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Cigna True Choice Medicare (PPO)

H7849 - 042 - 0

(3 / 5)

Cigna True Choice Medicare (PPO) is a Medicare Advantage Plan by Cigna Healthcare.

This page features plan details for 2025 Cigna True Choice Medicare (PPO) H7849 – 042 – 0 available in Oklahoma City.

Locations

Cigna True Choice Medicare (PPO) is offered in the following locations.

Canadian County, Oklahoma

Cleveland County, Oklahoma

Lincoln County, Oklahoma

Click to see more locations

Plan Overview

Cigna True Choice Medicare (PPO) offers the following coverage and cost-sharing.

Insurer:	Cigna Healthcare
Health Plan Deductible:	$150 annual deductible
MOOP:	$14,000 In and Out-of-network $9,350 In-network
Drugs Covered:	Yes

Ready to sign up for Cigna True Choice Medicare (PPO) ?

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

Premium Breakdown

Cigna True Choice Medicare (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.

Part B	Part C	Part D	Part B Give Back	Total
$185.00	$0.00	$0.00	$	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.
You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Cigna True Choice Medicare (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:	$0.00
Drug Out-Of-Pocket maximum:	$2,000.00
Drug Benefit Type:	Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part D	LIS Full
$0.00	$0.00

Initial Coverage Phase

After you pay your $0.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$9.00 Copay		$9.00 Copay
2) Generic	$4.00 Copay	$15.00 Copay	$4.00 Copay	$15.00 Copay
3) Preferred Brand	$45.00 Copay	$47.00 Copay	$45.00 Copay	$47.00 Copay
4) Non-Preferred Drug	$100.00 Copay	$100.00 Copay	$100.00 Copay	$100.00 Copay
5) Specialty Tier	33.00% Coinsurance	33.00% Coinsurance	33.00% Coinsurance	33.00% Coinsurance

60 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$18.00 Copay		$18.00 Copay
2) Generic	$8.00 Copay	$30.00 Copay	$8.00 Copay	$30.00 Copay
3) Preferred Brand	$90.00 Copay	$94.00 Copay	$90.00 Copay	$94.00 Copay
4) Non-Preferred Drug	$200.00 Copay	$200.00 Copay	$200.00 Copay	$200.00 Copay
5) Specialty Tier

90 Day

Tier	Pref. Pharm	Std. Pharm	Pref. Mail	Std. Mail
1) Preferred Generic		$27.00 Copay		$27.00 Copay
2) Generic	$12.00 Copay	$45.00 Copay		$45.00 Copay
3) Preferred Brand	$135.00 Copay	$141.00 Copay	$135.00 Copay	$141.00 Copay
4) Non-Preferred Drug	$300.00 Copay	$300.00 Copay	$300.00 Copay	$300.00 Copay
5) Specialty Tier

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

Cigna True Choice Medicare (PPO) also provides the following benefits.

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

- In-Network: No

Comprehensive Dental

Adjunctive General Services
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Endodontics
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Implant Services
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Maxillofacial Prosthetics
- Out-of-Network: No Coins – No Copay (Limits Apply)
Maxillofacial Prosthetics
- In-Network: No Coins – No Co pay (Limits Apply)
Oral and Maxillofacial Surgery
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Orthodontics
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Periodontics
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Prosthodontics, fixed
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Prosthodontics, removable
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Restorative Services
- In-Network: No Coins – No Co pay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic and Preventive Dental

Dental X-Rays
- In-Network: No Coins – No Copay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Fluoride Treatment
- In-Network: No Coins – No Copay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Oral Exams
- In-Network: No Coins – No Copay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Other Diagnostic Dental Services
- In-Network: No Coins – No Copay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Other Preventive Dental Services
- In-Network: No Coins – No Copay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)
Prophylaxis (cleaning)
- In-Network: No Coins – No Copay (Limits Apply)
- Out-of-Network: No Coins – No Copay (Limits Apply)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures
- In-Network: $0-50 copay (Authorization Required)
- Out-of-Network: 40% coinsurance (Authorization Required)
Outpatient x-rays
- In-Network: $5 copay (Authorization Required)
Lab services
- Out-of-Network: 40% coinsurance (Authorization Required)
Diagnostic radiology services (e.g., MRI)
- In-Network: $0-200 copay (Authorization Required)
- Out-of-Network: 40% coinsurance (Authorization Required)
Lab services
- In-Network: $0-50 copay (Authorization Required)
Outpatient x-rays
- Out-of-Network: 40% coinsurance (Authorization Required)

Doctor visits

Primary
- Out-of-Network: $0 copay
Specialist
- Out-of-Network: $35 copay per visit (Authorization Required)
Primary
- In-Network: $0 copay
Specialist
- In-Network: $30 copay per visit (Authorization Required)

