2021 Aetna Medicare Eagle Plan (HMO) H4982-013 By Aetna Medicare.

Summary of Benefits for
2021 Aetna Medicare Eagle Plan (HMO)


Aetna Medicare Eagle Plan (HMO) H4982-013 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in California. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Eagle Plan (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $4,200 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,200 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Eagle Plan (HMO) 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 require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

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 Eagle Plan (HMO) 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 Eagle Plan (HMO)
Plan ID:
H4982-013
Provider:Aetna Medicare
Year:2021
Type: Local HMO *
Monthly Premium C+D: $0
Part C Premium:
MOOP: $4,200
Similar Plan: H4982-015






2021 Aetna Medicare Eagle Plan (HMO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


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



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0-100 copay
Diagnostic tests and procedures $0 copay
Lab services $0 copay
Outpatient x-rays $0 copay



Doctor Visits


Primary $0 copay
Specialist $10 copay per visit



Emergency care/Urgent Care


Emergency $90 copay per visit (always covered)
Urgent care $10 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment $10 copay
Routine foot care Not covered



Ground Ambulance


$275 copay



Hearing


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



Inpatient Hospital Coverage


$50 per day for days 1 through 3
$0 per day for days 4 through 90



Medical Equipment/Supplies


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



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $370 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient group therapy visit $25 copay
Outpatient group therapy visit with a psychiatrist $25 copay
Outpatient individual therapy visit $25 copay
Outpatient individual therapy visit with a psychiatrist $25 copay



MOOP


$4,200 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0-50 copay per visit



Preventive Care


$0 copay



Preventive Dental


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



Rehabilitation Services


Occupational therapy visit $10 copay
Physical therapy and speech and language therapy visit $10 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100



Transportation


$0 copay



Vision


Contact lenses $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Other $0 copay
Routine eye exam $0 copay
Upgrades $0 copay



Wellness Programs (e.g. fitness nursing hotline)


Covered





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Sun 9am-6pm EST




Coverage Area for Aetna Medicare Eagle Plan (HMO)

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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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