Cigna Copay

  1. Cigna Copay
  2. Cigna Copay For Urgent Care
  3. Cigna Specialist Copay

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$25 copay for most insulin; Mammograms enhanced to include 100% coverage for in-network annual mammograms for women age 65+ Cigna Behavioral Health replaces Beacon Health Options to offer expanded coverage that features a larger, broader network of providers and enhanced services. Cigna Coronavirus (COVID-19) Interim Billing Guidance for Providers for Commercial Customers. Last updated April 6, 2021 – Highlighted text indicates updates Cigna welcomes the advent of safe and effective COVID-19 vaccines and applauds the quick and innovative responses from the pharmaceutical industry and regulators to the urgent need. This Cigna plan does offer additional coverage through the gap. H3949-031 Formulary or Drug Coverage. Cigna Alliance Medicare (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay.

Cigna Preferred Medicare (HMO) H9725-001T56 sequential shifter. is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Cigna available to residents in North Carolina. This plan includes additional Medicare prescription drug (Part-D) coverage. The Cigna Preferred Medicare (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out of pocket. This can be a extremely nice safety net.

Cigna Preferred Medicare (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Cigna works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Cigna Preferred Medicare (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Cigna and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Cigna except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2021 Cigna Medicare Advantage Plan Costs

Name:
Plan ID:
H9725-001
Provider:Cigna
Year:2021
Type: Local HMO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $4,900
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:No
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H9725-005

Cigna Preferred Medicare (HMO) Part-C Premium

Cigna plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


H9725-001 Part-D Deductible and Premium

Cigna Preferred Medicare (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Cigna plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Cigna above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.


Cigna Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Cigna plan does not offer additional coverage through the gap.


H9725-001 Formulary or Drug Coverage

Cigna Preferred Medicare (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.



2021 Cigna Preferred Medicare (HMO) Summary of Benefits



Additional Benefits


No


Comprehensive Dental


Diagnostic services$0 copay
Endodontics$0 copay
Extractions$0 copay
Non-routine services$0 copay
Periodontics$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay
Restorative services$0 copay


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-195 copay
Diagnostic tests and procedures$0-95 copay
Lab services$0 copay
Outpatient x-rays$0-20 copay


Doctor Visits


Primary$0 copay
Specialist$20 copay per visit


Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$20 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$20 copay
Routine foot careNot covered


Ground Ambulance


$245 copay


Hearing


Fitting/evaluation$0 copay
Hearing aids - inner ear$0 copay
Hearing aids - outer ear$0 copay
Hearing aids - over the ear$0 copay
Hearing exam$0-20 copay


Inpatient Hospital Coverage


$295 per day for days 1 through 6
$0 per day for days 7 through 90

Cigna Copay


Medical Equipment/Supplies


Diabetes supplies0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item


Medicare Part B Drugs


Chemotherapy20% coinsurance
Other Part B drugs20% coinsurance


Mental Health Services


Inpatient hospital - psychiatric$595 per day for days 1 through 3
$0 per day for days 4 through 90
Outpatient group therapy visit$0 copay
Outpatient group therapy visit with a psychiatrist$0 copay
Outpatient individual therapy visit$0 copay
Outpatient individual therapy visit with a psychiatrist$0 copay


MOOP


$4,900 In-network


Cigna Copay For Urgent Care

Option

Cigna copay at cvs minute clinic
Yes, contact plan for further details


Optional supplemental benefits


No


Outpatient Hospital Coverage


$0-275 copay per visit


Preventive Care


$0 copay

Cigna

Preventive Dental


Cleaning$0 copay
Dental x-ray(s)$0 copay
Fluoride treatment$0 copay
Oral exam$0 copay


Rehabilitation Services


Occupational therapy visit$20 copay
Physical therapy and speech and language therapy visit$20 copay


Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100


Transportation


$0 copay


Vision


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)$0 copay
OtherNot covered
Routine eye exam$0 copay
Upgrades$0 copay


Cigna Specialist Copay

Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for Cigna Preferred Medicare (HMO) H9725


2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Cigna Preferred Medicare (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Cigna Preferred Medicare (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Cigna Preferred Medicare (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


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Mon-Sat 8am-11pm EST
Sun 9am-6pm EST



Coverage Area for Cigna Preferred Medicare (HMO)

(Click county to compare all available Advantage plans)

State: North Carolina
County:Alexander,Cabarrus,Catawba,Cleveland,Davidson,
Davie,Forsyth,Gaston,Guilford,
Iredell,Lincoln,Mecklenburg,Polk,
Rowan,Stokes,Union,Yadkin,

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

What is an Open Access Plus (OAP) plan?

Open Access Plus (OAP) is a type of health insurance plan or health benefits plan that allows you to choose your health care providers. You may have to pay a deductible (annual amount) before the plan begins to pay for covered health care costs. Once you meet your deductible, you pay a copay or coinsurance (a portion of the charges). Depending on what your employer offers, plans may be different.

Cigna Open Access Plus and Cigna Open Access Plus In-Network plans have similar key features:

  • You have the option of choosing a primary care provider (PCP) to serve as your personal health advocate and coordinate your health care. It’s recommended, but it is not required.
  • Cigna may need to pre-certify hospitalizations and some types of outpatient care, but there's no paperwork for you when using in-network providers.
  • The plans include emergency and urgent care coverage* 24 hours a day, seven days a week.

It’s also important to know how these two plans are different: