Cigna-HealthSpring Advantage Putnam County, TN Medicare Advantage Plan

Cigna-HealthSpring Advantage by Cigna-HealthSpring, a 2016 Medicare Advantage plan available in Putnam County, TN Cigna-HealthSpring Advantage is a Medicare Advantage plan, from Cigna-HealthSpring, that's available in Putnam County, Tennessee. This is a Health Maintenance Organization (HMO) option, without prescription drug coverage, for people with Medicare Part A and Part B benefits. It gives you all of the same health insurance benefits as Original Medicare and offers extras that Medicare does not cover.

You can reach Cigna-HealthSpring directly at (866)593-4468 or (711)- for TTY users.

About HMO Plans without Part D

The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, a HMO plan limits your annual out-of-pocket costs. With Medicare Parts A and B, there's no cap, leaving you vulnerable to excessive medical bills.

IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.

NOTE: Cigna-HealthSpring Advantage does not include prescription drug coverage. To get it, you can add one of the stand-alone Medicare Part D plans available in Tennessee.

Monthly Premium

The premium on this plan is $0.00 per month. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventative care mandated by CMS (see H4454-012 Summary of Benefits below).

IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.

Maximum Out-of-Pocket (MOOP) Limit for Parts A & B

Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Cigna-HealthSpring Advantage plan MOOP is $6,700 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.

Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.

NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.

CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medigap plan in Putnam County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.

Plan Ratings

In this section we show you the quality rating for this plan. Each year the Centers for Medicare and Medicaid Services (CMS) rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this Cigna-HealthSpring plan.

2016 Overall RatingCigna-HealthSpring Advantage Overall Rating
Part C Summary RatingCigna-HealthSpring Advantage Medicare Part C Rating
Part D Summary RatingCigna-HealthSpring Advantage Medicare Part D Rating
Staying Healthy: Screenings, Tests, VaccinesCigna-HealthSpring Advantage Staying Healthy Rating
Managing Chronic (Long Term) ConditionsCigna-HealthSpring Advantage Managing Chronic Conditions Rating
Member Experience with Health PlanCigna-HealthSpring Advantage Member Experience with Health Plan Rating
Complaints and Changes in Plans PerformanceCigna-HealthSpring Advantage Complaints Rating
Health Plan Customer ServiceCigna-HealthSpring Advantage Health Plan Customer Service Rating
Drug Plan Customer ServiceCigna-HealthSpring Advantage Drug Plan Customer Service Rating
Complaints and Changes in the Drug PlanCigna-HealthSpring Advantage Drug Plan Member Complaints Rating
Member Experience with the Drug PlanCigna-HealthSpring Advantage Drug Plan Member Experience Rating
Drug Safety and Accuracy of Drug PricingCigna-HealthSpring Advantage Drug Safety and Accuracy of Drug Pricing Rating

Part D Prescription Drug Benefits

This plan does not include prescription drug benefits. You can purchase a Tennessee Medicare Part D plan to use with this health plan.

Summary of Benefits (H4454-012)

In this section we outline high-level information about the plan's co-payment and co-insurance costs for inpatient, outpatient, preventive care, transportation and other healthcare services. For complete details, download the Cigna-HealthSpring Advantage Summary of Benefits.

Outpatient Care and Services

All outpatient health care services (Medicare Part B benefits) have their own co-payment or co-insurance costs. Here's how this plan charges for the basics.

Primary Care Doctor:20% co-insurance
Physician Specialist:$30 co-payment
Chiropractor:$20 co-payment
Occupational Therapist:$15 co-payment
Physical Therapist:$15 co-payment
Speech Terapist:$15 co-payment
Psychotherapist:$30 co-payment
Psychiatrist:$30 co-payment
Podiatrist:$30 co-payment

Lab and Diagnostic Services

Lab and diagnostic services have co-payment or co-insurance costs. Some plans offer these services at no cost, but most do not.

Medicare-covered Diagnostic Procedures/Tests:$0 to $100 co-payment
Medicare-covered Lab Services:
Medicare-covered Diagnostic Radiological Services:$0 to $100 co-payment
Medicare-covered Therapeutic Radiological Services$30 co-payment
Medicare-covered X-Ray Services$0 to $50 co-payment

Urgent Care and Emergency Services

Urgent care and emergency room services (Medicare Part B benefits) have co-payment or co-insurance costs. Some plans waive these costs if you are admitted as an inpatient within a specified amount of time. Also, plans are not required to offer emergency care worldwide.

Urgent Care:$30 co-payment
Co-insurance waived if admitted within 24 Hours
Emergency Care:$75 co-payment
Co-insurance waived if admitted within 24 Hours
Worldwide Coverage:Yes ($50,000 limit)
Ambulance:$200 co-payment

Medicare Preventive Care

Cigna-HealthSpring Advantage covers preventive services, as required by law under Medicare Part B, including:

  • Abdominal aortic aneurysm screening
  • Alcohol misuse counseling
  • Bone mass measurement
  • Breast cancer screening (mammogram)
  • Cardiovascular disease (behavioral therapy)
  • Cardiovascular screenings
  • Cervical and vaginal cancer screening
  • Colorectal cancer screenings
  • Depression screening
  • Diabetes screenings
  • HIV screening
  • Medical nutrition therapy services
  • Obesity screening and counseling
  • Prostate cancer screenings (PSA)
  • Sexually transmitted infections screening and counseling
  • Tobacco use cessation counseling
  • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
  • "Welcome to Medicare" preventive visit
  • Yearly "Wellness" visit

All preventive healthcare services are provided at no cost to the beneficiary. Any additional preventative services approved by Medicare during the contract year will be covered.

Inpatient Care and Services

When you are admitted into a hospital or skilled nursing facility you will make copayments based on benefit periods. A benefit period begins when you are admitted and ends after not receiving inpatient care for 60 days in a row. If you are admitted again after a benefit period has ended a new benefit period begins.

You are required to pay an inpatient deductible for each benefit period. There are no limits on the the number of benefit periods. Here's how this plan charges:

  • Day 1 to 5 you pay $300 per day
  • See the Summary of Benefits for additional copayment periods.
The hospital benefit period is Health Plan Defined, See Notes.

Hospice

You pay nothing for hospice care from a Medicare-approved (certified) hospice facility. You may have to pay some of the cost for drugs and respite care.

Plan Availability

Cigna-HealthSpring Advantage is available to beneficiaries living in Cookeville, Baxter, Bloomington Springs, Buffalo Valley, Monterey, Silver Point, and all other areas of Putnam County, Tennessee.

For assistance 24 hours a day, call 1-800-MEDICARE (1-800-633-4227). TTY users should call 1-877-486-2048 or visit www.medicare.gov

Tips and Disclaimers

The Medicare Advantage plan data on MedicareWire.com comes directly from Medicare.gov and CMS.gov and is subject to change. The Centers for Medicare and Medicaid Services has neither reviewed nor endorsed the information on this site.

The benefit information provided on this page is a brief summary only, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly at (866)593-4468 or (711)- for TTY users.

The MedicareWire.com website is available for educational purposes. Our goal is to present information accurately and without bias, based on our interpretation of factual information. However, this site is not intended as a substitute for legal, health, or financial advice from a licensed professional.

MedicareWire.com is an independent research, technology and publishing organization. We are not affiliated with Medicare, Medicare plans, insurance carriers, or healthcare providers, nor are we compensated for Medicare plan enrollments.

Your privacy is important to us. We do not sell leads or share your personal information.

This Medicare Part C information is maintained by and was last updated on .