Aetna Medicare Premier Plus (PPO)

Health Insurance Company: Aetna Medicare

Medicare Advantage Plan Details

Aetna Medicare
$0 /mo
monthly premium
Aetna Medicare Premier Plus (PPO)
Additional Coverage
Overall Star Rating (2024)
  • Rx
  • Dental
  • Vision
  • Hearing
4
out of 5 stars

General Plan Details

Medical Deductible
$0
Out-of-Pocket Maximum
$4900
Rx Drug Coverage
Yes
Rx Deductible
$0

Additional Benefits

Dental Coverage
Yes
Vision Coverage
Yes
Mental Health Coverage
Yes
Chiropractic Coverage
No
Optional Supplemental Benefits
No
Part B Give Back
No

Doctor & Hospital Coverage

Primary Doctor Office Visit
In-network: $0 copay
Out-of-network: 50% coinsurance per visit
Specialist Office Visit
In-network: $30 copay per visit
Out-of-network: 50% coinsurance per visit
Periodic Exam Coverage
In-network: $0 copay
Out-of-network: 0-50% coinsurance

Emergency Room

$120 copay per visit (always covered)

Ambulance Coverage

In-network: $350 copay
Out-of-network: $350 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0-35 copay
Out-of-network: 50% coinsurance
Medicare-covered lab services: In-network: $0 copay
Out-of-network: 50% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $0-160 copay
Out-of-network: 50% coinsurance
Medicare-covered x-ray services: In-network: $0 copay
Out-of-network: 50% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $0-350 copay per visit
Out-of-network: 50% coinsurance per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $335 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 50% per stay
Inpatient hospital psychiatric:
In-network: $310 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 50% per stay

Rehabilitation Coverage

Occupational therapy services:
In-network: $35 copay
Out-of-network: 50% coinsurance
Physical therapy and speech and language therapy services:
In-network: $35 copay
Out-of-network: 50% coinsurance

Urgent Care Coverage

$35 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $0 per day for days 1 through 20
$203 per day for days 21 through 100
Out-of-network: 50% per stay

Mental Health Coverage

Medicare-covered individual sessions: In-network: $35 copay
Out-of-network: 50% coinsurance
Medicare-covered group sessions: In-network: $35 copay
Out-of-network: 50% coinsurance

Dental, Vision, Hearing Benefits

Dental Services

Oral exams: In-network: $0 copay
Out-of-network: $0 copay
Prophylaxis (cleaning): In-network: $0 copay
Out-of-network: $0 copay
Dental x-rays: In-network: $0 copay
Out-of-network: $0 copay

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: 50% coinsurance
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $30 copay
Out-of-network: 50% coinsurance
Hearing aids:
Hearing aids (all types): In-network: $0 copay
Out-of-network: $0 copay

Rx Drug Coverage - Preferred Retail Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Standard Retail Cost

Tier 1: Preferred Generic

$3.00 copay (30-day supply)
$9.00 copay (90-day supply)

Tier 2: Generic

$7.00 copay (30-day supply)
$21.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Standard Mail Order Cost

Tier 1: Preferred Generic

$3.00 copay (30-day supply)
$9.00 copay (90-day supply)

Tier 2: Generic

$7.00 copay (30-day supply)
$21.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Rx Drug Coverage - Preferred Mail Order Cost

Tier 1: Preferred Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 2: Generic

$0.00 copay (30-day supply)
$0.00 copay (90-day supply)

Tier 3: Preferred Brand

$47.00 copay (30-day supply)
$141.00 copay (90-day supply)

Tier 4: Non-Preferred Drug

$100.00 copay (30-day supply)
$300.00 copay (90-day supply)

Tier 5: Specialty Tier

33% coinsurance (30-day supply)

Plan Links

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Where This Plan is Available

Additional Plan Info

Year:
2024
Plan ID:
H1608-021-0
Insurance Company Website:
Aetna Medicare

Health Insurance Companies Offering Plans

Medicare Advantage and Part D plans and benefits offered by the following carriers:

  • Aetna Medicare
  • Anthem Blue Cross Blue Shield
  • Aspire Health Plan
  • Dean Health Plan
  • Devoted Health
  • GlobalHealth
  • Health Care Service Corporation
  • Cigna Healthcare
  • Humana
  • Medica Central Health Plan
  • Molina Healthcare
  • Mutual of Omaha
  • Premera Blue Cross
  • SCAN Health Plan
  • Scott and White Health Plan now part of Baylor Scott & White Health
  • UnitedHealthcareⓇ
  • Wellcare