2019 Aetna Better Health, Inc. (HMO SNP) BA-H1610

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

Aetna Better Health, Inc. (HMO SNP) is a 2019 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. (HMO SNP) BA-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.

2019 Medicare Special Needs Plan Details

Plan Name:
Aetna Better Health, Inc. (HMO SNP)
Plan ID:
Special Needs Type: Dual-Eligible
Provider: Aetna Better Health of Virginia
Plan Year:2019
Plan Type: Local HMO
Monthly Premium C+D: $27.50


The Aetna Better Health, Inc. (HMO SNP) BA-H1610 is available to residents in Virginia, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Aetna Better Health, Inc. (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. (HMO SNP) plan has a monthly drug premium of $27.50 and a $210.00 drug deductible. This Aetna Better Health of Virginia plan offers a $27.50 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 $27.50. 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. (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 $6.90 for 75% low income subsidy $13.70 for 50% and $20.60 for 25%.

Part C Premium: $0.00
Part D (Drug) Premium: $27.50
Part D Supplemental Premium $0.00
Total Part D Premium: $27.50
Drug Deductible: $210.00
Tiers with No Deductible: 1
Benchmark: below the regional benchmark
Type of Medicare Health Plan: Basic Alternative
Drug Benefit Type: Basic
Full LIS Premium: $0.00
75% LIS Premium: $6.90
50% LIS Premium: $13.70
25% LIS Premium: $20.60
Initial Coverage Limit:$3820
Gap Coverage: No

Gap Coverage

In 2019 once you and your plan provider have spent $3,820 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for brand-name drugs and 37% 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


Emergency care/Urgent care

Emergency $0 copay
Urgent care $0 copay

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
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 Not covered
Restorative services $0
Endodontics $0
Periodontics $0
Extractions $0
Prosthodontics, other oral/maxillofacial surgery, other services $0


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

Mental health services

Inpatient hospital - psychiatric $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

Ground ambulance

$0 copay

Other health plan deductibles?

In-Network No


$0 copay

Foot care (podiatry services)

Foot exams and treatment $0 copay
Routine foot care 20%

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


Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network No

Inpatient hospital coverage

$0 copay

Outpatient hospital coverage

$0 copay

Doctor visits

Primary $0 copay
Specialist $0 copay

Preventive care

$0 copay

Coverage Area for Aetna Better Health, Inc. (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,

Source: CMS.

Plans as of September 2, 2018.

Star Rating as of October 10, 2018.

Notes: Data are subject to change. All contracts for 2019 have not been finalized. For 2019, 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 2019 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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