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 Washington DC/Delaware. 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 $22.00. 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 $10000.00 (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 $10000.00 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, which varies depending on the drug tier and where you fill your prescriptions. 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, where you pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you will pay $22.00. Be sure to check the plan's formulary to see if your specific drugs are covered.
Additional Benefits
The Cigna True Choice Medicare (PPO) plan offers comprehensive coverage for various healthcare needs. This plan includes coverage for inpatient and outpatient services, with copays varying based on the specific service. Additional benefits include coverage for emergency services, primary care, preventive services, hearing, vision, and dental services. The plan also covers home health services with no copay, along with skilled nursing facility care.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including both Acute and Psychiatric care. For days 1-6, you will pay a $230 copay, and for days 7-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay ranging from $0 to $375, and observation services with a $375 copay. Ambulatory Surgical Center (ASC) services have no copay, and outpatient substance abuse services have a $45 copay per session. 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 have a $105 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Cigna True Choice Medicare (PPO) plan. Ground ambulance services have a copay of $265, while air ambulance services have a 20% coinsurance; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services has a $55 copay; all of these services have no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna True Choice Medicare (PPO) plan covers primary care services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $45 copay, physical therapy and speech-language pathology services with a $35 copay, and telehealth services with a copay between $0 and $45. The plan does not cover routine chiropractic care, individual and group sessions for mental health specialty services, podiatry services, individual and group sessions for psychiatric services.
Preventive Services See details
The Cigna True Choice Medicare (PPO) plan covers preventive services including Medicare-covered zero dollar services, annual physical exams, health education, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and fitness benefits, but 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, or counseling services.
Hearing Services See details
Hearing services with the Cigna True Choice Medicare (PPO) plan include hearing exams with a $25 copay. Prescription hearing aids (all types) are covered with a copay between $399 and $1800, while inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $40, and routine eye exams are covered once per year. Eyewear is covered, with a combined maximum benefit of $100 per year for both in-network and out-of-network services, and includes contact lenses, eyeglasses (lenses and frames), eyeglass lenses (one pair per year), and eyeglass frames (one pair per year).
Dental Services See details
Dental Services are covered, with a $45 copay for Medicare Dental Services. Other Dental Services, including Oral Exams, Dental X-Rays, and Orthodontics are covered. This plan has a maximum benefit coverage of $850 per year for 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 Medicare (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0% and 20%. Other Medicare Part B drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna True Choice Medicare (PPO) plan. This plan requires prior authorization and has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, and medical supplies are covered by Cigna True Choice Medicare (PPO). Durable Medical Equipment has a 20% coinsurance, and Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, while Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Cigna True Choice Medicare (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $50, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $225, Therapeutic Radiological Services have a $60 copay, and Outpatient X-Ray Services have a $35 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 none 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 are covered. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Cigna True Choice Medicare (PPO) plan, but require prior authorization. For days 1-20, there is a $10 copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Cigna True Choice Medicare (PPO) plan covers acupuncture, over-the-counter (OTC) items, and a meal benefit. Acupuncture has no copay, while OTC items are limited to $20 every three months, and the meal benefit has no maximum coverage amount. However, the plan does not cover services for Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and other services.
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