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 Richmond. 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 $3200.00 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, which varies depending on the drug tier and where you fill your prescription. The copays range from $4 to $100 for most drugs, and 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan also offers a Part D premium reduction if you qualify for the low-income subsidy.
Additional Benefits
The Cigna Preferred Medicare (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Emergency services, primary care, preventive services, and home health services are covered, with some services having no copay. The plan also provides coverage for hearing, vision, and dental services, with specific copays and annual maximums for certain services. Additional benefits include ambulance and transportation services, though some require prior authorization. The plan covers prescription hearing aids, with a copay, and offers an allowance for eyewear. Diagnostic, radiological, and home infusion services are covered, along with dialysis, medical equipment, and skilled nursing facility stays, each with their own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital services are covered, including acute and psychiatric care, but require prior authorization. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-6, and no copay for days 7-90. For Inpatient Hospital Psychiatric, you will pay a $250 copay for days 1-6, and no copay for days 7-90. Additional days and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services, including all outpatient hospital services, are covered by the Cigna Preferred Medicare (HMO) plan. Outpatient hospital services have a copay between $0 and $285, observation services have a $285 copay, and ambulatory surgical center services have no copay. Outpatient substance abuse services include individual and group sessions, both with a copay between $25 and $25. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under 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 $225 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for 20 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 by Cigna Preferred Medicare (HMO). 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; all services 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 $25 copay, physician specialist services with a $25 copay, and physical therapy and speech-language pathology services with a $25 copay. This plan also covers additional telehealth benefits with a copay between $0 and $25.
Preventive Services See details
Preventive services are covered, including Medicare-covered preventive services, annual physical exams, and additional preventive services such as health education and 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 are covered by the Cigna Preferred Medicare (HMO) plan, including hearing exams with a $25 copay. The plan covers Routine Hearing Exams and Fitting/Evaluation for Hearing Aids, each limited to one visit per year. Prescription Hearing Aids are covered, with a copay between $399 and $1800, but not for Inner Ear, Outer Ear, or Over the Ear hearing aids.
Vision Services See details
The Cigna Preferred Medicare (HMO) plan covers vision services, including routine eye exams with a copay of $0-$25, and eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades. Contact lenses are unlimited, and eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames have a limit of one per year. The plan offers a combined maximum benefit of $250 per year for all eyewear.
Dental Services See details
Dental Services are covered, with a $1,200 maximum benefit per year. Medicare Dental Services require prior authorization and have a $25 copay. Other dental services include 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 under the Cigna Preferred Medicare (HMO) plan and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Cigna Preferred Medicare (HMO) plan, but 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. Durable Medical Equipment has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies also have a 20% coinsurance. Diabetic Equipment is covered, but 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, diagnostic procedures/tests with a maximum copay of $20, and lab services with no copay. The plan also covers all radiological services, including diagnostic radiological services with a maximum copay of $195, therapeutic radiological services with a coinsurance of at most 20%, and outpatient X-Ray services with a $25 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. 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 these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Cigna Preferred Medicare (HMO) plan, but prior authorization is required. The copay is $20 for days 1-20, and $214 for days 21-100. Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The Cigna Preferred Medicare (HMO) plan covers Over-the-Counter (OTC) items up to $80 every three months, as well as a meal benefit for chronic illnesses or medical conditions that require you to stay 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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