| Medicare Advantage Plan Benefit Details in Plain Text |
The following Medicare Advantage plan benefits apply to the Cigna Achieve Medicare (HMO C-SNP) (H3949 - 024) in Philadelphia, Pennsylvania .
This plan is administered by BRAVO HEALTH PENNSYLVANIA, INC. To switch to a different Medicare Advantage plan or to change your location, click here. |
Click here to see the Cigna Achieve Medicare (HMO C-SNP) health and prescription benefit details in chart format or email and view benefits chart
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| Plan Premium |
This plan has a $0.00 monthly premium. Although you pay no additional monthly premium, you must continue to pay your Medicare Part B premium. If you have a premium penalty, your premium will be higher. Or if you have a higher income you would be subject to the Income Related Adjustment Amount (IRMAA).
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This Medicare Advantage Plan with Prescription Drug Coverage is a Local HMO plan.
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| Plan Membership and Plan Ratings |
The Cigna Achieve Medicare (HMO C-SNP) (H3949 - 024) currently has 2,505 members. There are 1,751 members enrolled in this plan in Philadelphia, Pennsylvania, and 2,497 members in Pennsylvania.
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The Centers for Medicare and Medicaid Services (CMS) has given this plan carrier a summary rating of 4 stars. The detail CMS plan carrier ratings are as follows:- Customer Service Rating of 4 out of 5 stars
- Member Experience Rating of 4 out of 5 stars
- Drug Cost Information Accuracy Rating of 3 out of 5 stars
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| Prescription Drug Coverage: Deductible, Cost-sharing, Formulary |
This plan does NOT have a deductible for the prescription drug coverage. That means that you have first dollar coverage. Some plans have a deductible that must be paid (in full) prior to the prescription coverage assisting in your prescription costs (see cost-sharing below). The maximum deductible for 2021 is $445. This plan (Cigna Achieve Medicare (HMO C-SNP)) has no deductible.
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| The following information is about the Cigna Achieve Medicare (HMO C-SNP) formulary (or drug list). There are 3446 drugs on the Cigna Achieve Medicare (HMO C-SNP) formulary. Click here to browse the Cigna Achieve Medicare (HMO C-SNP) Formulary. |
The Initial Coverage Phase (ICP) can be thought of as the cost-sharing phase of the plan. During this phase, you and the insurance company share your prescription costs. Since this plan has no deductible, your coverage (initial coverage phase) will start right away. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Cigna Achieve Medicare (HMO C-SNP)’s formulary is divided into 6 tiers. Every plan can name their tiers differently, and can place medications on any tier. The cost-sharing for this plan is divided as follows: - Tier 1 (Preferred Generic) contains 325 drugs and has a co-payment of $0.00.
- Tier 2 (Generic) contains 881 drugs and has a co-payment of $5.00.
- Tier 3 (Preferred Brand) contains 808 drugs and has a co-payment of $42.00.
- Tier 4 (Non-Preferred Drug) contains 719 drugs and has a co-payment of $95.00.
- Tier 5 (Specialty Tier) contains 676 drugs and has a co-insurance of 33% of the drug cost.
- Tier 6 (Select Diabetic Drugs) contains drugs and has a co-payment of $5.00.
Click here to browse the Cigna Achieve Medicare (HMO C-SNP) Formulary.
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The Coverage Gap, which is also known as the Donut (Doughnut) Hole is the phase of your Medicare Part D plan where you are responsible for 100% of your medication costs. Healthcare Reform mandates that the insurance carrier pay 75% of your generic drug prescription costs in the donut hole on your behalf.
The brand-name drug manufacturer will pay 70% and your plan will pay an additional 5% of the cost of your brand-name drugs purchased in the Donut Hole, for a total of 75% discount. The 70% paid by the brand-name drug manufacturer is paid on your behalf and therefore counts toward your TrOOP (or True Out-of-Pocket) costs. The portion paid by your plan, does not count toward TrOOP. Some Medicare Part D plans offer coverage during the Coverage Gap that is beyond the mandated discounts. Any drug not covered by the plan’s Gap Coverage will still receive the discounts noted above -- even if the plan has 'No Gap Coverage'. This plan (Cigna Achieve Medicare (HMO C-SNP)) offers No Coverage during the Coverage Gap phase.
