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Cigna True Choice Savings Medicare (PPO) - H7849-031-000
$0.00
Monthly Premium
Cigna True Choice Savings Medicare (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Cigna Healthcare
Plan ID: H7849-031-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
Pennsylvania 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 Pennsylvania 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 | $6,900.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $8,000.00 |
| Primary care doctor visit | $0 Out of Network $15 |
| Specialty doctor visit | $35 Out of Network $45 |
| Inpatient hospital care | $195 per day for days 1-7 $0 per day for days 8-90 Out of Network 40% |
| Urgent care | $45 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: $195 Ambulance - Air: 20% Out of Network Ambulance - Ground: $195 Ambulance - Air: 20% |
Health Care Services and Medical Supplies
Cigna True Choice Savings Medicare (PPO) covers a range of additional benefits. Learn more about Cigna True Choice Savings Medicare (PPO) 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 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 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 - $275 X-Ray Services: $30 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 | $175 per day for days 1-7 $0 per day for days 8-90 Out of Network 30% |
| Mental health outpatient care | Psychiatric-Individual: $0 Psychiatric-Group: $0 Out of Network Psychiatric-Individual: $55 Psychiatric-Group: $55 |
| Outpatient services/surgery | 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 | $35 Out of Network $55 |
| Over-the-counter items | $75 every three months Out of Network Combined with in-network Delivered via Cigna Health Today card |
| Podiatry services | $35 Out of Network $40 |
| Skilled Nursing Facility (SNF) 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, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | Dental Allowance Maximum Coverage amount for Preventive Dental: $1,100 combined preventive and comprehensive every year Maximum Coverage Amount for Comprehensive Dental: $1,100 combined preventive and comprehensive every year Out of Network Dental Allowance w 50% 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, 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 : $100 every year Out of Network 50% for one routine exam every year Eye Exams (Medicare-covered): $0 - $55 Max Coverage Amount for Routine Eye Wear Coverage : Combined with in-network |
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 | $30 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 50% 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 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 | Out-of-Network: Medicare-covered Zero Dollar Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $15.00 |
When reviewing Pennsylvania 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 Pennsylvania that offer similar benefits at similar or lower prices than the plan above. Call 1-888-876-5731 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Pennsylvania Counties Served
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.