Cigna is a global health service company that provides insurance and related products and services. It offers a wide range of health and wellness services to improve its customers’ health, well-being, and peace of mind. Founded in 1982, Cigna serves millions of customers worldwide and prides itself on its personalized approach to healthcare.
B. Role in providing Medicare Advantage plans Cigna is one of the private insurance companies that offer Medicare Advantage plans, also known as Medicare Part C. These plans combine the coverage of Medicare Part A (hospital insurance) and Part B (medical insurance) and often include additional benefits like prescription drug coverage (Part D), vision, hearing, and dental services that are not covered by Original Medicare. Cigna’s role is to administer these plans and provide customer service to its Medicare Advantage members.
C. Other plans and policies provided by Cigna In addition to Medicare Advantage plans, Cigna provides a range of other insurance products and services to cater to various customer needs.
Original Medicare and Medicare Advantage
The difference between Original Medicare and Medicare Advantage Original Medicare is the traditional program provided directly through the federal government. It includes Part A, which covers hospital services, and Part B, which covers doctor and outpatient services. Original Medicare allows you the freedom to choose your providers and you may use any doctor or hospital that accepts Medicare. However, it does not cover most prescription drugs, and it doesn’t cap out-of-pocket costs, meaning there’s no limit on how much you could spend per year.
C. Prescription Drug Coverage in Medicare Original Medicare does not cover most prescription drugs. However, you can add drug coverage by joining a standalone Medicare Prescription Drug Plan (Part D), offered by private companies approved by Medicare. On the other hand, most Medicare Advantage Plans (Part C) often include prescription drug coverage.
D. Medicare Part A (Hospital) and Part B (Medical) Coverage Medicare Part A, often referred to as hospital insurance, covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B, referred to as medical insurance, covers certain doctor’s services, outpatient care, medical supplies, and preventive services.
E. Eligibility and Enrollment in Medicare You are eligible for Medicare if you are a U.S. citizen or a permanent legal resident who has lived in the U.S. for at least five continuous years, and you are 65 years or older, or under 65 with a qualifying disability or disease (like ESRD). You can enrol in Medicare through the Social Security Administration or, if you worked for a railroad, the Railroad Retirement Board.
F. Medicare Part C (Medicare Advantage) Eligibility and Enrollment Information To enrol in a Medicare Advantage Plan (Part C), you must already be enrolled in Original Medicare, Part A and Part B. You must also live in the plan’s service area. These plans are offered by private companies approved by Medicare. You can join a Medicare Advantage Plan during your Initial Enrollment Period (when you first get Medicare), the Annual Election Period (from October 15 to December 7 every year), or during a Special Election Period (for special circumstances).
Medicare Part C (Medicare Advantage)
A. Definition and features of Medicare Part C Medicare Advantage, also known as Medicare Part C, is a type of health insurance plan in the United States that provides Medicare coverage through private insurance companies. These plans include the same coverage as Original Medicare, Part A (hospital insurance) and Part B (medical insurance), and often also include additional benefits such as prescription drug coverage, dental and vision care, hearing aids, and wellness programs.
B. What is covered under Part C Medicare Advantage plans provide all of the services that Original Medicare covers. They must cover all medically necessary services, and they must offer emergency and urgently needed care. Many Medicare Advantage plans also offer additional coverage for things not covered by Original Medicare, like vision, hearing, dental, and/or health and wellness programs.
C. Types of Medicare Advantage plans 1. HMO Medicare Advantage Plan: With a Health Maintenance Organization (HMO) plan, you generally must get your care and services from doctors, other healthcare providers, or hospitals in the plan’s network, except in an urgent or emergency situation.
D. Pros and cons of a Medicare Advantage plan Pros include having all coverage bundled together in one plan, lower costs, extra benefits like vision and dental coverage, prescription drug coverage, and rights and protections under the Medicare program. Cons can include limited provider networks, extra costs for certain services, and a potential lack of coverage if you travel frequently.
E. Cost of Medicare Advantage plans The cost of a Medicare Advantage plan can vary depending on the specific plan. Costs could include a monthly plan premium, an annual deductible, copayments or coinsurance for covered services, and costs for services that aren’t covered. You may also need to continue paying your Medicare Part B premium.
F. How to choose and enrol in a Medicare Advantage plan When choosing a Medicare Advantage plan, consider what doctors are in the plan’s network, what medications are covered under the plan’s formulary, the monthly premium, annual deductible, copayments or coinsurance, and what additional services are offered. You can enrol in a plan during certain times of the year, such as the Medicare Annual Election Period or a Special Election Period.
G. Changing your Medicare Advantage plan You can change your Medicare Advantage plan during the Annual Enrollment Period (October 15 to December 7), or during the Medicare Advantage Open Enrollment Period (January 1 to March 31). Special Enrollment Periods also allow you to change your plan if certain events happen in your life, like if you move or you lose other insurance coverage.
Other Terms and Resources
A. End-Stage Renal Disease (ESRD) End-Stage Renal Disease (ESRD) is a medical condition in which a person’s kidneys no longer function properly and require a kidney transplant or dialysis to survive. In most cases, individuals with ESRD are eligible for Medicare, regardless of their age.
B. CMS (Centers for Medicare & Medicaid Services) The Centers for Medicare & Medicaid Services (CMS) is a federal agency within the United States Department of Health and Human Services that administers the nation’s major healthcare programs including Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
C. Program of All-inclusive Care for the Elderly (PACE) The Program of All-inclusive Care for the Elderly (PACE) is a Medicare and Medicaid program that helps people meet their healthcare needs in the community instead of going to a nursing home or other care facility. It includes comprehensive medical and social services.
D. Medicare Supplement (Medigap) Insurance Plan Medicare Supplement Insurance, also known as Medigap, are policy sold by private companies that can help pay some of the healthcare costs that Original Medicare doesn’t cover, like copayments, coinsurance, and deductibles. Medigap policies don’t work with Medicare Advantage Plans.
E. Special Needs Plan (SNP) A Special Needs Plan (SNP) is a type of Medicare Advantage Plan that combines all the benefits of Original Medicare (Parts A and B) with prescription drug coverage (Part D), but is specifically designed to provide targeted care for individuals with certain unique needs. These needs may be related to a specific disease, certain healthcare needs, or limited incomes.
F. Lawfully Present Qualified Non-Citizen A lawfully present qualified non-citizen is a person who is not a U.S. citizen but is lawfully residing in the U.S. under immigration laws. They may be eligible for certain public benefits, including Medicare, depending on their immigration status, date of entry into the U.S., and other factors.
G. Cigna Glossary of Medicare terms The Cigna Glossary of Medicare terms is a comprehensive resource provided by Cigna that defines a wide range of terms related to Medicare. This glossary can be a valuable tool for understanding the intricacies of Medicare and the various plans and services associated with it.