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| The Cigna Achieve Medicare (HMO C-SNP) offers many Health and Prescription Drug Coverage Benefits. The following section will describe these benefits in detail. |
| ** Base Plan ** | | Premium | | • Health plan premium: $0 | | • Drug plan premium: $0 | | • You must continue to pay your Part B premium. | | • Part B premium reduction: No | | Deductible | | • Health plan deductible: $0 | | • Other health plan deductibles: In-network: No | | • Drug plan deductible: No annual deductible | | Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | | • $6,900 In-network | | Optional supplemental benefits | | • No | | Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions? | | • In-network: Yes, contact plan for further details | | Doctor visits | | • Primary: $0 copay | | • Specialist: $30 copay per visit (authorization required) | | Diagnostic procedures/lab services/imaging | | • Diagnostic tests and procedures: $0-50 copay (authorization required) | | • Lab services: $0 copay (authorization required) | | • Diagnostic radiology services (e.g., MRI): $0-225 copay (authorization required) | | • Outpatient x-rays: $40 copay (authorization required) | | Emergency care/Urgent care | | • Emergency: $90 copay per visit (always covered) | | • Urgent care: $55 copay per visit (always covered) | | Inpatient hospital coverage | • $285 per day for days 1 through 7
$0 per day for days 8 through 90 (authorization required) | | Outpatient hospital coverage | | • $0-295 copay per visit (authorization required) | | Skilled Nursing Facility | • $0 per day for days 1 through 20
$184 per day for days 21 through 100 (authorization required) | | Preventive care | | • $0 copay | | Ground ambulance | | • $230 copay | | Rehabilitation services | | • Occupational therapy visit: $35 copay (authorization required) | | • Physical therapy and speech and language therapy visit: $35 copay (authorization required) | | Mental health services | • Inpatient hospital - psychiatric: $350 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required) | | • Outpatient group therapy visit with a psychiatrist: $0 copay (authorization required) | | • Outpatient individual therapy visit with a psychiatrist: $0 copay (authorization required) | | • Outpatient group therapy visit: $0 copay (authorization required) | | • Outpatient individual therapy visit: $0 copay (authorization required) | | Medical equipment/supplies | | • Durable medical equipment (e.g., wheelchairs, oxygen): 20% coinsurance per item (authorization required) | | • Prosthetics (e.g., braces, artificial limbs): 20% coinsurance per item (authorization required) | | • Diabetes supplies: $0 copay (authorization required) | | Hearing | | • Hearing exam: $0-30 copay | | • Fitting/evaluation: $0 copay (limits apply) | | • Hearing aids - inner ear: $0 copay (limits apply) | | • Hearing aids - outer ear: $0 copay (limits apply) | | • Hearing aids - over the ear: $0 copay (limits apply) | | Preventive dental | | • Oral exam: $0 copay (limits apply, authorization required) | | • Cleaning: $0 copay (limits apply, authorization required) | | • Fluoride treatment: Not covered | | • Dental x-ray(s): $0 copay (limits apply, authorization required) | | Comprehensive dental | | • Non-routine services: Not covered | | • Diagnostic services: Not covered | | • Restorative services: $0 copay (limits apply, authorization required) | | • Endodontics: Not covered | | • Periodontics: $0 copay (limits apply, authorization required) | | • Extractions: $0 copay (limits apply, authorization required) | | • Prosthodontics, other oral/maxillofacial surgery, other services: $0 copay (limits apply, authorization required) | | Vision | | • Routine eye exam: $0 copay (limits apply, authorization required) | | • Other: Not covered | | • Contact lenses: $0 copay (limits apply) | | • Eyeglasses (frames and lenses): $0 copay (limits apply) | | • Eyeglass frames: $0 copay (limits apply) | | • Eyeglass lenses: $0 copay (limits apply) | | • Upgrades: $0 copay (limits apply) | | Wellness programs (e.g., fitness, nursing hotline) | | • Covered (authorization required) | | Transportation | | • $0 copay (authorization required) | | Foot care (podiatry services) | | • Foot exams and treatment: $30 copay | | • Routine foot care: $0 copay (limits apply) | | Medicare Part B drugs | | • Chemotherapy: 20% coinsurance (authorization required) | | • Other Part B drugs: 20% coinsurance (authorization required) |
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. Skilled Nursing Facility Copay is waived if admitted within 3 days of hospital discharge. Home Health Care services are covered when in lieu of hospitalization. Includes infusion (IV) therapy. Members are responsible for the balance of charges billed by out-of-network providers after payment for covered services has been made by Cigna.
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- Pulmonary rehab & cognitive therapy)-20 days maximum per calendar year# for all therapies combined Note: therapy sessions provided as part of Home Health Care accumulate to the Short-Term Rehab Therapy maximum. $25 or $50 copayment per office visit; No charge after office visit copay if only x-ray and/or lab services are performed and billed.
- . Physical therapy and speech and language therapy visit: $35 copay (authorization required) Mental health services. Inpatient hospital - psychiatric: $350 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required). Outpatient group therapy visit with a psychiatrist: $0 copay (authorization required).
