Cigna Premier Medicare (HMO-POS) H4513-036-000 is a 2021 Medicare Advantage plan with drug coverage provided by Cigna.

In terms of networks, this plan is a Local HMO. HMO plans require you to choose an in-network primary care doctor who coordinates your care with other healthcare providers in your network. With HMOs, you must generally seek care in-network. If you seek care outside of the plan’s network, the plan will only cover emergency or urgent care in most cases. Local HMOs cover only a small service area or part of the country. If you want to have costs covered out of network, you may want to look for PPOs in your county. Meanwhile, if you need a wider area of coverage, you may want to look at Regional PPO plans specifically.

When it comes to cost-sharing, you’ll want to consider both monthly costs and out-of-pocket costs. This plan has a monthly premium of $55, which covers both the health and drug portions of the plan.

The drug plan portion of this plan provides Enhanced Alternative (EA) benefits, which are benefits that exceed the required standard.

When it comes to out-of-pocket costs for drugs, this plan has a Part D drug Deductible of $200.00 and an Initial Coverage Limit of $4130. This plan also notably provides extra coverage in the coverage gap phase, meaning your insurer will pay a greater share of costs for covered drugs than the standard amount required by Medicare. Each drug tier may be subject to different cost-sharing in each coverage phase, so keep that in mind when considering out-of-pocket costs. Check out the drug formulary below for more information, or reach out to a licensed Medicare agent for help using the call number on this page. Alternatively, if you know what plan you want, you can enroll online yourself using our site as well.


Plan Basics
Contract Year 2021
Medicare Type Medicare Advantage Plan (Part C)
CMS Plan ID H4513-036-000
Plan Organization Cigna
Plan Type Local HMO
Plan Name Cigna Premier Medicare (HMO-POS)
Plan Organization Type Local CCP
Drugs Covered Yes
Doctors Choice Plan Doctors Only (some exceptions)
Benefit Type Enhanced Alternative
Special Needs Plan No
Overall Star Rating 4.5
Plan Cost Sharing
Premium $55.00
Total Premium (Includes Part B) $190.50
Monthly Part C Premium $22.20
Monthly Part D Basic Premium $32.80
Monthly Part D Supplemental Premium $0.00
Monthly Part D Total Premium $32.80
Monthly Part D Premium Full Assistance $2.60
Monthly Part D Premium 75% Assistance $10.10
Monthly Part D Premium 50% Assistance $17.70
Monthly Part D Premium 25% Assistance $25.20
Part D Drug Deductible $200.00
Annual Drug Deductible $200.00
Tiers Excluded From Deductible 1
Part D Initial Coverage Limit $4130.00
Part D Catastrophic Coverage Threshold $6550.00
Maximum Out-of-Pocket Limit for Parts A & B (MOOP) $6700.00
Gap Coverage Yes

