Cigna TotalCare (HMO D-SNP)

Cigna
Cigna TotalCare (HMO D-SNP) H4513-080 Plan Details
4 out of 5 stars

Cigna TotalCare (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Cigna
Plan ID: H4513-080

HelpAdvisor Editorial Team analysis of data from the 2024 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.

$0.00
Monthly Premium

Cigna TotalCare (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Cigna
Plan ID: H4513-080

HelpAdvisor Editorial Team analysis of data from the 2024 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.

Cigna
Cigna TotalCare (HMO D-SNP) H4513-080 Plan Details
4 out of 5 stars

Cigna TotalCare (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Cigna
Plan ID: H4513-080

HelpAdvisor Editorial Team analysis of data from the 2024 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.

$0.00
Monthly Premium

Georgia Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $6700
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
$0
Specialty Doctor Visit
$0
Inpatient Hospital Care
$325 per day for days 1-6
$0 per day for days 7-90
Urgent Care
$55
Copay is waived if hospital admission occurs within: 24 hours

Worldwide Urgent Coverage: $100
Emergency Room Visit
$100
Copay is waived if hospital admission occurs within: 24 hours

Worldwide Emergency Coverage: $100
Ambulance Transportation
Ambulance - Ground: $210
Ambulance - Air: 20%

Health Care Services and Medical Supplies

Cigna TotalCare (HMO D-SNP) 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
$0
Routine Chiropractic (Supplemental): Not covered
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%
Durable Medical Eqipment (DME)
20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: 0 - 20%
Diagnostic Radiological Services: 0 - 20%
X-Ray Services: 0 - 20%
Home Health Care
$0

Support for Caregivers of Enrollees: Not covered
Mental Health Inpatient Care
$1,850 per stay
Mental Health Outpatient Care
Psychiatric-Individual: $0
Psychiatric-Group: $0
Outpatient Services / Surgery
In-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00
Prior Authorization Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services $0.00
Prior Authorization Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $0.00
Prior Authorization Required for Ambulatory Surgical Center Services
Prior authorization required
Outpatient Substance Abuse Care
$0
Over-the-counter (OTC) Items
$300 every three months

Delivered via Cigna Health Today card
Podiatry Services
$0
Skilled Nursing Facility Care
$0 per day for days 1-20
$203 per day for days 21-100

Dental Benefits

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

Coverage Cost
Dental Care
Dental Allowance

Maximum Coverage amount for Preventive Dental: $2,000 combined preventive and comprehensive every year

Maximum Coverage Amount for Comprehensive Dental: $2,000 combined preventive and comprehensive every year

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 - 20%

Max Coverage Amount for Routine Eye Wear Coverage : $200 every year

Hearing Benefits

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

Coverage Cost
Hearing Benefits
$0

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
Actual cost-share will depend on hearing aid selected.

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:
  • COVID-19 shots
  • Flu shots
  • Hepatitis B shots
  • Pneumococcal shots
  • Tobacco use cessation
    Yearly "Wellness" visit