0 2020 Aetna Medicare Basics Plan (PPO) H5521-229 By Aetna Medicare.
2020 Aetna Medicare Basics Plan (PPO) H5521-229 By Aetna Medicare.

2020 Medicare Advantage Plan Services for
Aetna Medicare Basics Plan (PPO)


Aetna Medicare Basics Plan (PPO) H5521-229 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Alabama. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Basics Plan (PPO) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $6,400 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,400 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Basics Plan (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Basics Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.





2020 Aetna Medicare Medicare Advantage Plan Details

Name:
Aetna Medicare Basics Plan (PPO)
ID:
H5521-229
Provider:Aetna Medicare
Year:2020
Type: Local PPO *
Monthly Premium C+D: $-
Part C Premium:
MOOP: $6,400






2019 Plan Services

(*2020 Plan services will be added when available)




Health plan deductible


$0



Emergency care/Urgent care


Emergency $90 per visit (always covered)
Urgent care $5-20 per visit (always covered)



Diagnostic procedures/lab services/imaging


Diagnostic tests and procedures Out-of-Network 35%
Diagnostic tests and procedures In-Network $5-95
Lab services Out-of-Network 35%
Lab services In-Network $5-15
Diagnostic radiology services (e.g., MRI) Out-of-Network 35%
Diagnostic radiology services (e.g., MRI) In-Network $5-200
Outpatient x-rays Out-of-Network 35%
Outpatient x-rays In-Network $5-25



Hearing


Hearing exam Out-of-Network $30
Hearing exam In-Network $20
Fitting/evaluation Out-of-Network $30
Fitting/evaluation In-Network $20
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered



Preventive dental


Oral exam Out-of-Network $0 copay
Oral exam In-Network $0 copay
Cleaning Out-of-Network $0 copay
Cleaning In-Network $0 copay
Fluoride treatment Out-of-Network $0 copay
Fluoride treatment In-Network $0 copay
Dental x-ray(s) Out-of-Network $0 copay
Dental x-ray(s) In-Network $0 copay



Comprehensive dental


Non-routine services Out-of-Network $0 copay
Non-routine services In-Network $0 copay
Diagnostic services Out-of-Network $0 copay
Diagnostic services In-Network $0 copay
Restorative services Out-of-Network $0 copay
Restorative services In-Network $0 copay
Endodontics Out-of-Network $0 copay
Endodontics In-Network $0 copay
Periodontics Out-of-Network $0 copay
Periodontics In-Network $0 copay
Extractions Out-of-Network $0 copay
Extractions In-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services Out-of-Network $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services In-Network $0 copay



Vision


Routine eye exam Out-of-Network $0 copay
Routine eye exam In-Network $0 copay
Other Not covered
Contact lenses Out-of-Network $0 copay
Contact lenses In-Network $0 copay
Eyeglasses (frames and lenses) Out-of-Network $0 copay
Eyeglasses (frames and lenses) In-Network $0 copay
Eyeglass frames Out-of-Network $0 copay
Eyeglass frames In-Network $0 copay
Eyeglass lenses Out-of-Network $0 copay
Eyeglass lenses In-Network $0 copay
Upgrades Out-of-Network $0 copay
Upgrades In-Network $0 copay



Mental health services


Inpatient hospital - psychiatric Out-of-Network 35% per stay
Inpatient hospital - psychiatric In-Network $295 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit with a psychiatrist Out-of-Network $40
Outpatient group therapy visit with a psychiatrist In-Network $35
Outpatient individual therapy visit with a psychiatrist Out-of-Network $40
Outpatient individual therapy visit with a psychiatrist In-Network $35
Outpatient group therapy visit Out-of-Network $40
Outpatient group therapy visit In-Network $35
Outpatient individual therapy visit Out-of-Network $40
Outpatient individual therapy visit In-Network $35



Skilled Nursing Facility


Out-of-Network 35% per stay
In-Network $0 per day for days 1 through 20
$160 per day for days 21 through 100



Rehabilitation services


Occupational therapy visit Out-of-Network $40
Occupational therapy visit In-Network $20
Physical therapy and speech and language therapy visit Out-of-Network $40
Physical therapy and speech and language therapy visit In-Network $20



Ground ambulance


Out-of-Network $250
In-Network $250



Other health plan deductibles?


In-Network No



Transportation


Not covered



Foot care (podiatry services)


Foot exams and treatment Out-of-Network $30
Foot exams and treatment In-Network $20
Routine foot care Not covered



Medical equipment/supplies


Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-Network 25% per item
Durable medical equipment (e.g., wheelchairs, oxygen) In-Network 15% per item
Prosthetics (e.g., braces, artificial limbs) Out-of-Network 25% per item
Prosthetics (e.g., braces, artificial limbs) In-Network 15% per item
Diabetes supplies Out-of-Network 0-20% per item
Diabetes supplies In-Network 0-20% per item



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


Covered



Medicare Part B drugs


Chemotherapy Out-of-Network 35%
Chemotherapy In-Network 20%
Other Part B drugs Out-of-Network 35%
Other Part B drugs In-Network 20%



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


$5,900 In and Out-of-network
$4,500 In-network



Optional supplemental benefits


No



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


In-Network No



Inpatient hospital coverage


Out-of-Network 35% per stay
In-Network $225 per day for days 1 through 5
$0 per day for days 6 through 90



Outpatient hospital coverage


Out-of-Network 35% per visit
In-Network $20-150 per visit



Doctor visits


Primary Out-of-Network $20 per visit
Primary In-Network $5 per visit
Specialist Out-of-Network $30 per visit
Specialist In-Network $20 per visit



Preventive care


Out-of-Network $0 copay
In-Network $0 copay


Ratings for Aetna Medicare Basics Plan (PPO) H5521

2019 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


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
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Plan All-Cause Readmissions
Statin Therapy


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 Medicare Basics Plan (PPO) Plans Performance

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


Health Plan Customer Service Rating for Aetna Medicare Basics Plan (PPO)

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


Aetna Medicare Basics Plan (PPO) Drug Plan Customer Service ratings

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


Ratings For Member Complaints and Changes in the Drug Plans Performance

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


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
Statin with Diabetes


Coverage Area for Aetna Medicare Basics Plan (PPO)

(Click county to compare all available Advantage plans)



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Source: CMS.
Data as of September 4, 2019.
Star Rating as of October 10, 2019.
Plan Services are 2019 information as reference. 2020 information will be added when released.
Notes: Data are subject to change as contracts are finalized. For 2020, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2020 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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