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2024 Cigna TotalCare (HMO D-SNP) in Forrest, Mississippi

Medicare Advantage Plan Benefit Details in Plain Text
The following Medicare Advantage plan benefits apply to the Cigna TotalCare (HMO D-SNP) (H4407 - 004) in Forrest, Mississippi .

This plan is administered by HEALTHSPRING LIFE & HEALTH INSURANCE COMPANY, INC..  To switch to a different Medicare Advantage plan or to change your location, click here.
Click here to see the Cigna TotalCare (HMO D-SNP) health and prescription benefit details in chart format or email and view benefits chart

Plan Premium
The Cigna TotalCare (HMO D-SNP) has a monthly premium of $25.50. That is $306.00 for 12 months. There are a few factors that can increase or decrease this premium. If you qualify for extra help, your premium will be lower. If you have a premium penalty, your premium will be higher. Please remember that the $25.50 montly premium is in addition to 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 TotalCare (HMO D-SNP) (H4407 - 004) currently has 1,114 members. There are 164 members enrolled in this plan in Forrest, Mississippi, and 649 members in Mississippi.

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:
Prescription Drug Coverage: Deductible, Cost-sharing, Formulary
This plan has a $545 deductible. So, you are 100% responsible for the first $545 in medication costs. After you have met the deductible, the Cigna TotalCare (HMO D-SNP) will share the costs of your medications with you -- see cost-sharing below. $545 is the maximum deductible for 2024. There are other plans with a lower deductible or even a $0 deductible for all formulary drugs. Click here to review plans with a $0 deductible.

The following information is about the Cigna TotalCare (HMO D-SNP) formulary (or drug list). There are 3535 drugs on the Cigna TotalCare (HMO D-SNP) formulary. Click here to browse the Cigna TotalCare (HMO D-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. Once you have spent $545, your initial coverage phase will start. All medication are divided into tiers within the plans formulary. This helps the plan to organize and manage the prescription cost-sharing. The Cigna TotalCare (HMO D-SNP)’s formulary is divided into 5 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 contains 403 drugs and has a co-insurance of 15% of the drug cost.
  • Tier 2 contains 852 drugs and has a co-insurance of 15% of the drug cost.
  • Tier 3 contains 823 drugs and has a co-insurance of 15% of the drug cost.
  • Tier 4 contains 737 drugs and has a co-insurance of 15% of the drug cost.
  • Tier 5 contains 757 drugs and has a co-insurance of 15% of the drug cost.
    •  
All forms of insulin covered by this Medicare Part D plan will have a copay of $35 or less through all phases of coverage. Please contact the drug plan for more details.

Click here to browse the Cigna TotalCare (HMO D-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 TotalCare (HMO D-SNP)) offers No Coverage during the Coverage Gap phase.

The Cigna TotalCare (HMO D-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: $25.50
• 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: $545.00 annual deductible
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
• $6,700 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: $0 copay (authorization required)
Diagnostic procedures/lab services/imaging
• Diagnostic tests and procedures: 0% or 0-20% coinsurance (authorization required)
• Lab services: 0% or 0-20% coinsurance (authorization required)
• Diagnostic radiology services (e.g., MRI): 0% or 0-20% coinsurance (authorization required)
• Outpatient x-rays: 0% or 0-20% coinsurance (authorization required)
Emergency care/Urgent care
• Emergency: $0 or $100 copay per visit (always covered)
• Urgent care: $0 or $55 copay per visit (always covered)
Inpatient hospital coverage
• $0 or $195 per day for days 1 through 5
$0 per day for days 6 through 90 (authorization required)
Outpatient hospital coverage
• 0% or 0-20% coinsurance per visit (authorization required)
Skilled Nursing Facility
• $0 per day for days 1 through 20
$0 or $203 per day for days 21 through 100 (authorization required)
Preventive care
• $0 copay
Ground ambulance
• $0 or $245 copay
Rehabilitation services
• Occupational therapy visit: $0 copay (authorization required)
• Physical therapy and speech and language therapy visit: $0 copay
Mental health services
• Inpatient hospital - psychiatric: $0 or $1,850 per stay (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): 0% or 20% coinsurance per item (authorization required)
• Prosthetics (e.g., braces, artificial limbs): 0% or 20% coinsurance per item (authorization required)
• Diabetes supplies: $0 copay (authorization required)
Hearing
• Hearing exam: $0 copay
• Fitting/evaluation: $0 copay (limits apply)
• Hearing aids: $399-1,800 copay (limits apply)
Preventive dental
• Oral exam: $0 copay (limits apply)
• Cleaning: $0 copay (limits apply)
• Fluoride treatment: $0 copay (limits apply)
• Dental x-ray(s): $0 copay (limits apply)
Comprehensive dental
• Non-routine services: $0 copay (limits apply, authorization required)
• Diagnostic services: $0 copay (limits apply, authorization required)
• Restorative services: $0 copay (limits apply, authorization required)
• Endodontics: $0 copay (limits apply, authorization required)
• 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)
• 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)
Medically-approved non-opioid pain management services
• Chiropractic services: Not covered
• Acupuncture: Not covered
• Therapeutic Massage: Not covered
• Alternative Therapies: Not covered
More benefits
• Transportation services: Some coverage
• Over-the-counter drug benefits: Some coverage
• Meals for short duration: Some coverage
• Annual physical exams: Some coverage
• Telehealth: Some coverage
• WorldWide emergency transportation: Some coverage
• WorldWide emergency coverage: Some coverage
• WorldWide emergency urgent care: Some coverage
• Fitness Benefit: Some coverage
• In-Home Support Services: Some coverage
• Bathroom Safety Devices: Not covered
• Health Education: Some coverage
• In-Home Safety Assessment: Not covered
• Personal Emergency Response System (PERS): Not covered
• Medical Nutrition Therapy (MNT): Not covered
• Post discharge In-Home Medication Reconciliation: Not covered
• Re-admission Prevention: Not covered
• Wigs for Hair Loss Related to Chemotherapy: Not covered
• Weight Management Programs: Not covered
• Adult Day Health Services: Not covered
• Nutritional/Dietary Benefit: Not covered
• Home-Based Palliative Care: Not covered
• Support for Caregivers of Enrollees: Not covered
• Additional Sessions of Smoking and Tobacco Cessation Counseling: Not covered
• Enhanced Disease Management: Not covered
• Telemonitoring Services: Not covered
• Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline): Some coverage
• Counseling Services: Not covered
Wellness programs (e.g., fitness, nursing hotline)
• Covered
Transportation
• $0 copay (authorization required)
Foot care (podiatry services)
• Foot exams and treatment: $0 copay
• Routine foot care: Not covered
Medicare Part B drugs
• Part B Insulin drugs: 0% or 0-20% coinsurance (up to $35) (authorization required)
• Chemotherapy: 0% or 0-20% coinsurance (authorization required)
• Other Part B drugs: 0% or 0-20% coinsurance (authorization required)


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