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Cigna Preferred Savings Medicare (HMO)

H4513 - 083 - 4

(4.5 / 5)

Cigna Preferred Savings Medicare (HMO) is a Medicare Advantage Plan by Cigna Healthcare.

This page features plan details for 2025 Cigna Preferred Savings Medicare (HMO) H4513 – 083 – 4 available in Texas.

Locations

Cigna Preferred Savings Medicare (HMO) is offered in the following locations.

Atascosa County, Texas

Bandera County, Texas

Bexar County, Texas

Click to see more locations

Plan Overview

Cigna Preferred Savings Medicare (HMO) offers the following coverage and cost-sharing.

Insurer:	Cigna Healthcare
Health Plan Deductible:	$0
MOOP:	$7,200 In-network
Drugs Covered:	Yes

Ready to sign up for Cigna Preferred Savings Medicare (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

Cigna Preferred Savings Medicare (HMO) qualifies for a monthly Medicare Give Back Benefit of $125.00.

Premium Reduction:

$125.00

Premium Breakdown

Cigna Preferred Savings Medicare (HMO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.

Part B	Part C	Part D	Part B Give Back	Total
$185.00	$0.00	$0.00	$125.00	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.
You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Cigna Preferred Savings Medicare (HMO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$0.00
Drug Out-Of-Pocket maximum:	$2,000.00
Drug Benefit Type:	Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part D	LIS Full
$0.00	$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$5.00 Copay		$5.00 Copay
2) Generic		$10.00 Copay		$10.00 Copay
3) Preferred Brand	$45.00 Copay	$47.00 Copay	$45.00 Copay	$47.00 Copay
4) Non-Preferred Drug	$100.00 Copay	$100.00 Copay	$100.00 Copay	$100.00 Copay
5) Specialty Tier	33.00% Coinsurance	33.00% Coinsurance	33.00% Coinsurance	33.00% Coinsurance

60 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$10.00 Copay		$10.00 Copay
2) Generic		$20.00 Copay		$20.00 Copay
3) Preferred Brand	$90.00 Copay	$94.00 Copay	$90.00 Copay	$94.00 Copay
4) Non-Preferred Drug	$200.00 Copay	$200.00 Copay	$200.00 Copay	$200.00 Copay
5) Specialty Tier

90 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$15.00 Copay		$15.00 Copay
2) Generic		$30.00 Copay		$30.00 Copay
3) Preferred Brand	$135.00 Copay	$141.00 Copay	$135.00 Copay	$141.00 Copay
4) Non-Preferred Drug	$300.00 Copay	$300.00 Copay	$300.00 Copay	$300.00 Copay
5) Specialty Tier

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Cigna Preferred Savings Medicare (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

- In-Network: No

Comprehensive Dental

Adjunctive General Services
- In-Network: No Coins – 0.00-285.00 Copay (Limits Apply)
Endodontics
- In-Network: No Coins – 0.00-675.00 Copay (Limits Apply)
Oral and Maxillofacial Surgery
- In-Network: No Coins – No Co pay (Limits Apply)
Periodontics
- In-Network: No Coins – 0.00-595.00 Copay (Limits Apply)
Prosthodontics, fixed
- In-Network: No Coins – 50.00-525.00 Copay (Limits Apply)
Prosthodontics, removable
- In-Network: No Coins – 25.00-615.00 Copay (Limits Apply)
Restorative Services
- In-Network: No Coins – 0.00-550.00 Copay (Limits Apply)

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – No Copay
Fluoride Treatment
- In-Network: No Coins – No Copay
Oral Exams
- In-Network: No Coins – No Copay
Other Diagnostic Dental Services
- In-Network: No Coins – No Copay (Limits Apply)
Other Preventive Dental Services
- In-Network: No Coins – No Copay (Limits Apply)
Prophylaxis (cleaning)
- In-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

Lab services
- $0-50 copay (Authorization Required, Referral Required)
Diagnostic tests and procedures
- $0-50 copay (Authorization Required, Referral Required)
Diagnostic radiology services (e.g., MRI)
- $0-325 copay (Authorization Required, Referral Required)
Outpatient x-rays
- $10 copay (Authorization Required, Referral Required)
Diagnostic radiology services (e.g., MRI)
- $0-300 copay (Authorization Required, Referral Required)

Doctor visits

Primary
- $0 copay
Specialist
- $45 copay per visit (Authorization Required, Referral Required)
- $50 copay per visit (Authorization Required, Referral Required)

Emergency care/Urgent care

Urgent care
- $35 copay per visit (always covered)
Emergency
- $110 copay per visit (always covered)

Foot care (podiatry services)

Routine foot care
- Not covered
Foot exams and treatment
- $45 copay (Referral Required)
- $50 copay (Referral Required)

Ground ambulance

- $240 copay
- $250 copay

Health plan deductible

- $0

Hearing

Fitting/evaluation
- $0 copay (Limits Apply, Referral Required)
Medicare-Covered Hearing Exam
- $30 copay (Referral Required)
- $45 copay (Referral Required)
Hearing aids
- $399-1,800 copay (Limits Apply)
Hearing aids OTC
- Not covered
Medicare-Covered Hearing Exam
- $25 copay (Referral Required)
- $35 copay (Referral Required)
- $20 copay (Referral Required)
- $40 copay (Referral Required)

Inpatient hospital coverage

- $320 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required, Referral Required)
- $325 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required, Referral Required)
- $335 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required, Referral Required)
- $350 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required, Referral Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

- $7,200 In-network
- $7,500 In-network
- $6,900 In-network

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)
- 20% coinsurance per item (Authorization Required)
Prosthetics (e.g., braces, artificial limbs)
- 20% coinsurance per item (Authorization Required)
Diabetes supplies
- $0 copay (Authorization Required)

Medicare Part B drugs

Chemotherapy
- 0-20% coinsurance (Authorization Required)
Other Part B drugs
- 0-20% coinsurance (Authorization Required)

Mental health services

Inpatient hospital – psychiatric
- $350 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required)
Outpatient group therapy visit
- $0 copay (Authorization Required)
Outpatient individual therapy visit
- $0 copay (Authorization Required)
Inpatient hospital – psychiatric
- $320 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required)
- $325 per day for days 1 through 6
  $0 per day for days 7 through 90 (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- $0 copay (Authorization Required)
Outpatient group therapy visit with a psychiatrist
- $0 copay (Authorization Required)

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- $0-350 copay per visit (Authorization Required, Referral Required)

Preventive care

- $0 copay

Rehabilitation services

Physical therapy and speech and language therapy visit
- $35 copay (Referral Required)
Occupational therapy visit
- $35 copay (Referral Required)

Skilled Nursing Facility

- $0 per day for days 1 through 20
  $214 per day for days 21 through 100 (Authorization Required)

Transportation

- Not covered

Vision

Eyeglass lenses
- $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- $0 copay (Limits Apply)
Other
- Not covered
Contact lenses
- $0 copay (Limits Apply)
Upgrades
- $0 copay (Limits Apply)
Eyeglass frames
- $0 copay (Limits Apply)
Routine eye exam
- $0 copay (Limits Apply)

Wellness programs (e.g., fitness, nursing hotline)

- Covered