2018 Aetna Better Health, Inc. (VA) (HMO SNP) DS-H1610

Aetna Better Health, Inc. (VA) (HMO SNP) By Aetna Better Health of Virginia

Aetna Better Health, Inc. (VA) (HMO SNP) is a 2018 Medicare Advantage Special Needs Plan plan by Aetna Better Health of Virginia. This plan from Aetna Better Health of Virginia works with Medicare to give you significant coverage beyond original Medicare. If you decide to sign up you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Better Health of Virginia and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Aetna Better Health, Inc. (VA) (HMO SNP) DS-H1610 is a Dual Eligible Special Needs Plan (D-SNP). A Dual Eligible SNP is for beneficiaries who are eligible for both Medicare and Medicaid. If you have Medicare and get help from Medicaid you can join any Medicare SNP you qualify for or switch plans at any time.

2018 Medicare Special Needs Plan Details

Plan Name:
Aetna Better Health, Inc. (VA) (HMO SNP)
Plan ID:
Special Needs Type: Dual-Eligible
Provider: Aetna Better Health of Virginia
Plan Year:2018
Plan Type: Local HMO
Monthly Premium C+D: 25.1


Coverage Area for Aetna Better Health, Inc. (VA) (HMO SNP)

State: Virginia
County:Accomack, Albemarle, Alexandria City, Alleghany,
Amelia, Amherst, Appomattox,
Arlington, Augusta, Bath,
Bedford, Bland, Botetourt,
Bristol City, Brunswick, Buchanan,
Buckingham, Buena Vista City, Campbell,
Caroline, Carroll, Charles City,
Charlotte, Charlottesville City, Chesapeake City,
Chesterfield, Clarke, Colonial Heights City,
Covington City, Craig, Culpeper,
Cumberland, Danville City, Dickenson,
Dinwiddie, Emporia City, Essex,
Fairfax, Fairfax City, Falls Church City,
Fauquier, Floyd, Fluvanna,
Franklin, Franklin City, Frederick,
Fredericksburg City, Galax City, Giles,
Gloucester, Goochland, Grayson,
Greene, Greensville, Halifax,
Hampton City, Hanover, Harrisonburg City,
Henrico, Henry, Highland,
Hopewell City, Isle of Wight, James City,
King and Queen, King George, King William,
Lancaster, Lee, Lexington City,
Loudoun, Louisa, Lunenburg,
Lynchburg City, Madison, Manassas City,
Manassas Park City, Martinsville City, Mathews,
Mecklenburg, Middlesex, Montgomery,
Nelson, New Kent, Newport News City,
Norfolk City, Northampton, Northumberland,
Norton City, Nottoway, Orange,
Page, Patrick, Petersburg City,
Pittsylvania, Poquoson City, Portsmouth City,
Powhatan, Prince Edward, Prince George,
Prince William, Pulaski, Radford City,
Rappahannock, Richmond, Richmond City,
Roanoke, Roanoke City, Rockbridge,
Rockingham, Russell, Salem City,
Scott, Shenandoah, Smyth,
Southampton, Spotsylvania, Stafford,
Staunton City, Suffolk City, Surry,
Sussex, Tazewell, Virginia Beach City,
Warren, Washington, Waynesboro City,
Westmoreland, Williamsburg City, Winchester City,
Wise, Wythe, York,

The Aetna Better Health, Inc. (VA) (HMO SNP) DS-H1610 is available to residents in Virginia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Aetna Better Health, Inc. (VA) (HMO SNP) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you need special care for a physician specialist, your primary care physician will make the arrangements and tell you where you can go in the network. You will need your PCPs okay, called a referral. Without getting a referral or services received from out-of-network providers are not typically covered by the plan.

