Cigna True Choice Medicare (PPO) H7849-135-000 2025 Plan Details and Costs (2025)

Mississippi Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Mississippi Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage	Details
Monthly plan premium	$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible	$0.00
Out-of-pocket maximum	$4,200.00
Initial drug coverage limit	$0.00
Catastrophic drug coverage limit	$2,000.00
Primary care doctor visit	In Network In-Network: Doctor Office Visit: Copayment for Primary Care Office Visit $0 Out of Network Out-of-Network: Doctor Office Visit Services: Copayment for Medicare Covered Primary Care Office Visit $20
Specialty doctor visit	In Network In-Network: Doctor Specialty Visit: Copayment for Physician Specialist Office Visit $20 Prior Authorization Required for Doctor Specialty Visit Out of Network Out-of-Network: Doctor Specialty Visit Services: Copayment for Medicare Covered Physician Specialist Office Visit $50
Inpatient hospital care	In Network In-Network: Acute Hospital Services: $295 per day for days 1 to 7 $0 per day for days 8 to 90 Prior Authorization Required for Acute Hospital Services In some instances, a readmission policy may apply in which the benefit will continue from original admission. Out of Network Out-of-Network: Acute Hospital Services: Coinsurance for Acute Hospital Services per Stay 40% In some instances, a readmission policy may apply in which the benefit will continue from original admission.
Urgent care	Urgent Care: Copayment for Urgent Care $55 Copayment for Medicare Covered Urgent Care waived if you are admitted to hospital within 2 hours Worldwide Coverage: Copayment for Worldwide Urgent Coverage $125 Maximum Plan Benefit of $50,000
Emergency room visit	Emergency Care: Copayment for Emergency Care $125 Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital with in 24 hours Worldwide Coverage: Copayment for Worldwide Emergency Coverage $125 Copayment for Worldwide Emergency Transportation $125 Maximum Plan Benefit of $50,000
Ambulance transportation	In Network In-Network: Ground Ambulance: Copayment for Ground Ambulance Services $275 Air Ambulance: Coinsurance for Air Ambulance Services 20% Prior Authorization Required for Air Ambulance Out of Network Out-of-Network: Ambulance Services: Copayment for Medicare Covered Ambulance Services - Ground $275 Coinsurance for Medicare Covered Ambulance Services - Ground 20% Copayment for Medicare Covered Ambulance Services - Air $275 Coinsurance for Medicare Covered Ambulance Services - Air 20%

