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 Richmond. 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 $5.00. 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 combined Maximum Out-Of-Pocket cost of $10000.00 (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 $10000.00 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, which varies depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. Please check the plan's formulary for specific drugs covered and their associated costs.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and preventive services often have no copay. This plan covers hearing, vision, and dental services, with copays and annual maximums. Emergency and ambulance services are covered, with copays and coinsurance, and home health services have no copay.
Inpatient Hospital See details
Inpatient hospital services are covered, with a copay of $310 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute, and a copay of $295 for days 1-6 and no copay for days 7-90 for Inpatient Hospital Psychiatric. Additional days, upgrades, and non-Medicare covered stays for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, under the Cigna True Choice Medicare (PPO) plan, includes coverage for all outpatient hospital services, with a copay between $0 and $275, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $35 copay for both individual and group sessions. Outpatient Blood Services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna True Choice Medicare (PPO) plan, but requires prior authorization. You will have a $105 copay 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 $225 copay, while air ambulance services have a 20% coinsurance, and transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered by the Cigna True Choice Medicare (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $55 copay; all services have no coinsurance. Worldwide Emergency Services has a maximum benefit coverage of $50,000.
Primary Care See details
Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services are covered with a $20 copay, but routine care is not covered. Individual and group sessions for Mental Health and Psychiatric services are not covered, 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. Additional preventive services include health education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services are covered under the Cigna True Choice Medicare (PPO) plan. Routine hearing exams have a $30 copay, and the plan covers one exam per year, as well as Fitting/Evaluation for Hearing Aid, which also covers one exam per year. Prescription Hearing Aids (all types) are covered with a copay between $399 and $1800 for two hearing aids per year, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams with a copay between $0 and $35, and routine eye exams once per year. Eyewear is covered with a combined maximum of $150 per year, and contact lenses are also covered. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each covered once per year, and upgrades are covered.
Dental Services See details
The Cigna True Choice Medicare (PPO) plan covers dental services with a $650 annual maximum, and a $35 copay for Medicare dental services. Other dental services include 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 by the Cigna True Choice Medicare (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, while the plan also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Cigna True Choice Medicare (PPO) plan, but require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits for the Cigna True Choice Medicare (PPO) plan include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, but Durable Medical Equipment for use outside the home is not covered; Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, while Diabetic Supplies are not covered. Medical Supplies have a 20% coinsurance, and all services require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures and tests with a copay between $0 and $50, lab services with no copay, diagnostic radiological services with a copay up to $225, therapeutic radiological services with a copay of $60, and outpatient X-ray services with a $35 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered by the Cigna True Choice Medicare (PPO) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific sub-services including 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 are not covered. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Cigna True Choice Medicare (PPO) plan, but require prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Cigna True Choice Medicare (PPO) plan covers acupuncture with a maximum benefit coverage amount of $300 per year, and a meal benefit for chronic illnesses or medical conditions requiring the enrollee to stay home. Over-the-counter items, 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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