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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 $3650.00 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 prescriptions. For preferred generic drugs, the copay is $4 at preferred pharmacies and mail order, and $20 at standard pharmacies. For standard generic drugs, the copay is $45 at preferred pharmacies and mail order, and $47 at standard pharmacies. Preferred brand drugs have a $100 copay, and non-preferred drugs have 33% coinsurance. Once your total drug costs reach $2000, 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, including inpatient hospital stays with varying copays, and outpatient services with copays for some services like substance abuse. Preventive services, such as annual physical exams and glaucoma screenings, are covered with no copay, along with hearing and vision services like routine eye exams. This plan also provides dental services, including oral exams and x-rays, with no copay, and offers coverage for ambulance, emergency services, and home health services. Additional benefits include coverage for medical equipment, diagnostic services, and a quarterly allowance for over-the-counter items.
Inpatient Hospital See details
The Cigna Preferred Medicare (HMO) plan covers inpatient hospital stays with a $280 copay for days 1-5 and no copay for days 6-90 for acute care, and a $595 copay for days 1-3 and no copay for days 4-90 for psychiatric care. Additional days for inpatient hospital acute care are covered, while non-Medicare-covered stays and upgrades for inpatient hospital acute care, along with additional days and non-Medicare-covered stays for inpatient hospital psychiatric, are not covered.
Outpatient Services See details
The Cigna Preferred Medicare (HMO) plan covers a range of outpatient services, including outpatient hospital services with a copay between $0 and $300, observation services with a $300 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $20 copay for both individual and group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Cigna Preferred Medicare (HMO) covers partial hospitalization with a $130 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Cigna Preferred Medicare (HMO) plan. 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 24 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, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under 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; there is no coinsurance for any of these services. Worldwide Emergency Services have 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, other health care professional services with a copay between $0 and $20, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $20, and opioid treatment program services with a copay between $20 and $20. This plan does not cover routine chiropractic care, individual or group sessions for mental health specialty services, individual or group sessions for psychiatric services, or podiatry services.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services including 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 with no copay. However, services like in-home safety assessments, personal emergency response systems, and other specific services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $20 copay, and the plan covers routine hearing exams and fitting/evaluation for hearing aids once per year. Prescription hearing aids are covered with a copay between $399 and $1800, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a copay of $0-$20. Eyewear benefits are also covered, with a combined maximum benefit of $350 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered.
Dental Services See details
The Cigna Preferred Medicare (HMO) plan covers dental services, including oral exams, dental x-rays, and other diagnostic services, with no copay. Medicare dental services have a $20 copay and require prior authorization. The plan has a maximum benefit of $2500 per year for dental services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred Medicare (HMO) plan and require prior authorization. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services with a copay between $0 and $20, and lab services with no copay. Diagnostic Radiological Services have a copay up to $195, and Therapeutic Radiological Services have a coinsurance of at least 20%. 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 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 Preferred Medicare (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan. For days 1-20, there is a $20 copay, for days 21-60, there is a $214 copay, and for days 61-100, there is no copay.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $110 every three months. The plan also provides a meal benefit for chronic illnesses or medical conditions that require the enrollee to remain at home for a period of time. 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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