- Medicare Copay For Specialist Program
- Medicare Copay For Specialist
- Medicare Copay For Specialist Certification
- How Much Does Medicare Cover For Specialists
- Medicare Copay For Specialist Visits
- What Is The Copay For A Doctor Visit With Medicare
- A copay (or copayment) is a flat fee that you pay on the spot each time you go to your doctor or fill a prescription. For example, if you hurt your back and go see your doctor, or you need a refill of your child's asthma medicine, the amount you pay for that visit or medicine is your copay.
- . A copay applies for any care received for a medical condition that’s treated or monitored during a preventive visit. We follow the Centers for Medicare & Medicaid Services (CMS) Medicare. Coverage and coding guidelines for all network services. You can view Coverage Summaries on UHCprovider.com.
A copayment, or copay, is a fixed amount of money that you pay out-of-pocket for a specific service.Copays generally apply to doctor visits, specialist visits, and prescription drug refills.
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Cigna True Choice Plus Medicare (PPO) H7849-030 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 True Choice Plus Medicare (PPO) has a monthly premium of $39.00 and has an in-network Maximum Out-of-Pocket limit of $7,250 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,250 out of pocket. This can be a extremely nice safety net.
Cigna True Choice Plus Medicare (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
Cigna works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Cigna True Choice Plus Medicare (PPO) 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: | H7849-030 |
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| Provider: | Cigna |
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| Year: | 2021 |
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| Type: | Local PPO |
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| Monthly Premium C+D: | $39.00 |
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| Part C Premium: | $17.10 |
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| MOOP: | $7,250 |
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| Part D (Drug) Premium: | $21.90 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $21.90 |
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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: | H7849-031 |
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Cigna True Choice Plus Medicare (PPO) Part-C Premium
Cigna plan charges a $17.10 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.
Medicare Copay For Specialist Program
H7849-030 Part-D Deductible and Premium
Cigna True Choice Plus Medicare (PPO) has a monthly drug premium of $21.90 and a $0 drug deductible. This Cigna plan offers a $21.90 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 $21.90. 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.
Premium Assistance
The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Cigna True Choice Plus Medicare (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.50 for 75% low income subsidy $10.90 for 50% and $16.40 for 25%.
| Full LIS Premium: | $0 |
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| 75% LIS Premium: | $5.50 |
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| 50% LIS Premium: | $10.90 |
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| 25% LIS Premium: | $16.40 |
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H7849-030 Formulary or Drug Coverage
Cigna True Choice Plus Medicare (PPO) 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 True Choice Plus Medicare (PPO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | $0 copay |
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| Diagnostic services | $0 copay (Out-of-Network) |
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| Endodontics | $0 copay |
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| Endodontics | $0 copay (Out-of-Network) |
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| Extractions | $0 copay |
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| Extractions | $0 copay (Out-of-Network) |
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| Non-routine services | $0 copay |
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| Non-routine services | $0 copay (Out-of-Network) |
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| Periodontics | $0 copay |
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| Periodontics | $0 copay (Out-of-Network) |
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| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
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| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Out-of-Network) |
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| Restorative services | $0 copay |
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| Restorative services | $0 copay (Out-of-Network) |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-175 copay |
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| Diagnostic radiology services (e.g., MRI) | 30% coinsurance (Out-of-Network) |
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| Diagnostic tests and procedures | $0-50 copay |
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| Diagnostic tests and procedures | 30% coinsurance (Out-of-Network) |
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| Lab services | $0 copay |
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| Lab services | 0-30% coinsurance (Out-of-Network) |
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| Outpatient x-rays | $30 copay |
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| Outpatient x-rays | 30% coinsurance (Out-of-Network) |
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Doctor Visits
| Primary | $0 copay |
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| Primary | $40 copay per visit (Out-of-Network) |
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| Specialist | $20 copay per visit |
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| Specialist | $55 copay per visit (Out-of-Network) |
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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 | $20 copay |
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| Foot exams and treatment | $55 copay (Out-of-Network) |
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| Routine foot care | Not covered |
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Ground Ambulance
| $240 copay |
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| $240 copay (Out-of-Network) |
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Hearing
| Fitting/evaluation | $0 copay |
