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Cigna Preferred Medicare (HMO) (H4513-049-1)

Cigna Preferred Medicare HMO H4513-049-1 is a popular Cigna Medicare Advantage plan in Tennessee. Available for people living in select counties in the state, this HMO plan features a variety of benefits in addition to the coverage offered under Original Medicare.

Medicare Plan Rating – 4.5

Health Plan Rating – 4

Drug Plan Rating – 4

Plan Basics

Cigna Preferred Medicare HMO H4513-049-1 is an HMO plan. 

HMO stands for health maintenance organization. HMOs typically require you to have a primary care doctor and to get referrals to see specialists. These plans may not cover any services that you get outside of the plan’s network. HMOs may or may not cover prescription drugs. Either way, you can’t join a standalone Part D plan if you have an HMO plan.

With this Medicare Advantage HMO plan from Cigna Medicare, you may need a referral to see a specialist.

Some services may require pre-authorization, meaning Cigna Medicare may need to approve of the service first.

As a Medicare Advantage plan, the Cigna Preferred Medicare HMO H4513-049-1 plan covers everything that Original Medicare covers. That’s by law. Beyond these basic requirements, this MA plan from Cigna covers a broader range of benefits than you’ll find under Original Medicare. 

This plan covers prescription drugs. There may be a separate drug deductible and cost sharing for this coverage. Refer to plan details for specifics on tiers, drug pricing and more.

Below, we’ve outlined the costs and coverage of the Cigna Preferred Medicare Plan. Scroll down to the bottom for a complete table of costs for this MA health plan.

Basic Costs

In-Network Out-of-Network
Monthly premium $0
Annual deductible $0
Out-of-pocket maximum $6,700

The monthly premium for the Cigna Preferred Medicare HMO H4513-049-1 plan is $0. You will also be responsible for your premiums under Original Medicare, typically just Part B for most people, unless you did not pay enough into Medicare through your paycheck withholdings and taxes. 

This plan also has a $0 deductible.

Medicare Advantage plans cap out-of-pocket expenses for the year. With the Cigna Preferred Medicare HMO H4513-049-1 plan, you’ll have a cap of $6,700 for in-network services. 

Once you spend this amount out of pocket, Cigna Medicare will pay for your remaining covered services without any cost sharing — i.e., at 100%. 

Copays, coinsurance and deductibles typically count towards the Medicare Advantage out-of-pocket limit. Premiums and prescription drug costs typically do not count towards the cap.

Hospital Coverage (Medicare Part A)

In-Network Out-of-Network
Hospital day 1-5 $325 per day Not covered
Hospital day 6-90 $0 Not covered
Skilled nursing facility day 1-20 $0 Not covered
Skilled nursing facility day 21-100 $184 per day Not covered
Inpatient mental health care day 1-5 $300 per day Not covered
Inpatient mental health care day 6-90 $0  Not covered

Cigna Preferred Medicare HMO H4513-049-1 covers the same hospital and skilled nursing facility services as Original Medicare. But you may pay less out of pocket for these services thanks to how the plan covers Part A care. Medicare Part A is hospital and skilled nursing facility coverage.

For hospital care, you’ll have a copay of $325 per day for days 1 through 5. For days 6 through 90, you’ll pay $0 with the Cigna Preferred Medicare HMO plan. 

For skilled nursing facility (SNF) care, this Medicare Advantage plan from Cigna has a copay of $0 per day for days 1 through 20. From days 21 through 100, you pay $184 per day. Beyond that, you’ll pay the full cost of SNF care.