Emergency care/Urgent care

Emergency
- $110 copay per visit (always covered)
Urgent care
- $35 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment
- In-Network: $30 copay
- Out-of-Network: $35 copay
Routine foot care
- Not covered

Ground ambulance

- Out-of-Network: $250 copay or 20% coinsurance
- In-Network: $250 copay

Health plan deductible

- $150 annual deductible

Hearing

Hearing aids OTC
- Not covered
Medicare-Covered Hearing Exam
- In-Network: $20 copay
Fitting/evaluation
- In-Network: $0 copay (Limits Apply)
- Out-of-Network: 50% coinsurance (Limits Apply)
Medicare-Covered Hearing Exam
- Out-of-Network: $25 copay
Hearing aids
- In-Network: $399-1,800 copay (Limits Apply)
- Out-of-Network: $0 copay (Limits Apply)

Inpatient hospital coverage

- In-Network: $310 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required)
- Out-of-Network: 40% per stay (Authorization Required)

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

- $14,000 In and Out-of-network
  $9,350 In-network

Medical equipment/supplies

Diabetes supplies
- In-Network: $0 copay (Authorization Required)
Durable medical equipment (e.g., wheelchairs, oxygen)
- In-Network: 20% coinsurance per item (Authorization Required)
Diabetes supplies
- Out-of-Network: 40% coinsurance per item (Authorization Required)
Durable medical equipment (e.g., wheelchairs, oxygen)
- Out-of-Network: 40% coinsurance per item (Authorization Required)
Prosthetics (e.g., braces, artificial limbs)
- In-Network: 20% coinsurance per item (Authorization Required)
- Out-of-Network: 40% coinsurance per item (Authorization Required)

Medicare Part B drugs

Other Part B drugs
- In-Network: 0-20% coinsurance (Authorization Required)
Chemotherapy
- Out-of-Network: 35% coinsurance (Authorization Required)
Other Part B drugs
- Out-of-Network: 35% coinsurance (Authorization Required)
Chemotherapy
- In-Network: 0-20% coinsurance (Authorization Required)

Mental health services

Inpatient hospital – psychiatric
- In-Network: $310 per day for days 1 through 5
  $0 per day for days 6 through 90 (Authorization Required)
- Out-of-Network: 40% per stay (Authorization Required)
Outpatient individual therapy visit
- Out-of-Network: $35 copay (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- In-Network: $0 copay (Authorization Required)
Outpatient group therapy visit
- In-Network: $0 copay (Authorization Required)
Outpatient individual therapy visit
- In-Network: $0 copay (Authorization Required)
Outpatient individual therapy visit with a psychiatrist
- Out-of-Network: $35 copay (Authorization Required)
Outpatient group therapy visit with a psychiatrist
- In-Network: $0 copay (Authorization Required)
- Out-of-Network: $35 copay (Authorization Required)
Outpatient group therapy visit
- Out-of-Network: $35 copay (Authorization Required)

Optional supplemental benefits

- No

Other health plan deductibles?

- In-Network: No

Outpatient hospital coverage

- In-Network: $0-250 copay per visit (Authorization Required)
- Out-of-Network: 40% coinsurance per visit (Authorization Required)

Preventive care

- In-Network: $0 copay
- Out-of-Network: $0 copay

Rehabilitation services

Occupational therapy visit
- Out-of-Network: $35 copay
- In-Network: $30 copay
Physical therapy and speech and language therapy visit
- Out-of-Network: $35 copay
- In-Network: $30 copay

Skilled Nursing Facility

- In-Network: $0 per day for days 1 through 20
  $214 per day for days 21 through 100 (Authorization Required)
- Out-of-Network: 40% per stay (Authorization Required)

Transportation

- Not covered

Vision

Contact lenses
- Out-of-Network: $0 copay (Limits Apply)
Eyeglass frames
- Out-of-Network: $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- Out-of-Network: $0 copay (Limits Apply)
Routine eye exam
- Out-of-Network: 50% coinsurance (Limits Apply)
Contact lenses
- In-Network: $0 copay (Limits Apply)
Eyeglass frames
- In-Network: $0 copay (Limits Apply)
Eyeglass lenses
- In-Network: $0 copay (Limits Apply)
- Out-of-Network: $0 copay (Limits Apply)
Routine eye exam
- In-Network: $0 copay (Limits Apply)
Upgrades
- In-Network: $0 copay (Limits Apply)
- Out-of-Network: $0 copay (Limits Apply)
Eyeglasses (frames and lenses)
- In-Network: $0 copay (Limits Apply)
Other
- Not covered

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

- Covered