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 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 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 $250.00 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 $9500.00 (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 $9500.00 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 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 pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your Part D premium will be $27.00 per month.
Additional Benefits
The Cigna True Choice Plus Medicare (PPO) plan offers comprehensive coverage with a variety of services. Inpatient hospital stays have a $325 copay per admission, while outpatient services have varying copays, and emergency services have a $125 copay. The plan also covers primary care, preventive services, hearing, vision, and dental services with varying copays and coverage limits. Additional benefits include ambulance services, home health services with no copay, and skilled nursing facility care with a copay after the first 20 days. The plan also provides coverage for home infusion, dialysis, and medical equipment with coinsurance. Other benefits include OTC items and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with a copay of $325 per admission or stay. 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, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $250, and observation services have a $250 copay. ASC services have no copay, and outpatient substance abuse services have a $25 copay for both individual and group sessions. Outpatient blood services have an enhanced benefit with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna True Choice Plus Medicare (PPO) plan, but requires prior authorization. The copay for this benefit is $105.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna True Choice Plus 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 are covered under the Cigna True Choice Plus Medicare (PPO) plan, with a $125 copay and no coinsurance for Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation. Urgently Needed Services have a $55 copay and no coinsurance.
Primary Care See details
The Cigna True Choice Plus Medicare (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, other health care professional services with a copay between $0 and $25, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $25, and opioid treatment program services with a $25 copay. Individual and group sessions for mental health and psychiatric services, and podiatry services are not covered.
Preventive Services See details
The Cigna True Choice Plus Medicare (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education services, and other preventive services with no copay. 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 include hearing exams with a $25 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are partially covered, with a copay between $399 and $1800, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
The Cigna True Choice Plus Medicare (PPO) plan covers vision services, including eye exams with a copay of $0-$25 and routine eye exams once per year. Eyewear is covered, with a combined maximum benefit of $250 per year for both in-network and out-of-network services, and includes contact lenses, eyeglasses (lenses and frames) once per year, eyeglass lenses once per year, and eyeglass frames once per year.
Dental Services See details
The Cigna True Choice Plus Medicare (PPO) plan covers dental services, including 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. Medicare dental services have a $25 copay. Other dental services have a maximum plan benefit of $2,700 per year, covering both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna True Choice Plus Medicare (PPO) plan, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, and a coinsurance between 0% and 20%, while 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 Plus Medicare (PPO) plan, but require prior authorization. You will pay 20% coinsurance for this service.
Medical Equipment See details
The Cigna True Choice Plus Medicare (PPO) plan covers Durable Medical Equipment with a 20% coinsurance and no copay, but does not cover Durable Medical Equipment for use outside the home. Prosthetics/Medical Supplies are covered with a 20% coinsurance and no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray 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 of at most $225, Therapeutic Radiological Services have a copay of $60, and Outpatient X-Ray Services have a $30 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 covered, but the plan does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or 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 Plus Medicare (PPO) plan. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays are not covered.
Other Services See details
The Cigna True Choice Plus Medicare (PPO) plan's other services benefit covers over-the-counter (OTC) items with a maximum coverage amount of $65.00 every three months, including nicotine replacement therapy and Naloxone coverage. 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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