- Aetna Medicare Ppo Deductible
- Copay For Aetna Insurance
- Aetna Copay Plans
- Aetna Ppo Copay Advantage
- Aetna Medicare Ppo Copays
- Aetna Ppo Providers
- Aetna Ppo Copay
THE CHOICE IS YOURS
- 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.
- 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?”.
Video Transcript Aetna Vision Preferred Plan. Text on screen: Rick Tapnio. Retired Air Force. Current Aetna Employee. Aetna Vision Preferred Member. Rick Tapnio: (00:03) What I love about the Aetna Preferred Vision Plan is choice, savings and convenience. That really narrows down the three most important things for myself and my family simply because we just, we didn't have that before on the. For hospital care, you’ll have a copay of $300 per day for days 1 through 7. For days 8 through 90, you’ll pay $0 with the Aetna Medicare Value PPO plan. This plan covers an unlimited number of hospital days. For skilled nursing facility (SNF) care, this Medicare Advantage plan from Aetna has a copay of $0 per day for days 1 through 20.
Aetna offers easy to understand health benefit plans. Even if you like the plan you’re in, it’s a good idea to review your selections every year.
Aetna Medicare Ppo Deductible
All health plans give you access to quality doctors and hospitals, free 24-hour nurse hotline and a secure website to keep all of your personal health records in one place.
Two Aetna Medicare Advantage PPO plans:
Aetna PPO Extended Service Area (ESA)
- Aetna Medicare Advantage PPO ESA 10
- Aetna Medicare Advantage PPO ESA 15
Did you like your Freedom Plan as a pre-65 retiree? Than we have an even better plan for you now that you are Medicare eligible!
The Aetna Medicare (PPO) plan with an Extended Service Area (ESA) offers services and programs beyond Original Medicare and includes special programs only available to Aetna members. And, unlike a traditional PPO, you can use in-network or out-of-network providers, at the in-network cost sharing amount. This gives you added flexibility when it comes to your care.
Plan Details:
You can use providers who are in or out of the plan’s nationwide network. An out-of network provider must be eligible to receive Medicare payment and willing to accept the PPO ESA plan.
What's special?
- With these plans you have the same member cost-share in and out-of-network. For example, as long as you see a provider that is eligible to receive Medicare payment, your Primary Care Physician cost-share under the Medicare Advantage PPO ESA 10 plan will be $10 if you go in or out-of-network. It’s that simple.
- Our Care Management program is designed to help you manage health conditions such as hypertension.
- Freedom to use providers in and out of network as long as they are eligible for Medicare payment and agree to accept your PPO plan.
- Selecting a primary care physician (PCP) is not required, but we do encourage you to select one. A PCP is often the doctor who has a complete picture of your health.
- Access to the National Medical Excellence Program®, a select network of respected doctors and facilities designed to help those with a complex illness or injury receive the most appropriate care.
- Preventive benefits beyond Original Medicare at no additional cost.
What you should know
- You must be enrolled in Medicare Part A and/or B and continue to pay your Part B premium and Part A premium, if applicable.
- Guaranteed acceptance as long as you meet eligibility requirements.
- You must live in the plan service area offered by your former employer.
- You’ll enjoy limits to your out-of-pocket plan costs.
- If you use a provider that does not participate in the plan’s network, the provider must be licensed, eligible to receive Medicare payment and willing to accept the plan.
- For complete information, please refer to the plan documents in the links below.
Summary of Benefits and Coverage
Click here for the Summary of Benefits and Coverage page on the Division of Pension and Benefits website.
Two Aetna Medicare Advantage HMO plans:
Health Maintenance Organization (HMO)
- Aetna Medicare Advantage HMO 10
- Aetna Medicare Advantage HMO 1525
If you liked your Aetna HMO plan as a pre-65 retiree, we can’t wait for you to try our Aetna Medicare HMO plans!
The Aetna Medicare Plan (HMO) Open Access includes coverage for Medicare Parts A and B benefits, and it goes beyond those benefits to offer you additional benefits not covered under Original Medicare. Our HMO offers you an affordable way to help you manage your health care costs.
Plan Details:
You typically pay a flat fee, or copay, for most covered expenses. You are not required to select a Primary Care Physician (PCP) form the plan’s network.* With the Aetna Medicare Plan (HMO) Open Access, you may access care from participating providers without a PCP referral. If you seek care from a provider who does not accept the Aetna Medicare Plan, services will not be covered, except in an emergency or urgent care situation, or for out-of-area kidney dialysis. For some services, you may pay a percentage of the expense (coinsurance).
What's special?
- Our Care Management program is designed to help you manage health conditions such as hypertension.