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| Fitting/evaluation | 30% coinsurance (Out-of-Network) |
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| Hearing aids - inner ear | $0 copay |
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| Hearing aids - inner ear | $0 copay (Out-of-Network) |
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| Hearing aids - outer ear | $0 copay |
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| Hearing aids - outer ear | $0 copay (Out-of-Network) |
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| Hearing aids - over the ear | $0 copay |
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| Hearing aids - over the ear | $0 copay (Out-of-Network) |
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| Hearing exam | $0-20 copay |
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| Hearing exam | $55 copay (Out-of-Network) |
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Inpatient Hospital Coverage
$195 per day for days 1 through 6
$0 per day for days 7 through 90 |
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| 30% per stay (Out-of-Network) |
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Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
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| Diabetes supplies | 30% coinsurance per item (Out-of-Network) |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 30% coinsurance per item (Out-of-Network) |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 30% coinsurance per item (Out-of-Network) |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Chemotherapy | 30% coinsurance (Out-of-Network) |
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| Other Part B drugs | 20% coinsurance |
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| Other Part B drugs | 30% coinsurance (Out-of-Network) |
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Mental Health Services
| Inpatient hospital - psychiatric | $195 per day for days 1 through 6
$0 per day for days 7 through 90 |
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| Inpatient hospital - psychiatric | 30% per stay (Out-of-Network) |
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| Outpatient group therapy visit | $0 copay |
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| Outpatient group therapy visit | $55 copay (Out-of-Network) |
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| Outpatient group therapy visit with a psychiatrist | $0 copay |
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| Outpatient group therapy visit with a psychiatrist | $55 copay (Out-of-Network) |
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| Outpatient individual therapy visit | $0 copay |
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| Outpatient individual therapy visit | $55 copay (Out-of-Network) |
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| Outpatient individual therapy visit with a psychiatrist | $0 copay |
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| Outpatient individual therapy visit with a psychiatrist | $55 copay (Out-of-Network) |
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MOOP
$11,300 In and Out-of-network
$7,250 In-network |
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Option
| Yes, contact plan for further details |
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Optional supplemental benefits
Outpatient Hospital Coverage
| $0-195 copay per visit |
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| 30% coinsurance per visit (Out-of-Network) |
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Preventive Care
| $0 copay |
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| $0 copay (Out-of-Network) |
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Preventive Dental
| Cleaning | $0 copay |
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| Cleaning | $0 copay (Out-of-Network) |
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| Dental x-ray(s) | $0 copay |
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| Dental x-ray(s) | $0 copay (Out-of-Network) |
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| Fluoride treatment | $0 copay |
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| Fluoride treatment | $0 copay (Out-of-Network) |
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| Oral exam | $0 copay |
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| Oral exam | $0 copay (Out-of-Network) |
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Rehabilitation Services
| Occupational therapy visit | $20 copay |
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| Occupational therapy visit | $55 copay (Out-of-Network) |
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| Physical therapy and speech and language therapy visit | $20 copay |
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| Physical therapy and speech and language therapy visit | $55 copay (Out-of-Network) |
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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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| 30% per stay (Out-of-Network) |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Contact lenses | $0 copay (Out-of-Network) |
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| Eyeglass frames | $0 copay |
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| Eyeglass frames | $0 copay (Out-of-Network) |
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| Eyeglass lenses | $0 copay |
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| Eyeglass lenses | $0 copay (Out-of-Network) |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay (Out-of-Network) |
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| Other | Not covered |
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| Routine eye exam | $0 copay |
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| Routine eye exam | 30% coinsurance (Out-of-Network) |
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| Upgrades | $0 copay |
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| Upgrades | $0 copay (Out-of-Network) |
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Wellness Programs (e.g. fitness nursing hotline)
Medicare Copay For Specialist
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Medicare Copay For Specialist Certification
Coverage Area for Cigna True Choice Plus Medicare (PPO)
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How Much Does Medicare Cover For Specialists
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Medicare Copay For Specialist Visits
What Is The Copay For A Doctor Visit With Medicare
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.