Aetna Medicare Standard Plan (PPO) By Aetna Medicare
Aetna Medicare Standard Plan (PPO) is a 2014 Medicare Advantage ("Part C" or "MA Plan") plan by Aetna Medicare. This plan from Aetna Medicare works with Medicare to give you significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Standard Plan (PPO) you still retain Original Medicare. But you will get additional Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage plans your always covered for urgently needed and emergency care and you receive all of the benefits of Original Medicare from this plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.
2014 Medicare Advantage Plan Details
| Plan Name: | Aetna Medicare Standard Plan (PPO) |
|---|---|
| Plan ID: | H5521-040 |
| Provider: | Aetna Medicare |
| Plan Year: | 2014 |
| Plan Type: | Local PPO |
| Monthly Premium C+D: | $87.00 |
| MOOP: | $6,700 |
Coverage Area for Aetna Medicare Standard Plan (PPO)
(Click county to compare all available plans)
The Aetna Medicare Standard Plan (PPO) H5521-040 is available to residents in New York, and has a in-network Maximum Out-of-Pocket limit of $6,700 MOOP. This means that if you get sick or need a high cost procedure your co-pays are capped. If you enroll in Aetna Medicare Standard Plan (PPO) plan you will stop paying co-pays for the rest of the year once you pay out of pocket $6,700 This is a very nice safety net. This plan includes additional Medicare prescription drug (Part-D) coverage.
Aetna Medicare Standard 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.
Ratings for Aetna Medicare Standard Plan (PPO) H5521
| 2014 Overall Rating | ||
|---|---|---|
| Part C Summary Rating | ||
| Total Experience Rating | ||
| Complaints, Improvements | ||
| Total Customer Service Rating | ||
| Total Preventative Rating | ||
| Chronic And Long Term Care |
Member Experience Rating for Aetna Medicare Standard Plan (PPO)
| Total Experience Rating | ||
|---|---|---|
| Getting Needed Care | ||
| Timely Care and Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints, Problems Getting Service and Improvements in Health Plans
| Total Rating | ||
|---|---|---|
| Members Leaving the Plan | ||
| Complaints about Health Plan | ||
| Access to Service | ||
| Performance Problems | ||
| Health Plan Quality Improvement |
Customer Service Rating for Aetna Medicare Standard Plan (PPO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating | ||
|---|---|---|
| Breast Cancer Screening | ||
| Colorectal Cancel Screening | ||
| Cardiovascular Screening | ||
| Diabetes Care | ||
| Glaucoma Testing | ||
| Annual Flu Vaccine | ||
| Improving Physical | ||
| Improving Mental Health | ||
| Monitoring Physical Activity | ||
| Adult BMI Assessment |
Ratings For Managing Chronic And Long Term Care
| Total Rating | ||
|---|---|---|
| Medication Review | ||
| Functional Status Assessment | ||
| Pain Screening | ||
| Osteoporosis Management | ||
| Diabetes Care - Eye Exam | ||
| Diabetes Care - Kidney Disease | ||
| Diabetes Care - Blood Sugar | ||
| Diabetes Care - Cholesterol | ||
| Controlling Blood Pressure | ||
| Rheumatoid Arthritis | ||
| Improving Bladder Control | ||
| Reducing Risk of Falling | ||
| Plan - Cause Readmissions |
Part-C Premium
Aetna Medicare plan charges a $54.40 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 Medicare Standard Plan (PPO) plan has a monthly drug premium of $32.60 and a $0.00 drug deductible. This Aetna Medicare plan offers a $32.60 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 $0.00 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 $32.60. 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 Medicare Standard Plan (PPO) medicare insurance plan offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $8.10 for 75% low income subsidy $16.30 for 50% and $24.40 for 25%.
| Part C Premium: | $54.40 |
|---|---|
| Part D (Drug) Premium: | $32.60 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $32.60 |
| Drug Deductible: | $0.00 |
| Tiers with No Deductible: | 0 |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health Plan: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Full LIS Premium: | $0.00 |
| 75% LIS Premium: | $8.10 |
| 50% LIS Premium: | $16.30 |
| 25% LIS Premium: | $24.40 |
| Inital Coverage Limit: | $2850 |
| Gap Coverage: | Few Generics |
Gap Coverage
In 2014 once you and your plan provider have spent $2,850 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be require to pay 47.5% of the plan's cost for covered brand-name prescription drugs and 72% of the cost for generic drugs unless your plan offers additional coverage. This Aetna Medicare plan offers Few Generics through the gap. Few means 0% to 10% of the formulary drugs are covered if your are in the gap and must also be greather then 15 "brand" products covered through the gap.
Source: CMS.
Plans as of September 3, 2013.
Star Rating as of September 27, 2013.
For More Information on Ratings Please See the CMS Tech Notes Here.
Plans are subject to change as contracts are finalized.
Includes 2014 approved contracts/plans. Employer sponsored 800 series plans and plans under sanction are excluded.