D-SNP Plan Costs & Benefits

Cigna TotalCare is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Cigna TotalCare does allow out-of-network care for emergencies and out-of-area dialysis.

Premiums, deductibles, and copays can widely vary between plans. It is important to compare costs and apply them to your personal financial and healthcare needs.

Healthcare Service	Member Cost
Health plan deductible	$0
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$7,550 In-network
Doctor Visits
Primary	0% or 0-20% coinsurance per visit
Wellness programs (e.g., fitness, nursing hotline)	Covered
Preventive care	$0 copay
Mental Health Services
Outpatient group therapy visit with a psychiatrist	$0 copay (authorization required)
Inpatient hospital - psychiatric	$0 or $350 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required)
Outpatient individual therapy visit with a psychiatrist	$0 copay (authorization required)
Outpatient group therapy visit	$0 copay (authorization required)
Rehabilitation Services
Physical therapy and speech and language therapy visit	0% or 10% coinsurance (authorization required)
Medical Equipment / Supplies
Prosthetics (e.g., braces, artificial limbs)	0% or 20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen)	0% or 20% coinsurance per item (authorization required)
Diagnostic Procedures / Lab Services / Imaging
Lab services	$0 copay (authorization required)
Diagnostic tests and procedures	0% or 0-20% coinsurance (authorization required)
Diagnostic radiology services (e.g., MRI)	0% or 0-20% coinsurance (authorization required)
Medicare Part B Drugs
Chemotherapy	0% or 20% coinsurance (authorization required)
Foot Care (podiatry Services)
Foot exams and treatment	0% or 20% coinsurance
Hearing
Hearing aids	$0 copay (limits may apply)
Hearing exam	0% or 20% coinsurance
Preventive Dental
Dental x-ray(s)	$0 copay (limits may apply)
Cleaning	$0 copay (limits may apply)
Fluoride treatment	$0 copay (limits may apply)
Comprehensive Dental
Endodontics	$0 copay (authorization required, limits may apply)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (authorization required, limits may apply)
Non-routine services	Not covered
Extractions	$0 copay (authorization required, limits may apply)
Periodontics	$0 copay (authorization required, limits may apply)
Diagnostic services	$0 copay (authorization required, limits may apply)
Vision
Eyeglasses (frames and lenses)	$0 copay (limits may apply)
Other	Not covered
Routine eye exam	$0 copay (authorization required, limits may apply)
Upgrades	$0 copay (limits may apply)
Contact lenses	$0 copay (limits may apply)
Eyeglass frames	$0 copay (limits may apply)
Emergency Care / Urgent Care
Emergency	$0 or $95 copay per visit (always covered)
Ground ambulance	0% or 20% coinsurance
Inpatient hospital coverage	$0 or $1,300 per stay
Outpatient hospital coverage	0% or 0-20% coinsurance per visit
Skilled Nursing Facility	$0 per day for days 1 through 20 $0 or $196 per day for days 21 through 100
Optional supplemental benefits	No

Prescription Costs & Benefits

A basic benefit Part D plan is bundled with this health plan. This simply means that Cigna TotalCare covers the minimum amount required by Medicare, whereas enhanced benefit plans cover more of the overall costs and may include more benefits.

Prescription Drug Plan Premium

Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Cigna begins paying its share.

Prescription Drug Plan Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Cigna TotalCare has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

Medicare's 5-Star Rating Marks

The table below shows the quality ratings for this Cigna plan. Each year Medicare rates Special Needs Plans using nine categories. We do not recommend joining a plan with an overall rating of less than 3 stars.

Do You Qualify to Join Cigna TotalCare?

Unfortunately, not everyone on Medicare will qualify to join Cigna TotalCare. To join a 2023 Medicare Special Needs Plan in New Castle County, Delaware you must be eligible for both Medicare and Medicaid. To qualify for Medicare, you must be age 65 or older. People with SSDI benefits for a disability qualify after 24 months.

Delaware Medicaid eligibility is based on your income and assets. Here are Delaware's Medicaid thresholds.

Medicare beneficiaries who don't qualify to enroll in Cigna TotalCare, or another Special Needs Plan, are encouraged to look at New Castle County Medicare Advantage plans options.

Contact Cigna

The New Castle County Medicare SNP plan information on this page originates from Medicare.gov. It was last updated on February 5, 2023.