Medicare Advantage Plan Health Benefits


Additional Benefits And/or Reduced Cost-sharing For Enrollees With Certain Health Conditions?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - Yes, contact plan for further details
Comprehensive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic services Yes In-Network Yes No $0 copay
Endodontics Yes In-Network Yes No $0 copay
Extractions Yes In-Network Yes No $0 copay
Non-routine services Yes In-Network Yes No $0 copay
Periodontics Yes In-Network Yes No $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Yes In-Network Yes No $0 copay
Restorative services Yes In-Network Yes No $0 copay
Diagnostic Procedures/lab Services/imaging
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diagnostic radiology services (e.g., MRI) - Out-of-Network Yes No 30% coinsurance
Diagnostic tests and procedures - Out-of-Network Yes No 30% coinsurance
Lab services - Out-of-Network Yes No 0-30% coinsurance
Outpatient x-rays - Out-of-Network Yes No 30% coinsurance
Doctor Visits
Service Cap Network Auth. Req. Ref. Req. Cost Share
Primary - Out-of-Network - - 30% coinsurance per visit
Specialist - Out-of-Network Yes No 30% coinsurance per visit
Emergency Care/Urgent Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
Emergency - - - - $90 copay per visit (always covered)
Urgent care - - - - $30 copay per visit (always covered)
Foot Care (podiatry Services)
Service Cap Network Auth. Req. Ref. Req. Cost Share
Foot exams and treatment - Out-of-Network No No 30% coinsurance
Routine foot care - - - - Not covered
Ground Ambulance
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network - - $225 copay
Health Plan Deductible
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $0
Hearing
Service Cap Network Auth. Req. Ref. Req. Cost Share
Fitting/evaluation Yes In-Network No No $0 copay
Hearing aids - inner ear Yes In-Network No No $0 copay
Hearing aids - outer ear Yes In-Network No No $0 copay
Hearing aids - over the ear Yes In-Network No No $0 copay
Hearing exam - Out-of-Network No No 30% coinsurance
Inpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network Yes No 30% per stay
Maximum Out-of-pocket Enrollee Responsibility (does Not Include Prescription Drugs)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - $6,700 In-network
Medical Equipment/supplies
Service Cap Network Auth. Req. Ref. Req. Cost Share
Diabetes supplies - Out-of-Network Yes - 30% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) - Out-of-Network Yes - 30% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) - Out-of-Network Yes - 30% coinsurance per item
Medicare Part B Drugs
Service Cap Network Auth. Req. Ref. Req. Cost Share
Chemotherapy - Out-of-Network Yes - 30% coinsurance
Other Part B drugs - Out-of-Network Yes - 30% coinsurance
Mental Health Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Inpatient hospital - psychiatric - Out-of-Network Yes No 30% per stay
Outpatient group therapy visit - Out-of-Network Yes No 30% coinsurance
Outpatient group therapy visit with a psychiatrist - Out-of-Network Yes No 30% coinsurance
Outpatient individual therapy visit - Out-of-Network Yes No 30% coinsurance
Outpatient individual therapy visit with a psychiatrist - Out-of-Network Yes No 30% coinsurance
Optional Supplemental Benefits
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - No
Other Health Plan Deductibles?
Service Cap Network Auth. Req. Ref. Req. Cost Share
- In-Network - - No
Outpatient Hospital Coverage
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network Yes No 30% coinsurance per visit
Preventive Care
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network No No 30% coinsurance
Preventive Dental
Service Cap Network Auth. Req. Ref. Req. Cost Share
Cleaning Yes In-Network No No $0 copay
Dental x-ray(s) Yes In-Network No No $0 copay
Fluoride treatment Yes In-Network No No $0 copay
Oral exam Yes In-Network No No $0 copay
Rehabilitation Services
Service Cap Network Auth. Req. Ref. Req. Cost Share
Occupational therapy visit - Out-of-Network Yes No 30% coinsurance
Physical therapy and speech and language therapy visit - Out-of-Network Yes No 30% coinsurance
Skilled Nursing Facility
Service Cap Network Auth. Req. Ref. Req. Cost Share
- Out-of-Network Yes No 30% per stay
Transportation
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - - - Not covered
Vision
Service Cap Network Auth. Req. Ref. Req. Cost Share
Contact lenses Yes In-Network No No $0 copay
Eyeglass frames Yes In-Network No No $0 copay
Eyeglass lenses Yes In-Network No No $0 copay
Eyeglasses (frames and lenses) Yes In-Network No No $0 copay
Other No - - - Not covered
Routine eye exam Yes In-Network No No $0 copay
Upgrades Yes In-Network No No $0 copay
Wellness Programs (e.g., Fitness, Nursing Hotline)
Service Cap Network Auth. Req. Ref. Req. Cost Share
- - No No Covered
Plan Drug Info
Formulary Link Drug Formulary Directory
Official Medicare Contact
Medicare Phone 1-800-MEDICARE (1-800-633-4227)
Medicare TTY User 1-877-486-2048
Plan Available in these Counties
Bedford County, Tennessee, Benton County, Tennessee, Bledsoe County, Tennessee, Bradley County, Tennessee, Cannon County, Tennessee, Carroll County, Tennessee, Cheatham County, Tennessee, Chester County, Tennessee, Clay County, Tennessee, Coffee County, Tennessee, Crockett County, Tennessee, Cumberland County, Tennessee, Davidson County, Tennessee, Decatur County, Tennessee, Dekalb County, Tennessee, Dickson County, Tennessee, Fayette County, Tennessee, Fentress County, Tennessee, Gibson County, Tennessee, Giles County, Tennessee, Grundy County, Tennessee, Hamilton County, Tennessee, Hardeman County, Tennessee, Hardin County, Tennessee, Haywood County, Tennessee, Henderson County, Tennessee, Hickman County, Tennessee, Houston County, Tennessee, Humphreys County, Tennessee, Jackson County, Tennessee, Lauderdale County, Tennessee, Lawrence County, Tennessee, Lewis County, Tennessee, Lincoln County, Tennessee, Macon County, Tennessee, Madison County, Tennessee, Marion County, Tennessee, Marshall County, Tennessee, Maury County, Tennessee, Mcnairy County, Tennessee, Montgomery County, Tennessee, Moore County, Tennessee, Overton County, Tennessee, Perry County, Tennessee, Pickett County, Tennessee, Polk County, Tennessee, Putnam County, Tennessee, Robertson County, Tennessee, Rutherford County, Tennessee, Sequatchie County, Tennessee, Shelby County, Tennessee, Smith County, Tennessee, Stewart County, Tennessee, Sumner County, Tennessee, Tipton County, Tennessee, Trousdale County, Tennessee, Van Buren County, Tennessee, Warren County, Tennessee, Wayne County, Tennessee, White County, Tennessee, Williamson County, Tennessee, Wilson County, Tennessee

NOTE: Information on MedicarePolicyHelper.com is for educational purposes only. We are not affiliated with Medicare, or CMS. Medicare has not reviewed or endorsed the information on our site. All plan data on our site comes directly from medicare.gov and is subject to change.