A non-government entity
Cigna Preferred Medicare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Cigna Preferred Medicare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Cigna Preferred Medicare (HMO) in 2025, please refer to our full plan details page.
Cigna Preferred Medicare (HMO) is a HMO plan offered by The Cigna Group available for enrollment in 2025 to people living in North Carolina. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that Cigna Preferred Medicare (HMO) 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 Preferred Medicare (HMO).
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 Preferred Medicare (HMO), 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 Maximum Out-Of-Pocket cost of $3750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Preferred Medicare (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your medications. The copay amounts vary depending on the drug tier and whether you use a preferred or standard pharmacy. For example, for preferred generic drugs, the copay is $4.00, while for standard generic drugs, it's $45.00. Once your total drug costs reach $2000.00, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays, while outpatient services may have copays or no copay depending on the service. Emergency and urgent care services have copays, and ambulance services have copays or coinsurance. This plan also covers primary care, preventive, vision, dental, and hearing services, often with copays. Additionally, it includes coverage for home health, skilled nursing, and home infusion services with copays or coinsurance. The plan offers additional benefits like transportation, and over-the-counter items with set limits.
Inpatient Hospital See details
Inpatient Hospital services are covered. For Inpatient Hospital-Acute, you will pay a $290 copay for days 1-6, and no copay for days 7-90. Inpatient Hospital Psychiatric services have a $595 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, along with additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient Hospital Services have a copay between $0 and $305, and Observation Services have a $305 copay, while Ambulatory Surgical Center (ASC) Services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $20. Outpatient Blood Services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $130 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground ambulance services have a $270 copay, while air ambulance services have a 20% coinsurance. Transportation services to plan-approved health-related locations are covered for up to 30 one-way trips per year, but 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 Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have a $140 copay, while Urgently Needed Services have a $65 copay, and there is no coinsurance for any of these services. Worldwide Emergency Services has a maximum plan benefit coverage of $50,000.
Primary Care See details
The Cigna Preferred Medicare (HMO) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy services (with a $20 copay), physician specialist services (with a $20 copay), and physical therapy and speech-language pathology services (with a $20 copay). Mental health and psychiatric services are partially covered, but individual and group sessions are not covered. Podiatry services are not covered, and telehealth benefits have a copay between $0 and $20.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services including Medicare-covered services with no copay, annual physical exams, health education, kidney disease education services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs. However, in-home safety assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, and routine hearing exams and fitting/evaluation for hearing aids, each 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
Vision services are covered, including eye exams with a copay between $0 and $20. Eyewear is covered with a combined maximum benefit of $300 per year, and contact lenses, eyeglass lenses, eyeglass frames, and upgrades are covered as well.
Dental Services See details
Dental Services are covered, with a $20 copay for Medicare Dental Services. This plan offers up to $1950 per year for other 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.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. With this plan, you will pay a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for all of the covered services.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan and require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the Cigna Preferred Medicare (HMO) plan, with 20% coinsurance for Durable Medical Equipment and Prosthetic Devices, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay of up to $20, and lab services with no copay. Diagnostic Radiological Services have a copay of up to $195, while Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered by the Cigna Preferred Medicare (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. The plan has a copay of $20 for days 1-20, $214 for days 21-60, and no copay for days 61-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $90 every three months, and Meal Benefit. 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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