Aetna Copay For Specialist

  



Aetna Medicare Explorer Value (HMO) H3152-082 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in New Jersey. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Explorer Value (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This Aetna Medicare plan does offer additional coverage through the gap. H3146-004 Formulary or Drug Coverage. Aetna Medicare Value Plan (HMO) 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. Specialist telehealth visits at no extra cost. You’ll have a $0 copay. for specialist telehealth visits, including mental health counseling, until January 31, 2021. We will waive costs for mental health visits through: In-network providers who deliver virtual care, such as. Aetna Medicare Prime (HMO-POS) H2663-015 is a 2020 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Missouri. This plan includes additional Medicare prescription drug (Part-D) coverage. Fastest macbook pro. The Aetna Medicare Prime (HMO-POS) has a monthly premium of $- and has an in-network Maximum Out-of-Pocket limit of $2,600 (MOOP). Welcome Federal Employees Aetna Open Access ® HMO Plan. Aetnafeds.com DA: 17 PA: 10 MOZ Rank: 29. Preventive care copay: $0: Primary care visit copay: $20: Specialist visit copay: $35: Maternity: Prenatal Care: $0: Hospital Care: $250 per day, $1000 max per stay: Inpatient hospital copay: $250/day, $1,000 max per stay: Outpatient surgery copay: $175: Emergency room copay: $125: Urgent care.


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Aetna Medicare Advantra Gold (HMO) H3959-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Pennsylvania. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Advantra Gold (HMO) has a monthly premium of $49.00 and has an in-network Maximum Out-of-Pocket limit of $4,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,900 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Advantra Gold (HMO) 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 require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

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 Advantra Gold (HMO) 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. Ashampoo free. 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:
H3959-002
Provider:Aetna Medicare
Year:2021
Type: Local HMO
Monthly Premium C+D: $49.00
Part C Premium: $28.00
MOOP: $4,900
Part D (Drug) Premium: $21.00
Part D Supplemental Premium $0
Total Part D Premium: $21.00
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:H3959-010

Aetna Medicare Advantra Gold (HMO) Part-C Premium

Aetna Medicare plan charges a $28.00 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.


H3959-002 Part-D Deductible and Premium

Aetna Medicare Advantra Gold (HMO) has a monthly drug premium of $21.00 and a $0 drug deductible. This Aetna Medicare plan offers a $21.00 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 $21.00. 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 Advantra Gold (HMO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.20 for 75% low income subsidy $10.50 for 50% and $15.70 for 25%.


Full LIS Premium: $0
75% LIS Premium: $5.20
50% LIS Premium: $10.50
25% LIS Premium: $15.70

H3959-002 Formulary or Drug Coverage

Aetna Medicare Advantra Gold (HMO) 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 Advantra Gold (HMO) Summary of Benefits



Additional Benefits


Yes


Comprehensive Dental


Diagnostic servicesNot covered
Endodontics20% coinsurance
Extractions20-50% coinsurance
Non-routine services20-50% coinsurance
Periodontics20-50% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services20-50% coinsurance
Restorative services20-50% coinsurance


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-225 copay
Diagnostic tests and procedures$0-5 copay
Lab services$0 copay
Outpatient x-rays$20 copay


Doctor Visits


Primary$0 copay
Specialist$30 copay per visit

Aetna Copay For Specialist

Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$50 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$20 copay
Routine foot care$20 copay


Ground Ambulance


$225 copay


Hearing


Fitting/evaluation$0 copay
Hearing aids$0 copay
Hearing exam$35 copay
Copay

Inpatient Hospital Coverage


$300 per stay


Medical Equipment/Supplies


Diabetes supplies0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item


Medicare Part B Drugs


Chemotherapy20% coinsurance
Other Part B drugs20% coinsurance


Mental Health Services


Inpatient hospital - psychiatric$1,590 per stay
Outpatient group therapy visit$40 copay
Outpatient group therapy visit with a psychiatrist$40 copay
Outpatient individual therapy visit$40 copay
Outpatient individual therapy visit with a psychiatrist$40 copay


MOOP


$4,900 In-network


Option


Yes, contact plan for further details


Optional supplemental benefits


No


Outpatient Hospital Coverage


$0-225 copay per visit


Preventive Care


$0 copay


Preventive Dental


Cleaning$0 copay
Dental x-ray(s)$0 copay
Fluoride treatmentNot covered
Oral exam$0 copay


Rehabilitation Services


Occupational therapy visit$20 copay
Physical therapy and speech and language therapy visit$20 copay


Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100


Transportation


$0 copay


Vision


Contact lenses$0 copay
Eyeglass frames$0 copay
Eyeglass lenses$0 copay
Eyeglasses (frames and lenses)$0 copay
Other$35 copay
Routine eye exam$0 copay
Upgrades$0 copay


Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for Aetna Medicare Advantra Gold (HMO) H3959


2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Aetna Medicare Advantra Gold (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Aetna Medicare Advantra Gold (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

How To Pay Aetna Copay

Aetna Medicare Advantra Gold (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


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Aetna Copay For Specialist Doctors

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Coverage Area for Aetna Medicare Advantra Gold (HMO)

(Click county to compare all available Advantage plans)

Aetna Copay For Specialist Group

State: Pennsylvania
County:Armstrong,Beaver,Bedford,Butler,Cambria,
Cameron,Clearfield,Crawford,Elk,
Erie,Fayette,Forest,Greene,
Indiana,Jefferson,Lawrence,McKean,
Mercer,Somerset,Venango,Warren,
Washington,Westmoreland,

Aetna Copay For Specialist Services

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Aetna Copay For Specialist Dental


Aetna Copay For Specialist Card

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.