Health Care Services and Medical Supplies

Cigna True Choice Medicare (PPO) covers a range of additional benefits. Learn more about Cigna True Choice Medicare (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage	Details
Chiropractic services	In Network In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 Prior Authorization Required for Chiropractic Services Out of Network Out-of-Network: Medicare Covered Chiropractic Services: Copayment for Medicare Covered Chiropractic Services $15
Diabetes supplies, training, nutrition therapy and monitoring	In Network In-Network: Diabetic Supplies and Services: Copayment for Medicare-covered Diabetic Supplies $0 Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20% Out of Network Out-of-Network: Medicare Covered Diabetic Supplies and Services: Coinsurance for Medicare Covered Diabetic Supplies 40% Coinsurance for Medicare Covered Diabetic Therapeutic Shoes or Inserts 40%
Durable medical equipment (DME)	In Network In-Network: Durable Medical Equipment: Coinsurance for Medicare-covered Durable Medical Equipment 20% Prior Authorization Required for Durable Medical Equipment Out of Network Out-of-Network: Medicare Covered Durable Medical Equipment Services: Coinsurance for Medicare Covered Durable Medical Equipment 40%
Diagnostic tests, lab and radiology services, and X-rays	In Network In-Network: Outpatient Diag Procs/Tests/Lab Services: Copayment for Medicare-covered Diagnostic Procedures/Tests $0 to $75 Copayment for Medicare-covered Lab Services $0 to $50 Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services Minimum for EKG. Maximum for all other diagnostic procedures and tests. Outpatient Diag/Therapeutic Rad Services: Copayment for Medicare-covered Diagnostic Radiological Services $0 to $200 Copayment for Medicare-covered Therapeutic Radiological Services $80 Copayment for Medicare-covered X-Ray Services $0 to $25 If multiple test types (e.g. CT and PET) are performed on the same day, multiple copayments will apply. If multiple tests of the same type (e.g. CT scan of the head and CT scan of the chest) are performed on the same day, one copayment will apply. Out of Network Out-of-Network: Medicare Covered Diagnostic Procedures/Tests Services: Copayment for Medicare Covered Diagnostic Procedures/Tests $25 to $200 Copayment for Medicare Covered Lab Services $25 to $200 Copayment for Medicare Covered Diagnostic Radiological Services $25 to $200 Copayment for Medicare Covered Therapeutic Radiological Services $25 to $200 Copayment for Medicare Covered Outpatient X-Ray Services $25 to $200 Minimum for EKG. Maximum for all other diagnostic procedures and tests.
Home health care	In Network In-Network: Home Health Services: Copayment for Medicare-covered Home Health Services $0 Prior Authorization Required for Home Health Services Out of Network Out-of-Network: Medicare Covered Home Health Services: Coinsurance for Medicare Covered Home Health 40%
Mental health inpatient care	In Network In-Network: Psychiatric Hospital Services: $295 per day for days 1 to 7 $0 per day for days 8 to 90 Prior Authorization Required for Psychiatric Hospital Services In some instances, a readmission policy may apply in which the benefit will continue from original admission. Out of Network Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 40% In some instances, a readmission policy may apply in which the benefit will continue from original admission.
Mental health outpatient care	In Network In-Network: Outpatient Mental Health Services: Copayment for Medicare-covered Individual Sessions $0 Copayment for Medicare-covered Group Sessions $0 Out of Network Out-of-Network: Medicare Covered Mental Health Services: Copayment for Medicare Covered Individual Sessions $50 Copayment for Medicare Covered Group Sessions $50
Outpatient services/surgery	In Network In-Network: Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $0 to $250 Prior Authorization Required for Outpatient Hospital Services Minimum for any surgical procedures (e.g. polyp removal) during a colorectal screening. Maximum for all other outpatient services not provided in an Ambulatory Surgical Center. Outpatient Observation Services: Copayment for Medicare Covered Observation Services - Per stay $275 Prior Authorization Required for Outpatient Observation Services Ambulatory Surgical Center Services: Copayment for Ambulatory Surgical Center Services $0 to $200 Prior Authorization Required for Ambulatory Surgical Center Services Minimum for any surgical procedures (e.g. polyp removal) during a colorectal screening. Maximum for all other Ambulatory Surgical Center (ASC) services. Out of Network Out-of-Network: Medicare Covered Outpatient Hospital Services: Copayment for Medicare Covered Outpatient Hospital Services $200 to $275 Copayment for Medicare Covered Ambulatory Surgical Center Services $200 to $275 Minimum for any surgical procedures (e.g. polyp removal) during a colorectal screening. Maximum for all other outpatient services not provided in an Ambulatory Surgical Center.
Outpatient substance abuse care	In Network In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $20 Copayment for Medicare-covered Group Sessions $20 Prior Authorization Required for Outpatient Substance Abuse Services Out of Network Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Copayment for Medicare Covered Individual Sessions $50 Copayment for Medicare Covered Group Sessions $50
Over-the-counter items	In Network In-Network: Over-The-Counter (OTC) Items: Copayment for Over-The-Counter (OTC) Items $0 Maximum plan benefit of $65.00 every three months for Over-The-Counter (OTC) Items Maximum Plan Benefit of $65 every three months Catalog orders limited to one per member per month. Exceptions may apply. Out of Network Out-of-Network: Non-Medicare Covered Over-The-Counter (OTC) Items Services: Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0 Maximum 65 visits every three months Maximum Plan Benefit of $65
Podiatry services	In Network In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $20 Out of Network Out-of-Network: Medicare Covered Podiatry Services: Copayment for Medicare Covered Podiatry Services $40
Skilled Nursing Facility (SNF) care	In-Network: Skilled Nursing Facility Services: $0 per day for days 1 to 20 $214 per day for days 21 to 100 Prior Authorization Required for Skilled Nursing Facility Services In some instances, a readmission policy may apply in which the benefit will continue from original admission.

