Medicare Supplement
Retirees 65 years of age and older may supplement their government-provided Medicare plan with additional coverage.
Medicare Supplement
Plan Details
- Carrier
- Cigna
- Plan Type
- Medicare Supplement
- Network
- Cigna
- HSA Eligible
- No
- HRA Included
- No
Retiree Only
- Monthly Premium
- $315.00
Spouse Only
- Monthly Premium
- $315.00
Retiree + Spouse
- Monthly Premium
- $630.00
| Coverage Tier | Monthly Premium |
|---|---|
| Retiree Only | $315.00 |
| Spouse Only | $315.00 |
| Retiree + Spouse | $630.00 |
- Retiree medical subsidy no longer applies under this plan.
Annual Deductible - Per Individual
- Preferred (Network) - You Pay
- $500
- Non-Preferred (Non-Network) - You Pay
- $1,000
Coinsurance*
- Preferred (Network) - You Pay
- 20%
- Non-Preferred (Non-Network) - You Pay
- 40%
Annual Out-of-Pocket Limit - Per Individual (includes annual deductible and coinsurance)
- Preferred (Network) - You Pay
- $1,500
- Non-Preferred (Non-Network) - You Pay
- $2,700
Preventive Care (one exam per calendar year; includes routine adult physical exam, lab tests, immunizations, and routine cancer screenings)
- Preferred (Network) - You Pay
- 100% covered; deductible waived
- Non-Preferred (Non-Network) - You Pay
- 40%*
Outpatient Surgery*
- Preferred (Network) - You Pay
- 20%
- Non-Preferred (Non-Network) - You Pay
- 40%
Hospitalization and Inpatient Surgery*
- Preferred (Network) - You Pay
- 20%
- Non-Preferred (Non-Network) - You Pay
- 40%
Mental Health* - Inpatient/Outpatient
- Preferred (Network) - You Pay
- 20%/20%
- Non-Preferred (Non-Network) - You Pay
- 40%/40%
Urgent Care Facility*
- Preferred (Network) - You Pay
- 20%
- Non-Preferred (Non-Network) - You Pay
- 40%
Emergency Room and Ambulance*
- Preferred (Network) - You Pay
- 20%
- Non-Preferred (Non-Network) - You Pay
- 20%
| Benefit | Preferred (Network) - You Pay | Non-Preferred (Non-Network) - You Pay |
|---|---|---|
| Annual Deductible - Per Individual | $500 | $1,000 |
| Coinsurance* | 20% | 40% |
| Annual Out-of-Pocket Limit - Per Individual (includes annual deductible and coinsurance) | $1,500 | $2,700 |
| Preventive Care (one exam per calendar year; includes routine adult physical exam, lab tests, immunizations, and routine cancer screenings) | 100% covered; deductible waived | 40%* |
| Outpatient Surgery* | 20% | 40% |
| Hospitalization and Inpatient Surgery* | 20% | 40% |
| Mental Health* - Inpatient/Outpatient | 20%/20% | 40%/40% |
| Urgent Care Facility* | 20% | 40% |
| Emergency Room and Ambulance* | 20% | 20% |
- * After annual deductible
Plan Notes
- DFW Airport offers this supplemental plan; retirees originally hired before Jan.
- The plan provides medical coverage through the Cigna Post 65 Open Access Plan.
- Prescription drug coverage must be obtained through Medicare Part D or a private insurer.
- Medicare Part A and Part B are primary and the DFW Airport plan is secondary - claims are filed with Medicare first, and remaining unpaid costs are submitted to Cigna (no guarantee all costs are paid).
- Only the retiree and covered spouse are eligible; medical subsidy credits do not apply.
- A Medicare Advantage Plan does not integrate with the DFW Medicare Supplement Plan.
- Retiree medical subsidy no longer applies under this plan.
- * After annual deductible