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 Western Pennsylvania. 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 $125.00 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 $10100.00 (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 $10100.00 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 depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy, your plan premium may be reduced.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers a range of benefits with varying cost-sharing structures. Inpatient hospital stays have a copay, while outpatient services have a mix of copays and no copays, depending on the service. The plan also covers primary care, preventive services, hearing, vision, and dental, with associated copays and coverage limits. Emergency services, ambulance, and home health services are covered, along with durable medical equipment and medical supplies, but the cost sharing varies. Other covered services include over-the-counter items and a meal benefit, but there are exclusions for some services like cardiac rehabilitation and additional hours of care.
Inpatient Hospital See details
Inpatient Hospital benefits, including both Acute and Psychiatric, are covered by the Cigna True Choice Medicare (PPO) plan. For Inpatient Hospital-Acute, you will pay a copay of $290 for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a copay of $295 for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered by the Cigna True Choice Medicare (PPO) plan, with no copay for outpatient hospital services, and a copay of $295 for observation services. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a copay of $30 for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Cigna True Choice Medicare (PPO) plan, and requires prior authorization. You will pay a $70 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 $230 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. For Emergency Services and Worldwide Emergency Coverage, there is a $125 copay, and for Urgently Needed Services, there is a $55 copay; all have no coinsurance.
Primary Care See details
The Cigna True Choice Medicare (PPO) plan covers primary care, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $30 copay, and physical therapy and speech-language pathology services with a $30 copay. This plan also covers additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $30 copay. 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, annual physical exams, health education, kidney disease education services, and other preventive services with no copay. 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, 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 exams are covered with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids 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
The Cigna True Choice Medicare (PPO) plan covers vision services, including eye exams with a copay of $0-$30. Eyewear is covered up to a combined maximum of $250 per year, and contact lenses, upgrades, and eyeglasses are also covered.
Dental Services See details
Dental services are covered, including a $30 copay for Medicare dental services, with a $5,000 maximum plan benefit per year. Oral exams, dental x-rays, other diagnostic and preventive services, restorative services, and orthodontics are covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna True Choice Medicare (PPO) plan. The plan has a $35 copay for Medicare Part B Insulin Drugs and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the Cigna True Choice Medicare (PPO) plan. You will pay 20% coinsurance for these services, and prior authorization is required.
Medical Equipment See details
Medical equipment benefits are covered by the Cigna True Choice Medicare (PPO) plan, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. The plan does not cover Durable Medical Equipment for use outside the home, and Diabetic Supplies.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $50, 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 Medicare (PPO) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Cigna True Choice Medicare (PPO) plan. 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, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $214 copay; additional and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for Cigna True Choice Medicare (PPO) includes coverage for over-the-counter items with a maximum benefit of $95 every three months, and a meal benefit for chronic illness or medical conditions that require the enrollee to stay at home. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many other services are not covered.
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