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. Out-of-network differ between the Choice PPO and Basic PPO: . Choice PPO – Annual deductible is $800 single/$1,600 family; plan payment 70%, member pays 30% of the next $12,500 single/$25,000 family after which the plan pays at 100% . Basic PPO – Annual. By Aetna Health insurance companies use a lot of acronyms (HMO, PPO) and specialized terms like “deductible” and “copay.” You may be wondering if you’re the only one who’s confused: “Was I out sick the day that everyone else learned what this stuff means?”. State of Delaware: Aetna CDH Gold Coverage for: Individual + Family Plan Type: PPO. The Summary of Benefits and Coverage (SBC) document will help you choose a health plan. The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan.
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Aetna Medicare Choice Plan (PPO) H3288-001 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 $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 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: | |
|---|---|
| Plan ID: | H3288-001 |
| 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 |
| Similar Plan: | H3288-002 |
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.
H3288-001 Part-D Deductible and Premium
Aetna Medicare Choice 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 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 |
H3288-001 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.
2021 Aetna Medicare Choice 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 | $0-40 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
| $280 copay (Out-of-Network) |
|---|
| $280 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
| $325 per day for days 1 through 5 $0 per day for days 6 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 |
|---|
Aetna Copay Information
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?
Scooter software. Or Call
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Sun 9am-6pm EST
Coverage Area for Aetna Medicare Choice Plan (PPO)
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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.
2021 Biweekly rates for zip code
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
Aetna Ppo Copay Plan
| Aetna Open Access® HMO Plan | Code | Non-Postal | Postal 1 | Postal 2 |
|---|
Your 2021 benefits - DC, MD, Northern VA
| Plan Details | Basic Option |
|---|---|
| Preventive care copay | $0 |
| Primary care visit copay | $25 |
| Specialist visit copay | $55 |
| Maternity | You pay 20% |
| Prenatal Care | $0 |
| Hospital Care | You pay 20% |
| Inpatient hospital copay | You pay 20% |
| Outpatient surgery copay | $350 |
| Emergency room copay | $200 |
| Urgent care center copay | $50 |
| Lab/X-ray/diagnostic services | $25 PCP / $55 specialist ($100 for certain tests) |
| Prescription drug copays (for a 30-day supply at a retail pharmacy) | |
| Generic formulary* | $10 |
| Brand-name formulary* | 50% up to $200 maximum |
| Non-formulary* | 50% up to $300 |
For specialty drug information, see the federal plan brochure. | |
| Built-in Vision | |
| Routine eye exam copay | $55 |
| Money toward prescription eyewear | You get $100 every 24 months |
| Discounts on eyeglasses, contacts, eye exams and more | Included |
Built-in dental, too
Use our Basic Dental Network. Call 1-800-537-9384 to select a dentist OR to switch to our larger PPO network at no additional cost. It's your choice!
Aetna Medicare Ppo Deductible
Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD).
PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.**
- Large nationwide Aetna Network
- 24/7 access to doctors via phone or video with Teladoc®†
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists*
- Discounts on eyewear, LASIK surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
*** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
†Teladoc® is covered at the member cost share.
] Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.
Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's applicable Federal brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Discount programs are neither offered nor guaranteed under our contract with the FEHB Program, but are made available to all enrollees and their families who become members under an Aetna Health Insurance Plan. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. Information is believed to be accurate as of the production date; however, it is subject to change.
Postal and Non-Postal rates
- Non-Postal rates apply to most non-Postal employees.
- Postal rates apply to United States Postal Service employees.
- Postal Category 1 rates apply to career bargaining unit employees represented by the APWU, IT/AS, NALC and NPMHU.
- Postal Category 2 rates apply to career bargaining unit employees represented by the PPOA.
- Non-Postal rates apply to all career non-bargaining unit Postal Service employees and career employees represented by the NRLCA agreement.