Medical Coverage (Medicare Part B)

In-Network Out-of-Network
Primary care doctor $0 Not covered
Specialist $5 Not covered
Preventive care $0 Not covered
Chiropractor $5 Not covered
Outpatient Mental Healthcare (Therapy, Psychiatry) $0 Not covered
Outpatient Hospital Services $0 – $300 Not covered
Ambulatory surgery center $0 – $225 Not covered
Emergency care in the U.S. $90 $90
Urgent care in the U.S. $30 $30
Ground ambulance $240 $240
Physical therapy $30 Not covered
Diagnostic tests & procedures $0 – $150 Not covered
Diagnostic radiology $0 – $150 Not covered
Lab services $0 Not covered
X-rays 0-$50 Not covered
Medicare Part B drugs 20% Not covered

Medicare Part B covers outpatient services. Think doctor’s visits, routine checkups, outpatient surgery, flu shots, ambulance rides and other general medicare care. The Cigna Preferred Medicare HMO H4513-049-1 plan covers everything that Original Medicare covers but at different cost sharing amounts.

Under Original Medicare, you’ll pay 20% of the cost of Part B services. And there’s no cap on that amount, which means you’ll pay that 20% no matter how high it gets. Medicare Advantage plans, like this one from Cigna, cap these costs and also include different cost sharing in the first place.

For example, this MA plan from Cigna Medicare has a $0 copay for in-network primary care visits and charges $5 for in-network specialists.

As a reminder, PPO plans tend to cover in-network and out-of-network services, though costs are typically lower with in-network providers. HMO plans may not cover care that you get outside of the plan’s network.

The Cigna Preferred Medicare HMO H4513-049-1 plan also covers a variety of preventive medical services at $0 for in-network care. These may include:

  • Certain cancer screenings
  • Cardiovascular disease screenings
  • Tobacco use cessation & counseling
  • Depression screenings
  • Preventive vaccines (like flu and shingles)
  • Nutrition therapy services
  • & more

You may pay more out of pocket for non-network care under a PPO plan. With an HMO plan, non-network care may not be covered at all.

As a reminder, some covered benefits with the Cigna Preferred Medicare HMO plan may require pre-authorization. Always check your plan details carefully to see specific costs for the services you’ll need. 

Other Health Benefits

In-Network Out-of-Network
Preventive dental services $0 $0
Dental X-Rays $0 $0
Routine eye exams $0 Not covered
Glasses or contacts $200 per year Not covered
Routine hearing exams $0 Not covered
Hearing aids Up to $700 every 3 years Not covered

Original Medicare does not cover all of the medical care that you’ll need as you get older. Notably missing is coverage for prescription drugs, dental and vision benefits, hearing aids and exams, chiropractic services and routine foot care, among others.

Cigna Preferred Medicare HMO H4513-049-1 covers some of these and other benefits in addition to the standard benefits covered by Original Medicare. Added benefits under this Medicare Advantage plan from Cigna Medicare include:

  • Routine and comprehensive dental
  • Routine eye exams
  • An allowance for glasses and/or contact lenses
  • Routine hearing exams
  • Hearing aids up to a specific dollar limit

Always check plan details for specifics about additional medical benefits offered by Medicare Advantage plans.

Medicare Advantage plans may include additional benefits not described above, such as access to fitness memberships, telehealth, nurse phone lines, coverage for non-medical services, and more. These benefits vary by plan.

For specific info on these and other covered care and services, check with the Summary of Benefits for this Medicare Advantage plan from Cigna.

Prescription Drug Coverage

30-day Supply 
(retail & mail-order)
90-day Supply
(retail & mail-order) 
Tier 1: Preferred Generic

$0 preferred / $10 standard

$0 preferred / $30 standard

Tier 2: Generic

$12 preferred / $20 standard

$24 preferred / $60 standard

Tier 3: Preferred Brand

$42 preferred / $47 standard

$126 preferred / $141 standard

Tier 4: Non-preferred Drug

50%

50%

Tier 5: Specialty

33%

Not covered

The Cigna Preferred Medicare HMO H4513-049-1 plan covers prescription drugs. There’s no separate premium or annual deductible for this coverage. Tier 1 drugs have $0 cost-sharing for preferred generics if you get them at a preferred pharmacy.

How much you pay out of pocket for your medication depends on the drug tier. Like other Medicare Advantage plans, this MA plan with drug coverage from Cigna covers prescriptions at different tiers. Preferred generics cost less while specialty drugs (tier 5) tend to cost the most. 