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Dental care	In Network In-Network: Preventive Dental: Copayment for Office Visit $20 Prior Authorization Required for Preventive Dental Comprehensive Dental: Copayment for Non-routine Services $0 Copayment for Diagnostic Services $0 Copayment for Restorative Services $0 Copayment for Endodontics $0 Copayment for Periodontics $0 Copayment for Extractions $0 Maximum Plan Benefit of $1,700 every year Out of Network Out-of-Network: Medicare Covered Preventive Dental Services: Copayment for Medicare Covered Preventive Dental $50

Coverage

Details

Dental care

In Network
In-Network:

Preventive Dental:
Copayment for Office Visit $20
Prior Authorization Required for Preventive Dental

Comprehensive Dental:
Copayment for Non-routine Services $0
Copayment for Diagnostic Services $0
Copayment for Restorative Services $0
Copayment for Endodontics $0
Copayment for Periodontics $0
Copayment for Extractions $0
Maximum Plan Benefit of $1,700 every year

Out of Network

Out-of-Network:

Medicare Covered Preventive Dental Services:
Copayment for Medicare Covered Preventive Dental $50

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage

Coverage	Details
Vision care	In Network In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 to $30 Copayment for Routine Eye Exams $0 Maximum 1 Routine Eye Exam every year Eyewear: Copayment for Medicare-Covered Benefits $0 Copayment for Contact Lenses $0 Copayment for Eyeglasses (lenses and frames) $0 Maximum 1 Pair every year Copayment for Eyeglass Lenses $0 Maximum 1 Pair every year Copayment for Eyeglass Frames $0 Maximum 1 Pair every year Copayment for Upgrades $0 Maximum Plan Benefit of $350 every year Corrective lenses, frames and contacts are covered once per year. The plan will not cover both corrective lenses/frames and contacts in the same benefit year. Out of Network Out-of-Network: Medicare Covered Eye Exams Services: Coinsurance for Medicare Covered Eye Exams 40% Coinsurance for Medicare Covered Eyewear 40%

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Hearing care	In Network In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $20 Copayment for Routine Hearing Exams $0 Maximum 1 visit every year Copayment for Fitting/Evaluation for Hearing Aid $0 Maximum 1 visit every year Hearing Aids: Copayment for Hearing Aids $399 to $1800 Maximum 2 Hearing Aids every year Out of Network Out-of-Network: Medicare Covered Hearing Exams Services: Coinsurance for Medicare Covered Hearing Exams 40%

Coverage

Details

Hearing care

In Network
In-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $20
Copayment for Routine Hearing Exams $0

Maximum 1 visit every year

Copayment for Fitting/Evaluation for Hearing Aid $0

Maximum 1 visit every year

Hearing Aids:
Copayment for Hearing Aids $399 to $1800

Maximum 2 Hearing Aids every year

Out of Network

Out-of-Network:

Medicare Covered Hearing Exams Services:
Coinsurance for Medicare Covered Hearing Exams 40%

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage	Details
Preventive services and health/wellness education programs	In Network In-Network: $0.00 copay for Medicare Covered Preventive Services: Abdominal aortic aneurysm screening Alcohol misuse screenings & counseling Bone mass measurements (bone density) Cardiovascular disease screenings Cardiovascular disease (behavioral therapy) Cervical & vaginal cancer screening Colorectal cancer screenings Depression screenings Diabetes screenings Diabetes self-management training Glaucoma tests Hepatitis B (HBV) infection screening Hepatitis C screening test HIV screening Lung cancer screening Mammograms (screening) Nutrition therapy services Obesity screenings & counseling One-time Welcome to Medicare preventive visit Prostate cancer screenings(PSA) Sexually transmitted infections screening & counseling Shots: COVID-19 shots Flu shots Hepatitis B shots Pneumococcal shots Tobacco use cessation Yearly "Wellness" visit Out of Network Out-of-Network: Medicare Covered Medicare-covered Preventive Services: Copayment for Medicare Covered Medicare-covered Preventive Services $20

Coverage

Details

Preventive services and health/wellness education programs

In Network
In-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Glaucoma tests
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings(PSA)
Sexually transmitted infections screening & counseling
Shots:

COVID-19 shots

Flu shots

Hepatitis B shots

Pneumococcal shots

Tobacco use cessation
Yearly "Wellness" visit

Out of Network

Out-of-Network:

Medicare Covered Medicare-covered Preventive Services:
Copayment for Medicare Covered Medicare-covered Preventive Services $20

When reviewing Mississippi Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Mississippi that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Summary of benefits
Evidence of coverage
Star ratings

Mississippi Counties Served

Covington
Forrest
Greene
Jefferson Davis
Jones
Lamar
Lawrence
Marion
Pearl River
Perry
Walthall
Wayne

We represent carriers such as Humana, UnitedHealthcare^®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.