- You have access to the large Aetna Medicare HMO network of doctors, hospitals and other health care providers.
- Access to the National Medical Excellence Program®, a select network of respected doctors and facilities designed to help those with a complex illness or injury receive the most appropriate care.
- You have medical coverage whenever you travel to another Aetna Medicare Plan service area with Aetna’s U.S. Travel Advantage Program; however, you must enroll by calling Aetna Medicare before you travel.
- Preventive benefits beyond Original Medicare at no additional cost.
What you should know
- You must be enrolled in Medicare Part A and/or B and continue to pay your Part B premium and Part A premium, if applicable.
- Guaranteed acceptance as long as you meet eligibility requirements.
- You must live in the plan service area offered by your former employer.
- You’ll enjoy limits to your out-of-pocket plan costs.
- If you use a provider that does not participate in the plan’s network, the provider must be licensed, eligible to receive Medicare payment and willing to accept the plan.
- For complete information, please refer to the plan documents in the links below.
*Members residing in Illinois and California will be required to declare a Primary Care Physician when electing your plan.
Summary of Benefits and Coverage
Click here for the Summary of Benefits and Coverage page on the Division of Pension and Benefits website.
Health Home Visit
At your invitation, a licensed and board-certified nurse practitioner or physician will come to your home to give you a health assessment with our Healthy Home Visit, at no extra cost to you. At your request, they will also check your home for potential issues that may increase your chances of falling.
What does the Healthy Home Visit involve?
You can use this yearly visit to:
- Ask health care questions
- Review your medicines
- Update your medical history
- Discuss issues you may have getting the health resources you need
- Discuss concerns you may have to ensure that you can move around safely in your home
You can schedule a free Healthy Home Visit today. Just call 1-855-205-0431
Resources for Living
Happiness and peace of mind play an important role in living your best life.
The Aetna Medicare Advantage Resources For Living program may help you achieve that. With just one call, a life consultant can help you find services and support in your area. And the phone call doesn’t cost you anything. You’d pay the cost of any services you decide to use.
- Help at Home - for example cleaning, lawn service, maintenance and repairs
- Help for your caregiver
Find out how to start using these services at 1-866-370-4842 (TTY: 711), Monday – Friday, 8 a.m. to 6 p.m. (all time zones)
Medicare Claim form
Fill out this form if you are asking for a medical reimbursement that you paid a doctor, healthcare professional, or service provider who did not bill us directly.
Make copies of all of your receipts and itemized bills from your provider. Be sure to include your Aetna member ID number on each receipt and bill. All materials submitted will be retained by us and cannot be returned to you.
Summary of Benefits and Coverage
Click here for the Summary of Benefits and Coverage page on the Division of Pension and Benefits website.
Call 1-866-234-3129 and talk to someone from Member Services who knows all the details about the available Aetna plans.
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Aetna Medicare Choice Plan (PPO) H9431-005 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Oregon. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Choice Plan (PPO) has a monthly premium of $19.00 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.
Ready to Enroll?
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Mon-Fri 8am-9pm EST
Sat 9am-9pm EST
2021 Aetna Medicare Medicare Advantage Plan Costs
| Name: | |
|---|---|
| Plan ID: | H9431-005 |
| Provider: | Aetna Medicare |
| Year: | 2021 |
| Type: | Local PPO |
| Monthly Premium C+D: | $19.00 |
| Part C Premium: | $3.90 |
| MOOP: | $7,550 |
| Part D (Drug) Premium: | $15.10 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $15.10 |
| Drug Deductible: | $0 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H9431-006 |
Aetna Medicare Choice Plan (PPO) Part-C Premium
Aetna Medicare plan charges a $3.90 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.
H9431-005 Part-D Deductible and Premium
Aetna Medicare Choice Plan (PPO) has a monthly drug premium of $15.10 and a $0 drug deductible. This Aetna Medicare plan offers a $15.10 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 $15.10. 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 $3.80 for 75% low income subsidy $7.50 for 50% and $11.30 for 25%.
