Cigna Plan Guide for Texas 2023

All You Need to Know About Cigna Plans for 2023

Health insurance shopping in Texas can be confusing. Conducting research seems like an endless process. Varying deductibles, co-insurance levels, and premiums make selecting your company that much more difficult. Then, you need to pick a plan. If you’ve search has landed here, either you have chosen or are contemplating Cigna. We at CoverMile are here to help you understand what Cigna offers and better understand their coverage chart.

Health Insurance Terms to Understand

Before we dive in, let’s begin by defining a few terms you will frequently see but may not completely understand. This will help you select the best health coverage that fits your situation.

DeductibleA deductible is the amount you will pay out of pocket before your insurance kicks in. Cigna has deductibles from $0 up to $9100, depending on your plan choice. Deductibles are based on the calendar year and refresh each year. They also determine your overall cost. The higher your deductible, the lower your premium; the lower your deductible, the higher your premium. The deductible is broken down into two parts:  

            Individual: This is the per-person deductible.

            Family: This is the deductible for the entire family.

This will be shown on your Summary of Benefits, often in fraction form. For instance, $750 Individual/$2250 Family. Each family member has their own $750 out-of-pocket deductible to reach. You can read more about deductibles through the link above.

Co-insuranceThis is where your insurance kicks in. It is cost sharing between you and the insurance company, usually based on a percentage. You will see it written as 70/30. The 70 is the amount the insurance pays toward your medical expenses, and 30 percent is what you pay. This, like its sister, the deductible, refreshes each year.

Out-of-Pocket MaxAll insurance plans have a failsafe. It is called the out-of-pocket max. It helps policy owners with medical conditions and those who visit the doctor regularly. When you reach your deductible, pay through your co-insurance, and then reach your policy’s out-of-pocket amount, your insurance will pay 100 percent of medical expenses for that individual for the remainder of the calendar year. This also has an individual and family stipulation, like your deductible.

Primary Care PhysicianYour Primary Care Physician, who you will also see abbreviated as PCP, is the main doctor you visit for your medical care. With Cigna, an HMO, you are required to coordinate your treatment through them.

CopayCopays are the amount you pay a doctor or medical facility for your visit. This can be a flat dollar amount or a percentage and vary by plan. Keep in mind this will be for the office visit alone, not the treatment received. However, insurance plans can include some benefits such as well check-ups and immunizations within a doctor’s office visit at no extra cost.

Now that you have reviewed the basics of health insurance, let’s get into Cigna’s plans.

Cigna and the Affordable Care Act

Cigna offers health insurance in Texas as part of the Affordable Care Act. They offer plans on all three metal levels: Bronze, Silver, and Gold. You can purchase plans on the Marketplace. To view their full selection, visit the Cigna website. Cigna health insurance can also be direct purchased on their website. They have a handful of only-available-online plans there.

Below, we’ve listed a variety of Cigna health plans. For the sake of space, we’re only listing plans based on deductible, co-insurance, and out-of-pocket max. Also, to simplify our table, you will see the Individual and Family deductibles and out-of-pocket max expressed as a fraction. The first number is your Individual deductible, and the second is your Family. Be aware that these numbers are for in-network doctors and facilities.

Cigna Bronze

Cigna Bronze has eleven plans, twelve offered on the Marketplace. Bronze is the lowest level of coverage and has the highest out-of-pocket max and co-insurance.

BronzeCigna Connect 8900Cigna Connect 8200Cigna Connect 5500Cigna Simple Choice 7500
Out-of-Pocket Max$8900/$17,800$9100/$18,200$9100/$18,200$9000/$18,000
Primary Care Visit0% after deductible$0 copay$35$50
Specialist Visit0% after deductible50%50%$100
Emergency Room0% after deductible50%50%50%
Urgent Care0% after deductible$75 copay$75 copay$75 copay
Inpatient Hospital0% after deductible50%50%50%
Outpatient Hospital0% after deductible50%50%50%
Prescription (Pharmacy)All prescriptions 0% co-insurance after deductible is met$3/50%/50%/50%/ 50%$10/$30/50%/50%/ 50%$25/$50/$100/$500 $500

*Prescriptions are Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, and Specialty.

