offers coverage for various services, including Medicare Dental Services with 20% coinsurance, and other dental services with a $2,500 annual maximum. The plan covers oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, oral and maxillofacial surgery, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%. All other drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna TotalCare (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
The Cigna TotalCare (HMO D-SNP) plan covers medical equipment, including durable medical equipment with a 20% coinsurance and prosthetics, medical supplies, and diabetic therapeutic shoes/inserts, each with a 20% coinsurance. Durable medical equipment for use outside the home and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, are covered with a coinsurance of up to 20%, while Lab Services have no copay. Therapeutic Radiological Services have a coinsurance of up to 20%, 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 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 TotalCare (HMO D-SNP) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but prior authorization is required. The plan charges the Medicare-defined cost share for tier 1, and does not cover additional days beyond Medicare-covered SNF services or non-Medicare-covered SNF stays.
Other Services See details
Under "Other Services," Cigna TotalCare (HMO D-SNP) does not cover 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. Over-the-Counter (OTC) Items are covered with a maximum benefit of $250 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone. The plan also covers a Meal Benefit for chronic illness and medical conditions that require the enrollee to stay at home.
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