Cigna TotalCare Plus (HMO D-SNP)
Cigna TotalCare Plus (HMO D-SNP) is a Medicare Advantage (Part C) Special Needs Plan by Cigna Healthcare.
This page features plan details for 2024 Cigna TotalCare Plus (HMO D-SNP) H3949 – 009 – 0 available in Pennsylvania.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Cigna TotalCare Plus (HMO D-SNP) is offered in the following locations.
Plan Overview
Cigna TotalCare Plus (HMO D-SNP) offers the following coverage and cost-sharing.
| Special Needs Plan Type: | Dual-Eligible |
| Conditions Covered: |
| Insurer: | Cigna Healthcare |
| Health Plan Deductible: | $0.00 |
| MOOP: | $8,850 In-network |
| Drugs Covered: | Yes |
- This plan is a Medicare Special Needs Plan for people with both Medicare and Medicaid. Contact the plan for details.
- Depending on your level of Extra Help, you may pay less for the drugs than the cost sharing amount listed. Look on the Extra Help letters you get, or contact the plan to find out your exact costs.
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8am – 11pm EST. 7 days a week
Premium Breakdown
Cigna TotalCare Plus (HMO D-SNP) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
| Part B | Part C | Part D | Part B Give Back | Total |
|---|
| $174.70 | $0.00 | $0.00 | $0.00 | $174.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
- You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.
Drug Info
Cigna TotalCare Plus (HMO D-SNP) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
| Drug Deductible: | $545.00 |
| Initial Coverage Limit: | $5,030.00 |
| Catastrophic Coverage Limit: | $8,000.00 |
| Drug Benefit Type: | Basic |
| Additional Gap Coverage: | No |
| Formulary Link: | Formulary Link |
Part D Premium Reduction
The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.
The table below shows how the LIS impacts the Part D premium of this plan.
NOTE: The Inflation Reduction Act of 2022 has expanded full subsidy eligibility under the LIS program to individuals with incomes up to 150% of the Federal Poverty Level. People who qualify for Extra Help generally will pay no more than $4.50 for each generic drug and $11.20 for each brand-name drug.
Initial Coverage Phase
After you pay your $545.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00. Once you reach that amount, you will enter the next coverage phase.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| 25% | 25% |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| 25% | 25% |
Gap Coverage Phase
After your total drug costs (including what this plan has paid and what you have paid) reach $5,030.00, you will pay no more than the amounts below for any drug tier until you reach $8,000.00.
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| Generic drugs |
| Brand-name drugs |
| Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
|---|
| Generic drugs |
| Brand-name drugs |
| Drug Type | Cost Share | | Generic drugs | 25% |
| Brand-name drugs | 25% |
Catastrophic Coverage Phase
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $8,000.00, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
Cigna TotalCare Plus (HMO D-SNP) also provides the following benefits.
Health plan deductible
Other health plan deductibles?
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
Optional supplemental benefits
Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?
Outpatient hospital coverage
Doctor visits
| Specialist | $0 copay (Authorization is required.) (Referral is not required.) |
Preventive care
Emergency care/Urgent care
| Urgent care | $0 copay (Not applicable.) (Not applicable.) |
Diagnostic procedures/lab services/imaging
| Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | $0 copay (Authorization is required.) (Referral is not required.) |
| Outpatient x-rays | $0 copay (Authorization is required.) (Referral is not required.) |
Hearing
| Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $399-1,800 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Preventive dental
| Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Comprehensive dental
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Restorative services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Endodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Periodontics | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
Vision
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Rehabilitation services
| Physical therapy and speech and language therapy visit | $0 copay (Authorization is not required.) (Referral is not required.) |
Ground ambulance
Transportation
Foot care (podiatry services)
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
Medical equipment/supplies
| Prosthetics (e.g., braces, artificial limbs) | $0 copay (Authorization is required.) (Not applicable.) |
| Diabetes supplies | $0 copay (Authorization is required.) (Not applicable.) |
Wellness programs (e.g., fitness, nursing hotline)
Medicare Part B drugs
| Other Part B drugs | $0 copay (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $0 copay (Authorization is required.) (Not applicable.) |
Inpatient hospital coverage
Mental health services
| Outpatient group therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $0 copay (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit | $0 copay (Authorization is required.) (Referral is not required.) |
Skilled Nursing Facility
Ready to sign up for Cigna TotalCare Plus (HMO D-SNP) ?
Get help from a licensed insurance agent.
8am – 11pm EST. 7 days a week
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We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.
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