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Cigna Premier Medicare (HMO-POS) - H4513-084-000
$0.00
Monthly Premium
Cigna Premier Medicare (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Cigna Healthcare
Plan ID: H4513-084-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
Illinois Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.
Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.
Learn more about Illinois Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $0.00 |
| Out-of-pocket maximum | $4,200.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $8,000.00 |
| Primary care doctor visit | $0 Out of Network 30% |
| Specialty doctor visit | $35 Out of Network 30% |
| Inpatient hospital care | $265 per day for days 1-7 $0 per day for days 8-90 Out of Network 40% |
| Urgent care | $30 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: $260 Ambulance - Air: 20% Out of Network Ambulance - Ground: $260 Ambulance - Air: 20% |
Health Care Services and Medical Supplies
Cigna Premier Medicare (HMO-POS) covers a range of additional benefits. Learn more about Cigna Premier Medicare (HMO-POS) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | $15 Routine Chiropractic (Supplemental): Not covered Out of Network 30% |
| 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 30% Diabetic Therapeutic Shoes or Inserts: 30% |
| Durable medical equipment (DME) | 20% Out of Network 30% |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: 0 - 20% Diagnostic Radiological Services: $0 - $200 X-Ray Services: $0 Out of Network Lab Services: 30% Diagnostic Radiological Services: 30% X-Ray Services: 30% |
| Home health care | $0 Support for Caregivers of Enrollees: Not covered Out of Network 30% |
| Mental health inpatient care | $265 per day for days 1-7 $0 per day for days 8-90 Out of Network 40% |
| Mental health outpatient care | Psychiatric-Individual: $0 Psychiatric-Group: $0 Out of Network Psychiatric-Individual: 30% Psychiatric-Group: 30% |
| Outpatient services/surgery | In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $240.00 Prior Authorization Required for Outpatient Hospital Services Referral Required for Outpatient Hospital Services Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $240.00 Prior Authorization Required for Outpatient Observation Services Referral Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0.00 to $175.00 Prior Authorization Required for Ambulatory Surgical Center Services Referral Required for Ambulatory Surgical Center Services |
| Outpatient substance abuse care | $35 Out of Network 30% |
| Over-the-counter items | $45 every three months Delivered via Cigna Health Today card |
| Podiatry services | $35 Out of Network 30% |
| Skilled Nursing Facility (SNF) care | $10 per day for days 1-20 $203 per day for days 21-100 Out of Network 30% |
Dental Benefits
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | Preventive and Comprehensive Plus Maximum Coverage amount for Preventive Dental: $20,000 combined preventive and comprehensive every year Maximum Coverage Amount for Comprehensive Dental: $20,000 combined preventive and comprehensive every year |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | Routine Eye Exams: $0 for one routine exam every year Eye Exams (Medicare-covered): $0 - $35 Max Coverage Amount for Routine Eye Wear Coverage : $200 every year |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | $35 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. Out of Network 30% Fitting/Evaluation for Hearing Aids: Not covered Hearing Aids: Not covered Cost Sharing: Not covered Actual cost-share will depend on hearing aid selected. |
Preventive Services and Health/Wellness Education Programs
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | POS (Out-of-Network): Medicare-covered Zero Dollar Preventive Services: Coinsurance for Medicare Covered Medicare-covered Preventive Services 30% |
When reviewing Illinois Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.
You may be able to find plans in your part of Illinois that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Illinois Counties Served
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.