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 Long Island. 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 $7500.00 (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 $7500.00 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 will pay a copay for your prescriptions. For example, preferred generic drugs have a $5 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for your Part D covered drugs. Be sure to check the plan's formulary for specific drugs covered.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. The plan covers primary care, preventive services, and includes coverage for hearing, vision, and dental services. You can expect a copay for services like primary care visits, specialist visits, and hearing exams. Additional benefits include coverage for ambulance services, emergency services, and home health services, along with medical equipment and diagnostic services. The plan also provides coverage for home infusion and dialysis services with coinsurance. However, it's important to note that some services, such as certain home health services, and additional days of care in the hospital are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage under the Cigna True Choice Medicare (PPO) plan includes both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you'll pay a $330 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you'll pay a $335 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare-covered stays for both services are not covered.
Outpatient Services See details
Outpatient Services with Cigna True Choice Medicare (PPO) includes coverage for all outpatient hospital services, with a copay between $0 and $350, and observation services with a $350 copay. Ambulatory Surgical Center (ASC) Services have no copay, while Outpatient Substance Abuse Services have a $35 copay for both individual and group sessions. Outpatient Blood Services are also covered with a waived deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna True Choice Medicare (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground ambulance services have a $245 copay, and air ambulance services have a 20% coinsurance, while 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 by the Cigna True Choice Medicare (PPO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay. Urgently Needed Services have a $45 copay. There is no coinsurance for any of these services.
Primary Care See details
The Cigna True Choice Medicare (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, and physical therapy and speech-language pathology services with a $35 copay. Additionally, the plan covers additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $35 copay. However, individual and group sessions for mental health and psychiatric services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The Cigna True Choice Medicare (PPO) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, additional preventive services, health education, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, 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 of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers a fitness benefit.
Hearing Services See details
Hearing Services are covered by the Cigna True Choice Medicare (PPO) plan, including routine hearing exams with a $30 copay. The plan also covers fitting/evaluation for hearing aids, and prescription hearing aids (all types) with a copay between $399 and $1800, but does not cover prescription hearing aids for the inner or outer ear, over-the-ear hearing aids, or OTC hearing aids.
Vision Services See details
Vision Services include eye exams with a copay of $0-$35, and routine eye exams once per year. Eyewear has a combined maximum plan benefit of $200 per year, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are also covered.
Dental Services See details
The Cigna True Choice Medicare (PPO) plan offers dental services, including oral exams, dental X-rays, and other diagnostic services, with a $35 copay for Medicare dental services and a $2,100 annual maximum benefit. Additional services like orthodontics, restorative services, and oral surgery are also covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. 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 by the Cigna True Choice Medicare (PPO) plan, but prior authorization is required. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits under the Cigna True Choice Medicare (PPO) plan cover Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Medical Supplies and Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $40, and lab services with no copay. Radiological services are also covered, including diagnostic radiological services with a copay up to $300, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $10 copay.
Home Health Services See details
Home Health Services are covered by the Cigna True Choice Medicare (PPO) plan 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 of the 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. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna True Choice Medicare (PPO) plan, but require prior authorization. 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 are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $90 every three months, and a meal benefit for chronic illnesses or medical conditions requiring the enrollee to remain at home. 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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