2021 Aetna Medicare Choice Plan (PPO) H3288-046 By Aetna Medicare.

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


Aetna Medicare Choice Plan (PPO) H3288-046 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 Plan (PPO) has a monthly premium of $0 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 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 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.




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2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Aetna Medicare Choice Plan (PPO)
Plan ID:
H3288-046
Provider:Aetna Medicare
Year:2021
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $7,550
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
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
Similar Plan: H3288-047




Aetna Medicare Choice 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.



H3288-046 Part-D Deductible and Premium

Aetna Medicare Choice Plan (PPO) has a monthly drug premium of $0 and a $300.0 drug deductible. This Aetna Medicare plan offers a $0 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 $0 . 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.



H3288-046 Formulary or Drug Coverage

Aetna Medicare Choice 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 Plan (PPO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0-375 copay
Diagnostic radiology services (e.g., MRI) 50% coinsurance (Out-of-Network)
Diagnostic tests and procedures 50% coinsurance (Out-of-Network)
Diagnostic tests and procedures $0-50 copay
Lab services $0 copay
Lab services 50% coinsurance (Out-of-Network)
Outpatient x-rays $50 copay
Outpatient x-rays 50% coinsurance (Out-of-Network)



Doctor Visits


Primary 50% coinsurance per visit (Out-of-Network)
Primary $0 copay
Specialist $50 copay per visit
Specialist 50% 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 50% coinsurance (Out-of-Network)
Foot exams and treatment $50 copay
Routine foot care Not covered



Ground Ambulance


$300 copay
$300 copay (Out-of-Network)



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 50% coinsurance (Out-of-Network)
Hearing exam $50 copay



Inpatient Hospital Coverage


$335 per day for days 1 through 6
$0 per day for days 7 through 90
50% per stay (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies 0-20% coinsurance per item
Diabetes supplies 0-20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 50% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 50% coinsurance (Out-of-Network)
Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance
Other Part B drugs 50% coinsurance (Out-of-Network)



Mental Health Services


Inpatient hospital - psychiatric 50% per stay (Out-of-Network)
Inpatient hospital - psychiatric $1,871 per stay
Outpatient group therapy visit $40 copay
Outpatient group therapy visit 50% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist 50% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit $40 copay
Outpatient individual therapy visit 50% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $40 copay
Outpatient individual therapy visit with a psychiatrist 50% coinsurance (Out-of-Network)



MOOP


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



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-325 copay per visit
50% coinsurance per visit (Out-of-Network)



Preventive Care


$0 copay
0-50% coinsurance (Out-of-Network)



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit 50% coinsurance (Out-of-Network)
Occupational therapy visit $40 copay
Physical therapy and speech and language therapy visit 50% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit $40 copay



Skilled Nursing Facility


50% 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 (Out-of-Network)
Eyeglass lenses $0 copay
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Eyeglasses (frames and lenses) $0 copay
Other 50% coinsurance (Out-of-Network)
Other $50 copay
Routine eye exam $0 copay
Routine eye exam 50% coinsurance (Out-of-Network)
Upgrades $0 copay
Upgrades $0 copay (Out-of-Network)



Wellness Programs (e.g. fitness nursing hotline)


Covered





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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.

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