2021 Aetna Assure Premier Plus (HMO D-SNP) EA-H6399

Aetna Assure Premier Plus (HMO D-SNP) By Aetna Better Health of New Jersey



Aetna Assure Premier Plus (HMO D-SNP) is a 2021 Medicare Advantage Special Needs Plan plan by Aetna Better Health of New Jersey. This plan from Aetna Better Health of New Jersey 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 New Jersey and not Original Medicare. All Medicare SNPs also provide Medicare additional Part-D drug coverage. Aetna Assure Premier Plus (HMO D-SNP) EA-H6399 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.



2021 Medicare Special Needs Plan Details

Plan Name:
Aetna Assure Premier Plus (HMO D-SNP)
Plan ID:
EA-H6399
Special Needs Type: Dual-Eligible
Provider: Aetna Better Health of New Jersey
Plan Year:2021
Plan Type: Local HMO
Monthly Premium C+D: $24.30


The Aetna Assure Premier Plus (HMO D-SNP) EA-H6399 is available to residents in New Jersey, and all Medicare SNPs must provide Medicare additional prescription drug (Part-D) coverage. Aetna Assure Premier Plus (HMO D-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 New Jersey 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.



Part-D Deductible and Premium

The Aetna Assure Premier Plus (HMO D-SNP) plan has a monthly drug premium of $24.30 and a $190.0 drug deductible. This Aetna Better Health of New Jersey plan offers a $24.30 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 Better Health of New Jersey 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 $24.30. 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 Assure Premier Plus (HMO D-SNP) medicare insurance plan offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $6.10 for 75% low income subsidy $12.10 for 50% and $18.20 for 25%.



Part C Premium: $0
Part D (Drug) Premium: $24.30
Part D Supplemental Premium $0
Total Part D Premium: $24.30
Drug Deductible: $190.0
Tiers with No Deductible: 1
Benchmark: not below the regional benchmark
Type of Medicare Health Plan: Enhanced Alternative
Drug Benefit Type: Enhanced
Full LIS Premium: $0
75% LIS Premium: $6.10
50% LIS Premium: $12.10
25% LIS Premium: $18.20
Gap Coverage: No


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 brand-name drugs and 25% on generic drugs unless your plan offers additional coverage. This Aetna Better Health of New Jersey plan does not offer additional coverage through the gap.




Aetna Assure Premier Plus (HMO D-SNP) Part-C Premium

Aetna Better Health of New Jersey 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.



EA-H6399 Part-D Deductible and Premium

Aetna Assure Premier Plus (HMO D-SNP) has a monthly drug premium of $24.30 and a $190.0 drug deductible. This Aetna Better Health of New Jersey plan offers a $24.30 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 Better Health of New Jersey 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 $24.30. 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 Better Health of New Jersey 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 Better Health of New Jersey plan does not offer additional coverage through the gap.



EA-H6399 Formulary or Drug Coverage

Aetna Assure Premier Plus (HMO D-SNP) 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 NA $0
Tier 2 NA $0
Tier 3 NA $47
Tier 4 NA $100
Tier 5 NA 29%
*Initial Coverage Phase and 30 day supply








Coverage Area for Aetna Assure Premier Plus (HMO D-SNP)



Source: CMS.

Plans as of September 9, 2020.

Notes: Data are subject to change. All contracts for 2020 have not been finalized. For 2020, 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 2020 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.

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