Cigna Healthcare Extra Rx (PDP)

2.5 out of 5 stars

^$112.40

Monthly Premium

Cigna Healthcare Extra Rx (PDP) is a PDP plan offered by Cigna

Plan ID: S5617-255

HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.

Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.

Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.

Learn more about Medicare Advantage plans such as Cigna Healthcare Extra Rx (PDP) - S5617-255 by Cigna as well as other Medicare Advantage plans available in your area.

^$112.40

Monthly Premium

Georgia Counties Served

Appling Atkinson Bacon Baker Baldwin Banks Barrow Bartow Ben Hill Berrien Bibb Bleckley Brantley Brooks Bryan Bulloch Burke Butts Calhoun Camden Candler Carroll Catoosa Charlton Chatham Chattahoochee Chattooga Cherokee Clarke Clay Clayton Clinch Cobb Coffee Colquitt Columbia Cook Coweta Crawford Crisp Dade Dawson Decatur Dekalb Dodge Dooly Dougherty Douglas Early Echols Effingham Elbert Emanuel Evans Fannin Fayette Floyd Forsyth Franklin Fulton Gadsden Gilmer Glascock Glynn Gordon Grady Greene Gwinnett Habersham Hall Hancock Haralson Harris Hart Heard Henry Houston Irwin Jackson Jasper Jeff Davis Jefferson Jenkins Johnson Jones Lamar Lanier Laurens Lee Liberty Lincoln Long Lowndes Lumpkin Macon Madison Marion Mcduffie Mcintosh Meriwether Miller Mitchell Monroe Montgomery Morgan Murray Muscogee Newton Oconee Oglethorpe Paulding Peach Pickens Pierce Pike Polk Pulaski Putnam Quitman Rabun Randolph Richmond Rockdale Russell Schley Screven Seminole Spalding Stephens Stewart Sumter Talbot Taliaferro Tattnall Taylor Telfair Terrell Thomas Tift Toombs Towns Treutlen Troup Turner Twiggs Union Upson Walker Walton Ware Warren Washington Wayne Webster Wheeler White Whitfield Wilcox Wilkes Wilkinson Worth

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$175
Out of Pocket Max	In-Network: $-1 Out-of-Network: N/A
Initial Coverage Limit	$0
Catastrophic Coverage Limit	$2000
Primary Care Doctor Visit
Specialty Doctor Visit
Inpatient Hospital Care
Urgent Care
Emergency Room Visit
Ambulance Transportation

Health Care Services and Medical Supplies

Cigna Healthcare Extra Rx (PDP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Coverage	Cost
Chiropractic Services
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
Durable Medical Equipment (DME)
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Home Health Care
Mental Health Inpatient Care
Mental Health Outpatient Care
Outpatient Services / Surgery
Outpatient Substance Abuse Care
Over-the-counter (OTC) Items
Podiatry Services
Skilled Nursing Facility Care

Dental Benefits

The following dental services are covered from in-network providers.

Coverage	Cost
Dental Care

Vision Benefits

The following vision services are covered from in-network providers.

Coverage	Cost
Vision Benefits

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage	Cost
Hearing Benefits

Preventive Services and Health/Wellness Education Programs

The following services are covered from in-network providers.

Coverage	Cost
Preventive Services and Health/Wellness Education Programs

Prescription Drug Costs and Coverage

The Cigna Healthcare Extra Rx (PDP) plan offers the following prescription drug coverage, with an annual drug deductible of $175 (excludes Tiers 1 and 2) per year.

Coverage	Cost
Coverage & Cost
Annual Drug Deductible	$175 (excludes Tiers 1 and 2)
Preferred Generic	Preferred cost-share mail order $1.00 Standard retail $10.00 Standard mail order $10.00 Preferred cost-share retail $1.00
Generic	Preferred cost-share mail order $8.00 Standard retail $20.00 Standard mail order $20.00 Preferred cost-share retail $8.00
Annual Drug Deductible	$175 (excludes Tiers 1 and 2)
Preferred Generic	Preferred cost-share mail order $2.00 Standard retail $20.00 Standard mail order $20.00 Preferred cost-share retail $2.00
Generic	Preferred cost-share mail order $16.00 Standard retail $40.00 Standard mail order $40.00 Preferred cost-share retail $16.00
Annual Drug Deductible	$175 (excludes Tiers 1 and 2)
Preferred Generic	Preferred cost-share mail order $0.00 Standard retail $30.00 Standard mail order $30.00 Preferred cost-share retail $3.00
Generic	Preferred cost-share mail order $6.00 Standard retail $60.00 Standard mail order $60.00 Preferred cost-share retail $24.00

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