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 Portland. 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 $400.00 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 $8950.00 (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 $8950.00 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. For example, preferred generic drugs have a $4 copay at preferred pharmacies and $20 at standard pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers a range of benefits with varying costs. Hospital stays have a copay of $395 for the first four days, and then no copay for the next 86 days, while outpatient services and emergency services have copays that range from $0 to $275 and $120, respectively. The plan includes coverage for primary care, vision, dental, and hearing services, with copays varying by service, and also provides coverage for ambulance, home health, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital services are covered under the Cigna True Choice Medicare (PPO) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-4, the copay is $395, and for days 5-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
The Cigna True Choice Medicare (PPO) plan covers various outpatient services, including outpatient hospital services with a copay between $0 and $275, observation services with a $275 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services are covered with a $25 copay for both individual and group sessions, and 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. You will have a copay of $85 for this benefit.
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 $260 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 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 under the Cigna True Choice Medicare (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $120 copay, while Urgently Needed Services have a $25 copay; all services have no coinsurance.
Primary Care See details
The Cigna True Choice Medicare (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, other health care professional services with a copay between $0 and $25, physical therapy and speech-language pathology services with a $25 copay, and opioid treatment program services with a $25 copay. The plan does not cover routine chiropractic care, individual or group sessions for mental health specialty services, individual or group sessions for psychiatric services, or podiatry services.
Preventive Services See details
The Cigna True Choice Medicare (PPO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, health education, fitness benefits, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing services with the Cigna True Choice Medicare (PPO) plan cover hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, with a $25 copay for hearing exams. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, but 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 includes coverage for eye exams with a copay of $0-$25, and also covers routine eye exams. Eyewear is covered, with a combined maximum benefit of $350 per year for both in-network and out-of-network services. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are also covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 copay, and other services with a $1,500 annual maximum. 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 are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna True Choice Medicare (PPO) plan, with a coinsurance of 20%. Prior authorization is required for these services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with a 20% coinsurance and Prosthetics/Medical Supplies, and Diabetic Therapeutic Shoes/Inserts also with a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic Procedures/Tests have a copay between $0 and $40, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $160, and Outpatient X-Ray Services have a $15 copay. Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by Cigna True Choice Medicare (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any specific services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and 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 the Cigna True Choice Medicare (PPO) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Cigna True Choice Medicare (PPO) plan covers acupuncture with a maximum plan benefit coverage amount of $300 per year. The plan also covers over-the-counter items, including nicotine replacement therapy and Naloxone, with a maximum benefit of $45 every three months. Additionally, the plan provides a meal benefit for chronic illnesses or conditions requiring home care, but does not have a maximum benefit amount. Many other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and more are not covered.
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