Cigna Silver

Cigna Silver has 35 plans; all are offered through the Affordable Care Act Marketplace. Silver medal plans allow applicants to apply for tax credits and cost-sharing redeductions when they qualify based on their income level and family situation.

Silver – ConnectCigna Connect 425-4Cigna Connect 3000Cigna Connect 5000Cigna Connect 7250
Out-of-Pocket Max$1000/$2000$9100/$18,200$8000/$16,000$7250/$14,500
Primary Care Visit$0 copay$0 copay$30 copay$25
Specialist Visit$5$100 copay$55 copay$50
Emergency Room5%$1,200 copay20%0% after deductible
Urgent Care$5 copay$45 copay$55 copay$50
Inpatient Hospital5% co-insurance50% co-insurance20%0% after deductible
Outpatient Hospital5% co-insurance50% co-insurance20%0% after deductible
Prescription (Pharmacy)$0/$5/10%/35%/ 35%$3/$40/$80/$200 50%*$3/$40/40%50%50%*$3/$18/$55/0%/0%*

*Prescriptions are Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, and Specialty.

Silver – Simple ChoiceCigna Simple Choice 800-3Cigna Simple Choice 5800
Out-of-Pocket Max$3000/$6,000$8900/$17,800
Primary Care Visit$20 copay$30 copay
Specialist Visit$40 copay$60
Emergency Room30% co-insurance25% co-insurance
Urgent Care$30 copay$45 copay
Inpatient Hospital30% co-insurance25$ co-insurance
Outpatient Hospital30% co-insurance25% co-insurance
Prescription (Pharmacy)$10/$20/$60/$250/ $250*$15/$30/$60/ $250/$250*

*Prescriptions are Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, and Specialty.

Cigna Gold

Cigna Gold has seven plans, six offered on the Marketplace. Gold plans provide the highest level of coverage. This includes low deductibles, copays, and overall cost of insurance. They are best suited for those with medical conditions requiring frequent doctor’s visits and advanced medical care. However, this level of care comes with a higher price tag.

GoldCigna Connect 2500Cigna Simple Choice 2000
Out-of-Pocket Max$6500/$13,000$8700/$17,400
Primary Care Visit$25 copay$30 copay
Specialist Visit$50 copay$60
Emergency Room30% co-insurance25% co-insurance
Urgent Care$75 copay$45 copay
Inpatient Hospital30% co-insurance25$ co-insurance
Outpatient Hospital30% co-insurance25% co-insurance
Prescription (Pharmacy)$3/$15/$50/50%/ 50%*$15/$30/$60/ $250/$250*

*Prescriptions are Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, and Specialty.

Finding a Doctor or Facility in Your Network

Through your Cigna health insurance plan, you are required to remain within your physician and hospital network to receive benefits. You can only use out-of-network doctors and facilities in the event of an emergency. For instance,

  • Let’s say you have a Silver Connect 5000 plan. Your copay to see an in-network primary care physician is $30. However, you choose to see an out-of-network doctor and have a couple of tests done in the doctor’s office. Under your Cigna insurance plan, you will not be covered for that doctor’s visit because it was not an emergency.
  • If you are away from home and experience a medical emergency and cannot get to an in-network facility, you can visit a hospital or urgent care facility and pay your normal in-network benefit rate.

Cigna allows you to search for doctors and facilities near you, see their ratings, and figure out cost estimates for treatment.

Cigna Comparison Charts:

As noted, the above are just a few available plans from each medal option. For a complete list of the Affordable Care Act plans, follow the links below.

Comparison ChartPlanPlan
Cigna Health PlansEnglishSpanish

Benefit Notices:

Keep in mind that the above is a summary of highlights only.

–The benefits above represent what a member would pay. When a non-participating provider is used, benefits are reduced, or you may not have coverage at all.