Part-C Premium

Aetna Better Health of Virginia plan charges a $0.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

Part-D Deductible and Premium

The Aetna Better Health, Inc. (VA) (HMO SNP) plan has a monthly drug premium of $25.10 and a $405.00 drug deductible. This Aetna Better Health of Virginia plan offers a $25.10 Part D Basic Premium that is below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Aetna Better Health of Virginia above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $25.10. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Premium Assistance

Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Aetna Better Health, Inc. (VA) (HMO SNP) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.30 for 75% low income subsidy $12.50 for 50% and $18.80 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $25.10
Part D Supplemental Premium $0.00
Total Part D Premium: $25.10
Drug Deductible: $405.00
Tiers with No Deductible: 0
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Defined Standard Benefit
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $6.30
50% LIS Premium: $12.50
25% LIS Premium: $18.80
Initial Coverage Limit:$3750
Gap Coverage: No

Gap Coverage

In 2018 once you and your plan provider have spent $3,750 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 35% for brand-name drugs and 44% on generic drugs unless your plan offers additional coverage. This Aetna Better Health of Virginia plan does not offer additional coverage through the gap.

Plan Services

Health plan deductible


Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures $0 copay
Lab services $0 copay
Diagnostic radiology services (e.g., MRI) $0 copay
Outpatient x-rays $0 copay


Hearing exam $0 copay
Fitting/evaluation $0 copay
Hearing aids $0 copay

Preventive dental

Oral exam $0 copay
Cleaning $0 copay
Fluoride treatment $0 copay
Dental x-ray(s) $0 copay

Comprehensive dental

Non-routine services Not covered
Diagnostic services $0 copay
Restorative services $0 copay
Endodontics $0 copay
Periodontics $0 copay
Extractions $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay


Routine eye exam Not covered
Other Not covered
Contact lenses $0 copay
Eyeglasses (frames and lenses) Not covered
Eyeglass frames Not covered
Eyeglass lenses Not covered
Upgrades Not covered

Mental health services

$0 copay
Outpatient group therapy visit with a psychiatrist $0 copay
Outpatient individual therapy visit with a psychiatrist $0 copay
Outpatient group therapy visit $0 copay
Outpatient individual therapy visit $0 copay

Skilled Nursing Facility

$0 copay

Rehabilitation services

Occupational therapy visit $0 copay
Physical therapy and speech and language therapy visit $0 copay


$0 copay


$0 copay

Other health plan deductibles?

In-Network No

Foot care (podiatry services)

Foot exams and treatment $0 copay
Routine foot care $0 copay

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen) $0 copay
Prosthetics (e.g., braces, artificial limbs) $0 copay
Diabetes supplies $0 copay

Wellness programs (e.g., fitness, nursing hotline)


Medicare Part B drugs

Chemotherapy $0 copay
Other Part B drugs $0 copay

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,700 In-network

Optional supplemental benefits


Inpatient hospital coverage

$0 copay

Outpatient hospital coverage

$0 copay

Doctor visits

Primary $0 copay
Specialist $0 copay

Preventive care

$0 copay

Emergency care/Urgent care

Emergency $0 copay
Urgent care $0 copay

Ratings for Aetna Better Health, Inc. (VA) (HMO SNP) DS

2018 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Timely Care and Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Aetna Better Health, Inc. (VA) (HMO SNP) Plans Performance

Total Rating
Members Leaving the Plan
Complaints about Health Plan
Beneficiary Access
Health Plan Quality Improvement

Health Plan Customer Service Rating for Aetna Better Health, Inc. (VA) (HMO SNP)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Rheumatoid Arthritis
Improving Bladder Control
Reducing Risk of Falling
Plan - Cause Readmissions

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Beneficiary Access
Drug Plan Quality Improvement

Aetna Better Health, Inc. (VA) (HMO SNP) Drug Plan Customer Service ratings

Total Rating
Appeals Auto Forward
Appeals Upheld
Call Center, TTY, Foreign Language

Source: CMS.

Plans as of September 2, 2017.

Star Rating as of September 6, 2017.

For More Information on Ratings Please See the CMS Tech Notes Here.

Notes: Data are subject to change. All contracts for 2018 have not been finalized. For 2018, enhanced alternative plans may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part Part D benefit.

Includes 2018 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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