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 $3850.00 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 will pay a copay for your prescriptions based on the drug tier and pharmacy type. For example, preferred generic drugs have a $4 copay at preferred pharmacies and $20 at standard pharmacies. 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. Inpatient hospital stays have a copay, with different amounts depending on the type of care and length of stay. Outpatient services, emergency care, and primary care visits also have copays, varying by service. This plan includes coverage for ambulance services, vision, dental, hearing, and home health services. You can also receive coverage for medical equipment, diagnostic services, and skilled nursing facilities with copays or coinsurance. There are also some additional benefits for over-the-counter items and meals for certain conditions.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $260 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $595 copay for days 1-3, and no copay for days 4-90. Additional days for Inpatient Hospital-Acute are covered, but non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered. Additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are also not covered.
Outpatient Services See details
The Cigna Preferred Medicare (HMO) plan covers outpatient services, including outpatient hospital services with a copay between $0 and $310, observation services with a $310 copay, and ambulatory surgical center services with no copay. The plan also covers outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. You will have a $130 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required. Ground ambulance services have a $270 copay, while air ambulance services have a 20% coinsurance. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. Transportation services to any other health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Cigna Preferred Medicare (HMO) plan. Emergency Services and Worldwide Emergency Coverage, Urgent Coverage, and Emergency Transportation have a $140 copay, while Urgently Needed Services have a $65 copay; all have no coinsurance.
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). The plan does not cover Routine Chiropractic Care, Individual and Group Sessions for Mental Health Specialty Services, Podiatry Services, and Individual and Group Sessions for Psychiatric Services.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, kidney disease education services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. 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 of enrollees, 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 Cigna Preferred Medicare (HMO) include routine hearing exams with a $20 copay, fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $399 and $1800, while inner ear, outer ear, and over the ear prescription hearing aids, along with OTC hearing aids, are not covered. You are allowed one routine hearing exam and one fitting/evaluation per year, and two prescription hearing aids per year.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including eye exams with a copay of $0-$20. The plan also covers eyewear with a combined maximum benefit of $250 every year, contact lenses, eyeglasses (lenses and frames), eyeglass lenses (1 pair every year), eyeglass frames (1 frame every year), and upgrades.
Dental Services See details
Dental services are covered by the Cigna Preferred Medicare (HMO) plan. Medicare dental services have a $20 copay and require prior authorization, and other dental services have a maximum plan benefit of $1600 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Cigna Preferred Medicare (HMO) plan, and prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
Medical equipment is covered under the Cigna Preferred Medicare (HMO) plan, with no copay. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has a coinsurance, and Diabetic Equipment is covered with a coinsurance for Medicare-covered Diabetic Supplies, while 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 ranging from $0 to $20, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $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 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 by the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for this benefit, but all cardiac rehabilitation services have no coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan. For days 1-20, the copay is $20, for days 21-60, the copay is $214, and for days 61-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services," this plan covers Over-the-Counter (OTC) Items with a maximum benefit of $75 every three months, and a meal benefit for chronic illnesses or medical conditions that require the enrollee to remain at home. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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