1. Cigna Copay For Therapy
2. Cigna Therapy Copay Program
3. Cigna Copay Plan

Cigna Copay For Therapy

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

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).

This Medicare Advantage Plan with Prescription Drug Coverage is a Local HMO plan.

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.

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

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.

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.

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.

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)

Cigna Therapy Copay Program

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.

Cigna Copay Plan

1. Cigna Behavioral Health 1 administers claims related to the treatment of mental health conditions under employer-sponsored health plan s. Your employer’s plan may include access to: The Cigna Behavioral Health network of licensed mental health providers; Mental health services and follow up case management services.
2. Cigna Fundamental Medicare (HMO) H4513-009 is a 2021 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 $3,900 (MOOP).