A non-government entity
Cigna True Choice Medicare (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna True Choice Medicare (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna True Choice Medicare (PPO) in 2025, please refer to our full plan details page.
Cigna True Choice Medicare (PPO) is a PPO plan offered by The Cigna Group available for enrollment in 2025 to people living in South New Jersey. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna True Choice Medicare (PPO) 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 True Choice Medicare (PPO).
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 True Choice Medicare (PPO), 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 has a $500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $13300.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $13300.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 True Choice Medicare (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions depending on the drug tier and pharmacy type. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your premiums may be reduced.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers a variety of benefits, including inpatient hospital care with copays, outpatient services with copays ranging from $0 to $315, and emergency services with a $110 copay. Primary care visits have copays from $0-$30, and hearing and vision services are covered, with copays for exams and coverage for hearing aids, eyewear, and dental services. This plan also covers preventive services, home health services with no copay, and offers additional benefits like OTC items.
Inpatient Hospital See details
Inpatient Hospital coverage, including acute and psychiatric services, is available with this plan. For inpatient hospital acute services, you will pay a $315 copay for days 1-6, and no copay for days 7-90; for inpatient hospital psychiatric services, you will pay a $335 copay for days 1-6, and no copay for days 7-90.
Outpatient Services See details
The Cigna True Choice Medicare (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $315, observation services with a $315 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual and group sessions, each with a copay of $30. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna True Choice Medicare (PPO) plan, but requires prior authorization. The copay for this benefit is $80.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna True Choice Medicare (PPO) plan. Ground ambulance services have a $265 copay, while air ambulance services have a 20% coinsurance; however, 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 under the Cigna True Choice Medicare (PPO) plan. Emergency Services and Worldwide Emergency Coverage each have a $110 copay, while Urgently Needed Services has a $45 copay; all have no coinsurance.
Primary Care See details
The Cigna True Choice Medicare (PPO) plan covers primary care physician services, chiropractic services (with a $15 copay), occupational therapy (with a $30 copay), physician specialist services (with a $30 copay), other health care professional services (with a copay between $0 and $30), physical therapy and speech-language pathology services (with a $30 copay), additional telehealth benefits (with a copay between $0 and $30), and opioid treatment program services (with a copay between $30 and $30). 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 True Choice Medicare (PPO) plan covers preventive services, including Medicare-covered services with no copay, an annual physical exam, health education, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit, but 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, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing Services are covered, including hearing exams, routine hearing exams, and fitting/evaluation for hearing aids. Hearing exams have a $30 copay, while prescription hearing aids have a copay between $399 and $1800 depending on the type of hearing aid.
Vision Services See details
Vision services include eye exams with a copay of $0-$30, and eyewear with a combined maximum benefit of $125 per year. Contact lenses are covered, and so are eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a limit of one per year for each.
Dental Services See details
Dental services are covered by the Cigna True Choice Medicare (PPO) plan, with a $30 copay for Medicare dental services. Other services such as oral exams, dental x-rays, and orthodontics are covered with a maximum plan benefit of $3,000 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, you will pay a $35 copay and between 0-20% coinsurance. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you will pay between 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Cigna True Choice Medicare (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Cigna True Choice Medicare (PPO) plan, with a 20% coinsurance for Durable Medical Equipment (DME) and Prosthetic Devices, no copay, and Durable Medical Equipment for use outside the home, and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts also have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $195, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $40 copay.
Home Health Services See details
Home Health Services are covered by Cigna True Choice Medicare (PPO), with no copay or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Cigna True Choice Medicare (PPO). For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Cigna True Choice Medicare (PPO) plan's "Other Services" benefit covers Over-the-Counter (OTC) items with a maximum benefit of $75.00 every three months, and includes nicotine replacement therapy and Naloxone coverage. 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.
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