Plan Benefits for
2022 Cigna Fundamental Medicare (HMO)


Cigna Fundamental Medicare (HMO) H4513-009 is a 2022 Medicare Advantage Plan or Medicare Part-C plan by Cigna available to residents in Texas. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Cigna Fundamental Medicare (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,300 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,300 out-of-pocket. This can be a extremely nice safety net.

Cigna Fundamental 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 Fundamental 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 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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2022 Cigna Medicare Advantage Plan Costs

Name:
Cigna Fundamental Medicare (HMO)
Plan ID:
H4513-009
Provider:Cigna
Year:2022
Type: Local HMO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $4,300
Similar Plan: H4513-026




2021 Cigna Fundamental Medicare (HMO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics Not covered
Extractions $0 copay
Non-routine services Not covered
Periodontics $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Restorative services $0 copay



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0-200 copay
Diagnostic tests and procedures $0-150 copay
Lab services $0 copay
Outpatient x-rays $0 copay



Doctor Visits


Primary $0 copay
Specialist $30 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $30 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $30 copay
Routine foot care Not covered



Ground Ambulance


$200 copay



Hearing


Fitting/evaluation $0 copay
Hearing aids - inner ear $0 copay
Hearing aids - outer ear $0 copay
Hearing aids - over the ear $0 copay
Hearing exam $0-30 copay



Inpatient Hospital Coverage


$600 per stay



Medical Equipment/Supplies


Diabetes supplies 0-10% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $150 per day for days 1 through 7
$0 per day for days 8 through 90
Outpatient group therapy visit $0 copay
Outpatient group therapy visit with a psychiatrist $0 copay
Outpatient individual therapy visit $0 copay
Outpatient individual therapy visit with a psychiatrist $0 copay



MOOP


$3,900 In-network



Option


Yes, contact plan for further details



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-250 copay per visit



Preventive Care


$0 copay



Preventive Dental


Cleaning $0 copay
Dental x-ray(s) $0 copay
Fluoride treatment Not covered
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit $30 copay
Physical therapy and speech and language therapy visit $30 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100



Transportation


$0 copay



Vision


Contact lenses $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $0 copay
Upgrades $0 copay



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for Cigna Fundamental Medicare (HMO) H4513



2021 Overall Rating
Part C Summary Rating
Part D Summary 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


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Cigna Fundamental Medicare (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for Cigna Fundamental Medicare (HMO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Cigna Fundamental Medicare (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



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Coverage Area for Cigna Fundamental Medicare (HMO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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