Cigna Preferred Medicare (HMO) H3949-034 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Cigna available to residents in New Jersey. This plan includes additional Medicare prescription drug (Part-D) coverage. The Cigna Preferred Medicare (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,100 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,100 out of pocket. This can be a extremely nice safety net.
Cigna Preferred Medicare (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.
Cigna works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Cigna Preferred Medicare (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Cigna and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Cigna except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
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2021 Cigna Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H3949-034 |
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| Provider: | Cigna |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $7,100 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $0 |
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| Tiers with No Deductible: | 0 |
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| Gap Coverage: | Yes |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H3949-035 |
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Cigna Preferred Medicare (HMO) Part-C Premium
Cigna plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.
H3949-034 Part-D Deductible and Premium
Cigna Preferred Medicare (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Cigna plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Cigna above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.
Cigna Gap Coverage
In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Cigna plan does offer additional coverage through the gap.
H3949-034 Formulary or Drug Coverage
Cigna Preferred Medicare (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.
2021 Cigna Preferred Medicare (HMO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | $0 copay |
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| Non-routine services | Not covered |
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| Periodontics | $0 copay |
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| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
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| Restorative services | $0 copay |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-155 copay |
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| Diagnostic tests and procedures | $0-50 copay |
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| Lab services | $0 copay |
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| Outpatient x-rays | $30 copay |
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Doctor Visits
| Primary | $0 copay |
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| Specialist | $30 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $55 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $30 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
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| Hearing aids - inner ear | $0 copay |
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| Hearing aids - outer ear | $0 copay |
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| Hearing aids - over the ear | $0 copay |
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| Hearing exam | $0-30 copay |
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Inpatient Hospital Coverage
$350 per day for days 1 through 5
$0 per day for days 6 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $320 per day for days 1 through 5
$0 per day for days 6 through 90 |
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| Outpatient group therapy visit | $0 copay |
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| Outpatient group therapy visit with a psychiatrist | $0 copay |
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| Outpatient individual therapy visit | $0 copay |
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| Outpatient individual therapy visit with a psychiatrist | $0 copay |
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MOOP
Option
| Yes, contact plan for further details |
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Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Preventive Dental
| Cleaning | $0 copay |
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| Dental x-ray(s) | $0 copay |
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| Fluoride treatment | Not covered |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $30 copay |
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| Physical therapy and speech and language therapy visit | $30 copay |
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Skilled Nursing Facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Eyeglass frames | $0 copay |
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| Eyeglass lenses | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Other | Not covered |
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| Routine eye exam | $0 copay |
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| Upgrades | $0 copay |
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Wellness Programs (e.g. fitness nursing hotline)
Reviews for Cigna Preferred Medicare (HMO) H3949
| 2019 Overall Rating |
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| Part C Summary Rating |
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| Part D Summary Rating |
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| Staying Healthy: Screenings, Tests, Vaccines |
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| Managing Chronic (Long Term) Conditions |
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| Member Experience with Health Plan |
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| Complaints and Changes in Plans Performance |
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| Health Plan Customer Service |
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| Drug Plan Customer Service |
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| Complaints and Changes in the Drug Plan |
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| Member Experience with the Drug Plan |
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| Drug Safety and Accuracy of Drug Pricing |
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Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
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| Breast Cancer Screening |
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| Colorectal Cancer Screening |
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| Annual Flu Vaccine |
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| Improving Physical |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
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| SNP Care Management |
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| Medication Review |
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| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
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| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
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Member Experience with Health Plan
Cigna Therapy Copay Assistance
| Total Experience Rating |
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| Getting Needed Care |
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| Customer Service |
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| Health Care Quality |
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| Rating of Health Plan |
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| Care Coordination |
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Member Complaints and Changes in Cigna Preferred Medicare (HMO) Plans Performance
| Total Rating |
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| Complaints about Health Plan |
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| Members Leaving the Plan |
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| Health Plan Quality Improvement |
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| Timely Decisions About Appeals |
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Health Plan Customer Service Rating for Cigna Preferred Medicare (HMO)
| Total Customer Service Rating |
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| Reviewing Appeals Decisions |
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| Call Center, TTY, Foreign Language |
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Cigna Preferred Medicare (HMO) Drug Plan Customer Service Ratings
| Total Rating |
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| Call Center, TTY, Foreign Language |
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| Appeals Auto |
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| Appeals Upheld |
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Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
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| Complaints about the Drug Plan |
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| Members Choosing to Leave the Plan |
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| Drug Plan Quality Improvement |
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Member Experience with the Drug Plan
| Total Rating |
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| Rating of Drug Plan |
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| Getting Needed Prescription Drugs |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
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| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
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| MTM Program Completion Rate for CMR |
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| Statin with Diabetes |
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Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Cigna Preferred Medicare (HMO)
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Cigna Copay Basic
Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.
