Cigna TotalCare (HMO D-SNP) Costs & Coverage, Madison County, Mississippi
Cigna TotalCare (HMO D-SNP) Costs & Coverage, Madison County, Mississippi
Discover how Cigna TotalCare (HMO D-SNP) stands out as a 2025 Special Needs Plan (SNP), offering tailored coverage to fit your individual needs. This page provides a comprehensive look at the plan’s benefits and costs, helping you make an informed choice.
Delivery of healthcare services and costs by Cigna Healthcare are different than Original Medicare. This private health insurance option, available to qualified individuals in Madison County, MS, may include additional benefits that are not provided by Medicare Part A and Part B.
- Doctor Visits
- Foot Care
- Chiropractic
- Urgent & Emergency
- Mental Health
- Rehab Services
- Equipment & Supplies
- Diag, Lab, Imaging
- Part B Drugs
- Dental
- Hearing Aids
- Vision
- Prescriptions
| Plan ID H4407-004-0 Overview | |
|---|---|
| Health Plan ID: | H4407-004-0 |
| Medicare Advantage Plan Type: | HMO D-SNP |
| Plan Year: | 2025 |
| Monthly Premium: | $17.90 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | 6,750.00 |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Basic, $590.00 deductible |
| Supplemental Benefits: | Vision, Hearing |
| Availability: | Madison County, MS |
| Insured By: | Cigna Healthcare |
| We're Here to Help You Enroll |
|---|
Health Plan Cost Sharing & Benefits
Cigna TotalCare is a Health Maintenance Organization (HMO) plan. As an HMO {plan_type_2} member, you typically receive healthcare services through the plan’s local network of providers, with referrals generally required to see specialists and other providers. However, Cigna TotalCare does cover out-of-network care for emergencies and out-of-area dialysis.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | Not Covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $55 Copay |
| Ground ambulance: | $245 Copay |
| Inpatient hospital care: | $195.00 per day for days 1 through 6 $0.00 per day for days 7 and beyond |
| Skilled Nursing Facility: | $10.00 per day for days 1 through 20 $214.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | Not Covered |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | Not Covered |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | Not Covered |
| Outpatient group therapy: | Not Covered |
| Inpatient psychiatric hospital care: | $1,850.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | Not Covered |
| Occupational therapy: | Not Covered |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | 20% Coinsurance Prior Authorization Required |
| Lab services: | $50 Copay Prior Authorization Required |
| Outpatient x-rays: | 20% Coinsurance Prior Authorization Required |
| Diagnostic tests and procedures: | 20% Coinsurance Prior Authorization Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | $0 |
| Dental x-rays | $0 |
| Cleaning | $0 |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $300.00 Every year |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $17.90 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $17.90 |
| Low Income Premium Subsidy: | $47.25 |
| Low Income Premium Subsidy CMS Pays: | $17.90 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Prescription Drug Plan Deductible
The Medicare Part D annual deductible with this plan is $590.00. This is the amount you must pay at the pharmacy before Cigna Healthcare begins paying its share.
Prescription Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and deductible, Cigna TotalCare has out-of-pocket costs that you must pay when you pick up your prescriptions. The following table shows you those costs.
| Drug Tier | Retail | Mail Order | |
|---|---|---|---|
| Cost data not available. | |||
| *Deductible does not apply. | |||
5-Star Rating Marks
Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates Medicare Advantage {plan_type_2}s across nine broad categories using a 5-star rating system. These star ratings provide insight into the quality of care and service you can expect from this Cigna Healthcare plan.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify for Enrollment in Cigna TotalCare
To enroll in Cigna TotalCare you must qualify for both Medicare and Medicaid and live in one of the plan's service areas. Eligibility for Medicare requires you to be either 65 years of age or older, or have received Social Security Disability Insurance for at least 24 months. For Medicaid eligibility, your income and assets must fall at or below your state's thresholds.
Medicare Special Needs Plan Enrollment Periods
After determining your eligibility for Cigna TotalCare , it’s important to be aware of the Medicare Enrollment Periods, which determine when you can enroll in or change your plan. Depending on your circumstances, one of the following periods will apply:
- Initial Enrollment Period (IEP): Your first opportunity to enroll when you become eligible for Medicare.
- Annual Enrollment Period (AEP): The time each year when you can change your Medicare plan or enroll in a new one.
- Special Enrollment Periods (SEPs): Times outside of AEP when you can make changes due to specific circumstances, such as moving to a new area or losing other insurance coverage.
For more details on enrollment periods, you can learn more here and make sure you’re well-informed about your Medicare choices.
Contact Cigna Healthcare
| Website: | Cigna Healthcare Plan Page |
|---|---|
| Providers: | Cigna Healthcare Providers Page |
| Formulary: | Cigna Healthcare Formulary Page |
| Pharmacy: | Cigna Healthcare Pharmacy Page |
| New Member Health Plan Help: | (800)313-0973 |
| New Member Health Plan TTY: | (877)843-6493 |
| New Member Part D Help: | (800)313-0973 |
| New Member Part D TTY Users: | (877)843-6493 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov.
Plans Offered through Medicare.org
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.