| Full LIS Premium: | $0 |
|---|---|
| 75% LIS Premium: | $3.80 |
| 50% LIS Premium: | $7.50 |
| 25% LIS Premium: | $11.30 |
H9431-005 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 | $0 copay |
|---|---|
| Diagnostic services | $0 copay (Out-of-Network) |
| Endodontics | $0 copay |
| Endodontics | $0 copay (Out-of-Network) |
| Extractions | $0 copay |
| Extractions | $0 copay (Out-of-Network) |
| Non-routine services | $0 copay |
| Non-routine services | $0 copay (Out-of-Network) |
| Periodontics | $0 copay |
| Periodontics | $0 copay (Out-of-Network) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Out-of-Network) |
| Restorative services | $0 copay |
| Restorative services | $0 copay (Out-of-Network) |
Deductible
| $0 |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-295 copay |
|---|---|
| Diagnostic radiology services (e.g., MRI) | 45% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | $0-15 copay |
| Diagnostic tests and procedures | 45% coinsurance (Out-of-Network) |
| Lab services | $0 copay |
| Lab services | 45% coinsurance (Out-of-Network) |
| Outpatient x-rays | $0 copay |
| Outpatient x-rays | 45% coinsurance (Out-of-Network) |
Doctor Visits
| Primary | $0 copay |
|---|---|
| Primary | 45% coinsurance per visit (Out-of-Network) |
| Specialist | $45 copay per visit |
| Specialist | 45% coinsurance per visit (Out-of-Network) |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $45 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $45 copay |
|---|---|
| Foot exams and treatment | 45% coinsurance (Out-of-Network) |
| Routine foot care | Not covered |
Ground Ambulance
| $260 copay |
|---|
| $260 copay (Out-of-Network) |
Hearing
| Fitting/evaluation | $0 copay |
|---|---|
| Fitting/evaluation | 45% coinsurance (Out-of-Network) |
| Hearing aids | $0 copay |
| Hearing aids | $0 copay (Out-of-Network) |
| Hearing exam | $0 copay |
| Hearing exam | 45% coinsurance (Out-of-Network) |
Inpatient Hospital Coverage
| $420 per day for days 1 through 4 $0 per day for days 5 through 90 |
|---|
| 45% per stay (Out-of-Network) |
Medical Equipment/Supplies
Copay For Aetna Insurance
| Diabetes supplies | 0-20% coinsurance per item |
|---|---|
| Diabetes supplies | 0-20% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 45% coinsurance per item (Out-of-Network) |
| 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 | 20% coinsurance |
|---|---|
| Chemotherapy | 45% coinsurance (Out-of-Network) |
| Other Part B drugs | 20% coinsurance |
| Other Part B drugs | 45% coinsurance (Out-of-Network) |
Mental Health Services
| Inpatient hospital - psychiatric | $1,871 per stay |
|---|---|
| Inpatient hospital - psychiatric | 45% per stay (Out-of-Network) |
| Outpatient group therapy visit | $40 copay |
| Outpatient group therapy visit | 45% coinsurance (Out-of-Network) |
| Outpatient group therapy visit with a psychiatrist | $40 copay |
| Outpatient group therapy visit with a psychiatrist | 45% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit | $40 copay |
| Outpatient individual therapy visit | 45% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
| Outpatient individual therapy visit with a psychiatrist | 45% coinsurance (Out-of-Network) |
MOOP
| $11,300 In and Out-of-network $7,550 In-network |
|---|
Option
| No |
|---|
Aetna Copay Plans
Optional supplemental benefits
| No |
|---|
Outpatient Hospital Coverage
| $0-325 copay per visit |
|---|
| 45% coinsurance per visit (Out-of-Network) |
Preventive Care
| $0 copay |
|---|
| 0-45% coinsurance (Out-of-Network) |
Preventive Dental
| Cleaning | $0 copay |
|---|---|
| Cleaning | $0 copay (Out-of-Network) |
| Dental x-ray(s) | $0 copay |
| Dental x-ray(s) | $0 copay (Out-of-Network) |
| Fluoride treatment | $0 copay |
| Fluoride treatment | $0 copay (Out-of-Network) |
| Oral exam | $0 copay |
| Oral exam | $0 copay (Out-of-Network) |
Rehabilitation Services
| Occupational therapy visit | $30 copay |
|---|---|
| Occupational therapy visit | 45% coinsurance (Out-of-Network) |
| Physical therapy and speech and language therapy visit | $30 copay |
| Physical therapy and speech and language therapy visit | 45% coinsurance (Out-of-Network) |
Skilled Nursing Facility
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
|---|
| 35% per stay (Out-of-Network) |
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 | $0 copay |
| Other | 45% coinsurance (Out-of-Network) |
| Routine eye exam | $0 copay |
| Routine eye exam | 45% coinsurance (Out-of-Network) |
| Upgrades | $0 copay |
| Upgrades | $0 copay (Out-of-Network) |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Aetna Ppo Copay Advantage
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Aetna Medicare Ppo Copays
Coverage Area for Aetna Medicare Choice Plan (PPO)
Aetna Ppo Providers
(Click county to compare all available Advantage plans)
Aetna Ppo Copay
| State: | Oregon |
|---|---|
| County: | Clackamas,Marion,Multnomah,Polk,Washington, Yamhill, |
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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.