If you fall into the Part D coverage gap — also known as the “donut hole” — then you’ll be responsible for 25% of the cost of your medications until you hit the out-of-pocket spending threshold for the year. 

The initial coverage limit with this Cigna Preferred Medicare HMO plan is $4,130 in 2021. That amount comes from:

  • What you pay at the pharmacy counter out of pocket
  • What your drug plan pays for the drug

Once you and your plan’s combined spending reaches the initial coverage limit, you’ll be in the donut hole until spending hits $6,550 in 2021. While you’re in the donut hole, you’ll pay no more than 25% of the cost of your drugs. 

But with this Cigna Medicare HMO plan, you may get a bit of extra help paying for drugs in the donut hole. 

That’s because 30-day supplies of tier 1 drugs require a $0 copay at preferred pharmacies ($10 for standard), and 30-day supplies of tier 2 drugs require only a $12 copay at preferred locations ($20 for standard). All other tiers have the standard 25% cost sharing.

While you’re in the Part D coverage gap, what you pay out of pocket and about 70% of the cost of brand name drugs count towards your total out-of-pocket spending, which will help you get out of the gap faster. 

Once that happens, the plan’s catastrophic Part D coverage level kicks in. At this point, the Cigna Preferred Medicare HMO plan charges the greater of:

  • 5% or $3.70 for generic drugs in 2021
  • 5% or $9.20 for brand name drugs in 2021

Plan Costs for Cigna Preferred Medicare (HMO) (H4513-049-1)

Plan Costs for WellCare Absolute PPO H2775-111-0
In-Network Out-of-Network
Monthly premium $0
Annual deductible $0
Out-of-pocket maximum $6,700
Part A Costs

Hospital day 1-5

$325 per day Not covered

Hospital day 6-90

$0 Not covered

Skilled nursing facility day 1-20

$0 Not covered

Skilled nursing facility day 21-100

$184 per day Not covered

Inpatient mental health care day 1-5

$300 per stay Not covered

Inpatient mental health care day 6-90

$0 per day Not covered
Medical Costs

Primary care doctor

$0 Not covered

Specialist

$5 Not covered

Preventive care

$0 Not covered

Chiropractor

$5 Not covered

Mental Healthcare (Therapy, Psychiatry)

$0 Not covered

Outpatient Hospital Services

$0-$300 Not covered

Ambulatory surgery center

$0-$225 Not covered

Emergency care in the U.S.

$90 $90

Urgent care in the U.S.

$30 $30

Ground ambulance

$240 $240

Physical therapy

$30 Not covered

Diagnostic tests & procedures

$0-$150 Not covered

Diagnostic radiology

$0-$150 Not covered

Lab services

$0 Not covered

X-rays

$0-$50 Not covered

Medicare Part B drugs

$0-$150 Not covered
Other Health Benefit Costs

Preventive dental services

$0 $0

Dental X-Rays

$0 $0

Routine eye exams

$0 Not covered

Glasses or Contacts

$200 per year Not covered

Routine hearing exams

$0 Not covered

Hearing aids

Up to $700 every 3 years Not covered
Prescription Drug Costs
(Network restrictions may apply)

Annual deductible

$0

Initial coverage limit

$4,130

Out-of-pocket threshold

$6,550
30-day Supply
(retail & mail-order)
90-day Supply
(retail & mail-order) 

Tier 1: Preferred/ Generic

$0 preferred / $10 standard

$0 preferred / $30 standard

Tier 2: Generic

$12 preferred / $20 standard

$24 preferred / $60 standard

Tier 3: Preferred Brand

$42 preferred / $47 standard

$126 preferred / $141 standard

Tier 4: Non-preferred Drug

50%

50%

Tier 5: Specialty

33%

Not covered

Donut hole coverage

30-day supply for tier 1: $0 preferred/$10 standard 30-day supply for tier 2: $12 preferred/$20 standard
25% of the cost for tiers 3, 4 and 5

Catastrophic drug coverage

Greater of 5% or $3.70 for generics Greater of 5% or $9.20 for brand name