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Cigna TotalCare Plus (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna TotalCare Plus (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 Plus (HMO D-SNP) in 2025, please refer to our full plan details page.
Cigna TotalCare Plus (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 Plus (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 Plus (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 Plus (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 Plus (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 Plus (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs in each tier until your total drug costs reach $2000, at which point you will enter the next coverage phase. If you qualify for the low-income subsidy, you will pay $31.80 per month for Part D. Once your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Cigna TotalCare Plus (HMO D-SNP) plan offers a range of benefits with a focus on managing costs. Inpatient and outpatient services are covered, with copays and coinsurance varying by service. Emergency services and primary care visits have set copays or coinsurance, and preventive services are covered with no copay. The plan also includes coverage for hearing, vision, and dental services, with specific copays, coinsurance, and annual maximums. Additional benefits include home health services with no copay, and coverage for medical equipment and diagnostic services, with varying coinsurance amounts. The plan offers an OTC allowance and meal benefits, but does not cover certain services such as cardiac rehabilitation and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered and require prior authorization, with a copay. Additional days for inpatient hospital, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the Cigna TotalCare Plus (HMO D-SNP) plan, including outpatient hospital services with a coinsurance between 0% and 20%, observation services with a 20% coinsurance, and ambulatory surgical center services with a coinsurance between 0% and 20%. Outpatient substance abuse services are covered with a 20% coinsurance for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Cigna TotalCare Plus (HMO D-SNP) covers partial hospitalization with a 35% coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna TotalCare Plus (HMO D-SNP), including ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are also covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. For Emergency Services, the copay is $110.00, and for Urgently Needed Services, the copay is $45.00; both have no coinsurance. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a copay of $110.00 and no coinsurance.
Primary Care See details
Cigna TotalCare Plus (HMO D-SNP) covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services, physician specialist services, and psychiatric services require prior authorization, and routine chiropractic care, individual and group sessions for mental health specialty services, and individual and group sessions for psychiatric services are not covered. You will pay 20% coinsurance for primary care physician services, chiropractic services, physician specialist services, and physical therapy and speech-language pathology services.
Preventive Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan covers preventive services, including Medicare-covered services with no copay, and an annual physical exam with a 20% coinsurance. Additional preventive services are partially covered, with in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more not covered.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of at most 20% and fitting/evaluation for hearing aids, both of which are covered once per year. Prescription hearing aids are partially covered; 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.
Vision Services See details
Vision Services includes coverage for eye exams with a coinsurance of 0% to 20%, and eyewear with a combined maximum benefit of $500 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services, which require prior authorization. Other Dental Services have a $2,500 maximum benefit per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Cigna TotalCare Plus (HMO D-SNP). For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. 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 TotalCare Plus (HMO D-SNP) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance, while Diabetic Supplies are not covered; Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests and Diagnostic Radiological Services have a coinsurance of up to 20%, while Lab Services have no copay. Therapeutic Radiological Services and Outpatient X-Ray Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the Cigna TotalCare Plus (HMO D-SNP) plan with no copay and no coinsurance, but require authorization. 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 Plus (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 under the Cigna TotalCare Plus (HMO D-SNP) plan, but prior authorization is required. There is no information on the copay or coinsurance for this benefit, but additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Cigna TotalCare Plus (HMO D-SNP) plan 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. The plan covers over-the-counter (OTC) items up to $300 every three months, and also covers meal benefits for chronic illnesses or for a medical condition that requires the enrollee to remain at home.
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