–You are required to pay all the costs up to the deductible amount before your plan begins to pay for covered services. What is shown is the per-person deductible and out-of-pocket maximum. Deductibles do not apply to services where only copays are charged.

 –All percentages shown are of the allowable amount for covered services.

–Cigna Healthcare provides access to dedicated virtual care. Providers are responsible for treatment provided to their patients. Video chat may not be available in all areas or with all providers.

–Prescriptions are Preferred Generic, Generic, Preferred Brand, Non-Preferred Brand, and Specialty.

–Refill by text is only available on certain prescriptions.

–On Tier 5 medication, one cannot receive more than a 30-day supply. Coverage for some drugs may also be limited.

Cigna Dental

Cigna offers a Dental add-on for its subscribers. This plan offers benefits for different types of insurance shoppers.

Low Deductible Plans

  • $0-$50 deductibles
  • Up to $1,500 in benefits
  • $0 dental check-ups, including cleanings and routine x-rays
  • Orthodontia is available on select plans
  • See any dentist you’d like, but save more with a dentist

High Annual Max Plans

  • $100-$250 deductibles
  • Up to $5,000 in benefits
  • $0 dental check-ups, after deductible, including cleanings and routine x-rays
  • See any dentist you’d like, but save more with a dentist 

Bundled Plans – with Dental, Vision, and Hearing

  • $50-$100 deductibles
  • Up to $2,500 in dental benefits
  • Up to $300 in vision benefits
  • Up to $700 in hearing benefits
  • Dental implants available on select plans
  • See any dentist you’d like, but save more with a dentist 

Prescription Coverage with Cigna

In accordance with the Affordable Care Act, all Cigna Plans customers receive Prescription coverage. Each plan has varied coverage, tiers and benefits.

  • Express Scripts ProgramHome delivery of your prescription medication. You can have auto refill and up to a 90-day supply ordered with doctor’s approval.
  • Accredo pharmacyA special Cigna pharmacy that provides members with chronic medical conditions personal service.
  • 24/7 Customer Support If you have questions about your coverage or a prescription you are taking. This includes the Virtual Care benefits.
  • 90-day SupplyReceive a 90-day supply of your prescription to save on your medication cost.

Cigna can help you find a pharmacy in your area through its website.

At Cover Mile, we desire to help you find the best health insurance in Texas that suits you and your family. We will guide you through each Cigna plan and help you sign up for Affordable Care Act insurance. Contact us today.

Frequently Asked Questions

  1. Is Cigna available in the entire state of Texas?

    Currently, Cigna only operates in 11 Texas counties. Among these are Dallas, Lubbock, El Passo, and Tarrant. Visit their website for a full list of counties they serve. It is important to note that if you travel outside of your local area, Cigna only covers you in the event of an emergency.

  2. Does Cigna cover Diabetes in Texas?

    Yes, Cigna covers Diabetes. In fact, Cigna has its own schedule of benefits for those with Diabetes. They also have a schedule of benefits for those with Asthma and COPD.

  3. Is Cigna an EPO or an HMO?

    Cigna is an EPO in many states, but in Texas, Cigna health insurance is an HMO. An EPO restricts you to only a network of physicians and facilities. An HMO is less restrictive and sometimes allows you to be treated in a non-network facility with the insurance company’s approval. In emergency situations, all networks allow you to be treated with no restrictions.

  4. How to Cancel Cigna.

    To cancel your Cigna health insurance policy, you must notify the company in writing at least seven days prior to the renewal date of your new policy. You can email the company or send them a letter. In both cases, you need to include your full name, email address, and policy number.

  5. Does Cigna cover Dental and Vision?

    Cigna’s base plan does not charge for Children’s eye exams and glasses. This goes a step further than the mandated 10 Essential Benefits of the ACA which just calls for pediatric dental and vision care. Cigna then takes their plan a step further, their add-on benefit is offered to both children and adults. Their higher tiered Dental plan also offers Vision and Hearing benefits.