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Cigna Courage Medicare (HMO)

H4513 - 062 - 0

(5 / 5)

Cigna Courage Medicare (HMO) is a Medicare Advantage Plan by Cigna.

This page features plan details for 2023 Cigna Courage Medicare (HMO) H4513 – 062 – 0.

IMPORTANT: This page features the 2023 version of this plan. See the 2025 version using the link below:

No 2025 version found. You can use the location links below to find 2025 plans in your area.

Locations

Cigna Courage Medicare (HMO) is offered in the following locations.

Click to see more locations

Plan Overview

Cigna Courage Medicare (HMO) offers the following coverage and cost-sharing.

Insurer:	Cigna
Health Plan Deductible:	$0.00
MOOP:	$4,300 In-network
Drugs Covered:	No

Ready to sign up for Cigna Courage Medicare (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

Cigna Courage Medicare (HMO) qualifies for a monthly Medicare Give Back Benefit of $60.00.

Premium Reduction:

$60.00

Premium Breakdown

Cigna Courage Medicare (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.

Part B	Part C	Part B Give Back	Total
$164.90	$0.00	$60.00	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Cigna Courage Medicare (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:	$0 copay (limits may apply) (authorization required) (referral not required)
Endodontics:	$38-675 copay (limits may apply) (authorization required) (referral not required)
Extractions:	$0 copay (limits may apply) (authorization required) (referral not required)
Non-routine services:	Not covered (no limits)
Periodontics:	$15-115 copay (limits may apply) (authorization required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:	$0-615 copay (limits may apply) (authorization required) (referral not required)
Restorative services:	$0-525 copay (limits may apply) (authorization required) (referral not required)

Dental (preventive)

Cleaning:	$0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):	$0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:	$0 copay (limits may apply) (authorization not required) (referral not required)
Oral exam:	$0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):	$0-170 copay (authorization required) (referral required)
Diagnostic tests and procedures:	$0-50 copay (authorization required) (referral required)
Lab services:	$0 copay (authorization required) (referral required)
Outpatient x-rays:	$10 copay (authorization required) (referral required)

Doctor visits

Primary:	$0 copay
Specialist:	$25 copay per visit (authorization required) (referral required)

Emergency care/Urgent care

Emergency:	$110 copay per visit (always covered)
Urgent care:	$30 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:	$25 copay (authorization not required) (referral required)
Routine foot care:	Not covered

Ground ambulance

$240 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:	$0 copay (limits may apply) (authorization not required) (referral required)
Hearing aids:	$0 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam:	$25 copay (authorization not required) (referral required)

Hospital coverage (inpatient)

$100 per day for days 1 through 6
$0 per day for days 7 through 90 (authorization required) (referral required)

Hospital coverage (outpatient)

$0-175 copay per visit (authorization required) (referral required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$4,300 In-network

Medical equipment/supplies

Diabetes supplies:	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):	15% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):	20% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:	20% coinsurance (authorization required)
Other Part B drugs:	20% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:	$250 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required)
Outpatient group therapy visit:	$0 copay (authorization required) (referral not required)
Outpatient group therapy visit with a psychiatrist:	$0 copay (authorization required) (referral not required)
Outpatient individual therapy visit:	$0 copay (authorization required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:	$0 copay (authorization required) (referral not required)

Optional supplemental benefits

Preventive care

$0 copay (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:	$25 copay (authorization required) (referral required)
Physical therapy and speech and language therapy visit:	$25 copay (authorization required) (referral required)

Skilled Nursing Facility

$10 per day for days 1 through 20
$196 per day for days 21 through 100 (authorization required) (referral not required)

Transportation

$0 copay (limits may apply) (authorization required) (referral not required)

Vision

Contact lenses:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):	$0 copay (limits may apply) (authorization not required) (referral not required)
Other:	Not covered (no limits)
Routine eye exam:	$0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades:	$0 copay (limits may apply) (authorization not required) (referral not required)

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)