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Aetna Medicare Choice Plan (PPO) H3288-008 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. Figurative languageteam patton. 2000sthe history of video games. This can be a extremely nice safety net.
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.A formulary is a list of generic and brand-name drugs your health plan prefers. InterGlobal is now part of Aetna, one of the largest and most innovative providers of international medical insurance. We have combined our businesses to create one market-leading health care benefits company. This means we can better serve people who depend on Aetna International and InterGlobal to meet their health and wellness needs. How to File a Claim with Kaiser Permanente and Aetna Insurance. Kaiser Permanente. To submit claims for reimbursement, contact member services at 1-888-901-4636. Otherwise, you should be covered except for copay. If you need reimbursement for Medicare Part D prescriptions, you must use the Member reimbursement drug claim form (PDF). Copay Reimbursements Burlington Township School District. If you are enrolled in the Patriot V or Patriot X medical plan, Aetna will reimburse a percentage of eligible copays. Just submit copied receipts with the reimbursement cover sheet directly to Aetna. Once your plan deductible is met, Aetna will reimburse 70% (Patriot V) or 80% (Patriot.
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. Game 248: march 22, 2019the initials game.
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: | H3288-008 |
| 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: | H3288-009 |
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.
H3288-008 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.
H3288-008 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
Aetna Copayment
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) | $0-325 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
| $280 copay |
|---|
| $280 copay (Out-of-Network) |
Aetna Copay For Colonoscopy
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
| $315 per day for days 1 through 7 $0 per day for days 8 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) | 45% 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) | 45% 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
| $0-275 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 |
|---|
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Aetna Copay Amounts
Coverage Area for Aetna Medicare Choice Plan (PPO)
(Click county to compare all available Advantage plans)
| State: | Texas |
|---|---|
| County: | Anderson,Bell,Bosque,Cherokee,Cooke, Ellis,Fannin,Grayson,Gregg, Harrison,Henderson,Hill,Hood, Hunt,Johnson,Kaufman,Limestone, Marion,McLennan,Montague,Nacogdoches, Navarro,Parker,Rains,Rockwall, Rusk,Smith,Somervell,Upshur, Van Zandt,Wise,Wood, |
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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.