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 Southwest Ohio/North Kentucky. 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 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 $13200.00 (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 $13200.00 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. In the initial coverage phase, you'll pay a copay for your prescriptions. 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. In this phase, you pay nothing for covered drugs.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers coverage for inpatient and outpatient hospital services, with varying copays depending on the service. You'll also have access to primary care, preventive, hearing, vision, and dental services, along with ambulance, emergency, and skilled nursing facility care. Many services have copays, coinsurance, and some require prior authorization, so be sure to review the details of each benefit to understand your costs.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a $450 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a $400 copay for days 1-4 and no copay for days 5-90. Additional days and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Cigna True Choice Medicare (PPO) plan. Outpatient Hospital Services have a copay between $0 and $450, Observation Services have a $450 copay, and Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay between $50 and $50. 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 pay a copay of $80 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 $245 copay, while air ambulance services have a 20% coinsurance. 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 each have a $110 copay, while Urgently Needed Services have 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 $35 copay, physician specialist services with a $50 copay, physical therapy and speech-language pathology services with a $35 copay, and other health care professional services with a copay between $0 and $50. This plan does not cover routine chiropractic care, individual or group mental health specialty sessions, podiatry services, or individual or group psychiatric sessions. Additional telehealth benefits are covered with a copay between $0 and $50, and Opioid Treatment Program Services are covered with a $50 copay.
Preventive Services See details
The Cigna True Choice Medicare (PPO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, health education, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additionally, the plan covers fitness benefits. However, the plan 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 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.
Hearing Services See details
Hearing services are covered, including routine hearing exams with a $35 copay. Fitting/evaluation for hearing aids is covered. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, while prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services, including eye exams and eyewear, are covered. Eye exams have a copay of $0-$40, and routine eye exams are covered once per year. Eyewear has a combined maximum benefit of $100 per year for both in-network and out-of-network services, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered.
Dental Services See details
Dental services are covered, including oral exams with a $50 copay, dental x-rays with a $50 copay, other diagnostic dental services with a $50 copay, prophylaxis (cleaning) with a $50 copay, fluoride treatment with a $50 copay, other preventive dental services with a $50 copay, restorative services with a $50 copay, adjunctive general services with a $50 copay, endodontics with a $50 copay, periodontics with a $50 copay, prosthodontics (removable) with a $50 copay, maxillofacial prosthetics with a $50 copay, implant services with a $50 copay, prosthodontics (fixed) with a $50 copay, oral and maxillofacial surgery with a $50 copay, and orthodontics with a $50 copay. This plan has a maximum benefit of $1300 per year for in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance; Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 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 for these services.
Medical Equipment See details
Medical equipment benefits with the Cigna True Choice Medicare (PPO) plan include durable medical equipment, prosthetics, medical supplies, and diabetic equipment. Durable Medical Equipment (DME) has a 20% coinsurance and requires prior authorization, while durable medical equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and Medical Supplies have a 20% coinsurance, and no copay applies to either. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, while Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, and outpatient X-ray services, are covered. Lab services have no copay, while diagnostic procedures/tests have a copay between $0 and $150. Diagnostic radiological services have a copay up to $350 and therapeutic radiological services have a copay of $60. Outpatient X-Ray Services have a $30 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 prior authorization is required. 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 any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD 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. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, and a Meal Benefit for chronic illnesses and medical conditions. 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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