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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 $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 will pay a copay for each prescription, which varies depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $4 copay at preferred pharmacies. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You'll have access to primary care, preventive, hearing, vision, and dental services. The plan also covers ambulance, emergency, and home health services. Additional benefits include coverage for medical equipment, diagnostic and radiological services, and skilled nursing facilities. You'll also have access to over-the-counter items. However, it's important to note that some services, like cardiac rehabilitation, are not covered, and some services require prior authorization.
Inpatient Hospital See details
Inpatient Hospital coverage, including acute and psychiatric care, requires prior authorization. For Inpatient Hospital-Acute, you pay a $270 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 and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all 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 $310, observation services have a $310 copay, individual and group sessions for outpatient substance abuse have a $20 copay, and ASC services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Cigna Preferred Medicare (HMO) plan, but requires prior authorization. The plan has a copay of $130 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Cigna Preferred Medicare (HMO). Ground ambulance services have a $270 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations 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 Transportation have a $140 copay, while Urgently Needed Services has 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, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services, Physician Specialist Services, and Other Health Care Professional have a $20 copay, while Physical Therapy and Speech-Language Pathology Services have a $20 copay. Additional Telehealth Benefits have a copay between $0 and $20. Individual and group sessions for Mental Health Specialty Services and Psychiatric Services are not covered, and Podiatry Services are not covered.
Preventive Services See details
The Cigna Preferred Medicare (HMO) plan covers preventive services including annual physical exams, health education, kidney disease education, and other preventive services such as glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan also covers fitness benefits. 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 $20 copay, and also cover Routine Hearing Exams and Fitting/Evaluation for Hearing Aids once per year. Prescription Hearing Aids are partially covered, with a copay between $399 and $1800 for all types of prescription hearing aids, but Inner Ear, Outer Ear, and Over the Ear aids are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including eye exams with a copay of $0-$20, and eyewear with a combined maximum benefit of $250 per year. Contact lenses, eyeglass lenses, and eyeglass frames are covered, and upgrades are covered.
Dental Services See details
The Cigna Preferred Medicare (HMO) plan covers dental services, including oral exams, X-rays, and cleanings, with a $20 copay for Medicare Dental Services; other services have a maximum benefit of $1600 per year. Orthodontic services are covered under Diagnostic and Preventive Dental.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Cigna Preferred Medicare (HMO), including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Cigna Preferred Medicare (HMO) plan, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the Cigna Preferred Medicare (HMO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices, and Medical Supplies with 20% coinsurance. Diabetic Therapeutic Shoes/Inserts are covered with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic services and lab services with no copay, while diagnostic procedures/tests have a copay between $0 and $20. Diagnostic Radiological Services have a copay up to $195, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have no copay.
Home Health Services See details
Home Health Services are covered under the Cigna Preferred Medicare (HMO) 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 not covered by the Cigna Preferred Medicare (HMO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. 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 for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) Items with a maximum benefit of $55.00 every three months, including Nicotine Replacement Therapy (NRT) and Naloxone coverage. However, 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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