2021 Aetna Medicare Choice II Plan (PPO) H3288-002 By Aetna Medicare.

Summary of Benefits for
2021 Aetna Medicare Choice II Plan (PPO)


Aetna Medicare Choice II Plan (PPO) H3288-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Texas. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Choice II Plan (PPO) has a monthly premium of $15.00 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Choice II 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 Choice II 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.




Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Aetna Medicare Choice II Plan (PPO)
Plan ID:
H3288-002
Provider:Aetna Medicare
Year:2021
Type: Local PPO
Monthly Premium C+D: $15.00
Part C Premium: $0
MOOP: $7,550
Part D (Drug) Premium: $15.00
Part D Supplemental Premium $0
Total Part D Premium: $15.00
Drug Deductible: $300.0
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced




Aetna Medicare Choice II Plan (PPO) Part-C Premium

Aetna Medicare plan charges a $0 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.



H3288-002 Part-D Deductible and Premium

Aetna Medicare Choice II Plan (PPO) has a monthly drug premium of $15.00 and a $300.0 drug deductible. This Aetna Medicare plan offers a $15.00 Part D Basic Premium that is not 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 this Premium covers any enhanced plan benefits offered by Aetna Medicare 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 $15.00. 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.



Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 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 prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Aetna Medicare Choice II Plan (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.70 for 75% low income subsidy $7.50 for 50% and $11.20 for 25%.



Full LIS Premium: $0
75% LIS Premium: $3.70
50% LIS Premium: $7.50
25% LIS Premium: $11.20


H3288-002 Formulary or Drug Coverage

Aetna Medicare Choice II Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $0 $15
Tier 2 $0 $20
Tier 3 $47 $47
Tier 4 $100 $100
Tier 5 27% 27%
*Initial Coverage Phase and 30 day supply







2021 Aetna Medicare Choice II Plan (PPO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


Diagnostic services Not covered
Endodontics 70% coinsurance (Out-of-Network)
Endodontics 50% coinsurance
Extractions 70% coinsurance (Out-of-Network)
Extractions 50% coinsurance
Non-routine services 50% coinsurance
Non-routine services 70% coinsurance (Out-of-Network)
Periodontics 50% coinsurance
Periodontics 70% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services Not covered
Restorative services 70% coinsurance (Out-of-Network)
Restorative services 50% coinsurance



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) 40% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI) $0-325 copay
Diagnostic tests and procedures $0-50 copay
Diagnostic tests and procedures 40% coinsurance (Out-of-Network)
Lab services $0 copay
Lab services 40% coinsurance (Out-of-Network)
Outpatient x-rays 40% coinsurance (Out-of-Network)
Outpatient x-rays $35 copay



Doctor Visits


Primary $0 copay
Primary 40% coinsurance per visit (Out-of-Network)
Specialist $35 copay per visit
Specialist 40% coinsurance per visit (Out-of-Network)



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $0-65 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 40% coinsurance (Out-of-Network)
Foot exams and treatment $35 copay
Routine foot care Not covered



Ground Ambulance


$285 copay (Out-of-Network)
$285 copay



Hearing


Fitting/evaluation Not covered
Hearing aids - inner ear Not covered
Hearing aids - outer ear Not covered
Hearing aids - over the ear Not covered
Hearing exam 40% coinsurance (Out-of-Network)
Hearing exam $35 copay



Inpatient Hospital Coverage


$335 per day for days 1 through 6
$0 per day for days 7 through 90
40% per stay (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 0-20% coinsurance per item (Out-of-Network)
Diabetes supplies 0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen) 40% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 40% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 40% coinsurance (Out-of-Network)
Chemotherapy 20% coinsurance
Other Part B drugs 40% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $1,871 per stay
Inpatient hospital - psychiatric 40% per stay (Out-of-Network)
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit with a psychiatrist 40% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay



MOOP


$11,300 In and Out-of-network
$7,550 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-275 copay per visit
40% coinsurance per visit (Out-of-Network)



Preventive Care


0-40% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


Cleaning $0 copay
Cleaning 30% coinsurance (Out-of-Network)
Dental x-ray(s) 30% coinsurance (Out-of-Network)
Dental x-ray(s) $0 copay
Fluoride treatment Not covered
Oral exam $0 copay
Oral exam 30% coinsurance (Out-of-Network)



Rehabilitation Services


Occupational therapy visit 40% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit $40 copay
Physical therapy and speech and language therapy visit 40% coinsurance (Out-of-Network)



Skilled Nursing Facility


40% per stay (Out-of-Network)
$0 per day for days 1 through 20
$184 per day for days 21 through 100



Transportation


Not covered



Vision


Contact lenses $0 copay
Contact lenses $0 copay (Out-of-Network)
Eyeglass frames $0 copay
Eyeglass frames $0 copay (Out-of-Network)
Eyeglass lenses $0 copay
Eyeglass lenses $0 copay (Out-of-Network)
Eyeglasses (frames and lenses) $0 copay
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Other 40% coinsurance (Out-of-Network)
Other $35 copay
Routine eye exam $0 copay
Routine eye exam 40% coinsurance (Out-of-Network)
Upgrades $0 copay
Upgrades $0 copay (Out-of-Network)



Wellness Programs (e.g. fitness nursing hotline)


Covered





Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




Coverage Area for Aetna Medicare Choice II Plan (PPO)

(Click county to compare all available Advantage plans)



Go to top

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, 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 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Call For A licensed Sales Agent


Or Enroll Online Here

Call to Enroll!