Cigna True Choice Medicare (PPO)
Cigna True Choice Medicare (PPO) H7849-017 Plan Details
Cigna True Choice Medicare (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Cigna
Plan ID: H7849-017
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$0.00
Monthly Premium
Cigna True Choice Medicare (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Cigna
Plan ID: H7849-017
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Cigna True Choice Medicare (PPO) H7849-017 Plan Details
Cigna True Choice Medicare (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Cigna
Plan ID: H7849-017
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
$0.00
Monthly Premium
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $4500 Out-of-Network: N/A |
| Initial Coverage Limit | $5030 |
| Catastrophic Coverage Limit | $8,000 |
| Primary Care Doctor Visit | $0 Out of Network $45 |
| Specialty Doctor Visit | $30 Out of Network $60 |
| Inpatient Hospital Care | $235 per day for days 1-6 $0 per day for days 7-90 Out of Network 50% |
| Urgent Care | $20 Copay is waived if hospital admission occurs within: 24 hours Worldwide Urgent Coverage: $120 |
| Emergency Room Visit | $120 Copay is waived if hospital admission occurs within: 24 hours Worldwide Emergency Coverage: $120 |
| Ambulance Transportation | Ambulance - Ground: $265 Ambulance - Air: 20% Out of Network Ambulance - Ground: $265 Ambulance - Air: 20% |
Health Care Services and Medical Supplies
Cigna True Choice Medicare (PPO) 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 | $15 Routine Chiropractic (Supplemental): Not covered Out of Network 50% |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | If you’re managing diabetes, Cigna Healthcare makes it easier and more affordable to get monitoring and testing supplies. Your plan covers preferred brand diabetic supplies plus home delivery options. So you have less to worry about. Diabetic Supplies: $0 Diabetic Therapeutic Shoes or Inserts: 20% Out of Network 40% Diabetic Therapeutic Shoes or Inserts: 40% |
| Durable Medical Eqipment (DME) | 20% Out of Network 40% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: 0 - 20% Diagnostic Radiological Services: $0 - $195 X-Ray Services: $0 - $25 Out of Network Lab Services: 0 - 20% Diagnostic Radiological Services: $0 - $195 X-Ray Services: $0 - $25 |
| Home Health Care | $0 Support for Caregivers of Enrollees: Not covered Out of Network $0 |
| Mental Health Inpatient Care | $235 per day for days 1-6 $0 per day for days 7-90 Out of Network 50% |
| Mental Health Outpatient Care | Psychiatric-Individual: $0 Psychiatric-Group: $0 Out of Network Psychiatric-Group: $50 |
| Outpatient Services / Surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $235.00 Prior Authorization Required for Outpatient Hospital Services Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $235.00 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0.00 to $200.00 Prior Authorization Required for Ambulatory Surgical Center Services Prior authorization required Out-of-Network: Outpatient Hospital and ASC Services: Coinsurance for Medicare Covered Outpatient Hospital Services 40% Coinsurance for Medicare Covered Ambulatory Surgical Center Services 40% |
| Outpatient Substance Abuse Care | $30 Out of Network $60 |
| Over-the-counter (OTC) Items | $80 every three months Out of Network Combined with in-network Delivered via Cigna Health Today card |
| Podiatry Services | $30 Out of Network $45 |
| Skilled Nursing Facility Care | $0 per day for days 1-20 $203 per day for days 21-100 Out of Network 40% |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | Dental Allowance Maximum Coverage amount for Preventive Dental: $1,600 combined preventive and comprehensive every year Maximum Coverage Amount for Comprehensive Dental: $1,600 combined preventive and comprehensive every year Out of Network Dental Allowance Maximum Coverage amount for Preventive Dental: Combined with in-network Maximum Coverage Amount for Comprehensive Dental: Combined with in-network |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | Routine Eye Exams: $0 for one routine exam every year Eye Exams (Medicare-covered): $0 - $30 Max Coverage Amount for Routine Eye Wear Coverage : $200 every year Out of Network 50% for one routine exam every year Eye Exams (Medicare-covered): $0 - $60 Max Coverage Amount for Routine Eye Wear Coverage : Combined with in-network |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | $25 Fitting/Evaluation for Hearing Aids: $0 for one fitting evaluation for hearing aid every year Hearing Aids: Hearing aids (all types): two every year Cost Sharing: $399 - $1,800 per device Out of Network $30 Fitting/Evaluation for Hearing Aids: 50% for one fitting evaluation for hearing aid every year Hearing Aids: Combined with in-network Cost Sharing: Combined with in-network |
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 | In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots:
Yearly "Wellness" visit Out-of-Network: Medicare-covered Zero Dollar Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $45.00 |
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