A non-government entity
Cigna True Choice Plus Medicare (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna True Choice Plus 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 Plus Medicare (PPO) in 2025, please refer to our full plan details page.
Cigna True Choice Plus Medicare (PPO) is a PPO plan offered by The Cigna Group available for enrollment in 2025 to people living in Lehigh Valley. This plan received an overall rating of 3 out of 5 stars in 2025.
It's important to know that Cigna True Choice Plus 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 Plus 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 Plus Medicare (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.00. 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 $11300.00 (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 $11300.00 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 Plus Medicare (PPO) plan has an enhanced alternative drug benefit. This plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay. You will enter the catastrophic coverage phase once your total drug costs reach $2000.00.
Additional Benefits
The Cigna True Choice Plus Medicare (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services have copays that vary by service. Emergency services have a $110 copay, and primary care services have copays between $15 and $30. Preventive services are covered, and there are benefits for hearing, vision, and dental services with copays and varying limits. The plan also covers home health services, skilled nursing facilities, and over-the-counter items with specific copays or coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization; the copay for Inpatient Hospital-Acute is $275 for days 1-5 and no copay for days 6-90, and for Inpatient Hospital Psychiatric is $250 for days 1-5 and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades for Inpatient Hospital-Acute and Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $250, observation services with a $250 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services, with individual and group sessions each having a $30 copay, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna True Choice Plus Medicare (PPO) plan, with a $70 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for 20 one-way trips per year. 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. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $110 copay, while Urgently Needed Services has a $45 copay; all have no coinsurance.
Primary Care See details
Primary Care benefits cover Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic services have a $15 copay, while Occupational Therapy Services have a $30 copay, Physician Specialist Services have a $30 copay, and Physical Therapy and Speech-Language Pathology Services have a $30 copay. Additional Telehealth Benefits have a copay between $0 and $30. 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 Plus Medicare (PPO) plan covers preventive services, including annual physical exams, health education, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Additional preventive services such as in-home safety assessments, personal emergency response systems, medical nutrition therapy, and more are not covered.
Hearing Services See details
Hearing exams are covered with a $30 copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are partially covered, with a copay between $399 and $1800 for all types of prescription hearing aids, but not for inner ear, outer ear, or over the ear hearing aids.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$30. Eyewear benefits are covered with a combined maximum of $350 per year for both in-network and out-of-network services, contact lenses are covered, and eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered, each with a limit of one per year.
Dental Services See details
Cigna True Choice Plus Medicare (PPO) offers dental services with a $30 copay for Medicare dental services, and a yearly maximum of $1800 for other dental services. 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 all covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while 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 Plus Medicare (PPO) plan. This plan requires prior authorization, and has a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Cigna True Choice Plus Medicare (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $225, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the Cigna True Choice Plus 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 technically covered, but not covered in practice, as Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna True Choice Plus Medicare (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include coverage for over-the-counter items and a meal benefit, but acupuncture and several other services are not covered. The plan provides up to $130 every three months for over-the-counter items, including nicotine replacement therapy and Naloxone.
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