Aetna Medicare Premier Plan (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H2663-034
HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied bySunFire, Inc.,a private company that creates software solutionsfor agents and brokers to compareMedicare plans. For more information, visitwww.sunfireinc.com.
$0.00
Monthly Premium
Aetna Medicare Premier Plan (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H2663-034
HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied bySunFire, Inc.,a private company that creates software solutionsfor agents and brokers to compareMedicare plans. For more information, visitwww.sunfireinc.com.
4.5 out of 5 stars
Aetna Medicare Premier Plan (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H2663-034
HelpAdvisor Editorial Team analysis of data from the 2024 MA Landscape Source Files and carrier-provided plan data supplied bySunFire, Inc.,a private company that creates software solutionsfor agents and brokers to compareMedicare plans. For more information, visitwww.sunfireinc.com.
$0.00
Monthly Premium
Oklahoma Counties Served
Oklahoma Canadian Logan
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $150 |
Out of Pocket Max | In-Network: $6000 Out-of-Network: N/A |
Initial Coverage Limit | $5030 |
Catastrophic Coverage Limit | $8,000 |
Primary Care Doctor Visit | $0 |
Specialty Doctor Visit | $30 |
Inpatient Hospital Care | $295 per day, days 1-7; $0 per day, days 8-90 |
Urgent Care | Copayment for Urgent Care $60.00 Worldwide Coverage: |
Emergency Room Visit | $120 If you are admitted to the hospital within 0 hours your cost share may be waived, for more information see the Evidence of Coverage |
Ambulance Transportation | $250 |
Health Care Services and Medical Supplies
Aetna Medicare Premier Plan (HMO) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
Coverage | Cost |
---|---|
Chiropractic Services | In-Network: |
Diabetes Supplies, Training, Nutrition Therapy and Monitoring | 0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies. |
Durable Medical Eqipment (DME) | 20% |
Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: Lab Services: $0 in-network, for more information see Evidence of Coverage |
Home Health Care | $0 |
Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: |
Mental Health Outpatient Care | Mental Health: |
Outpatient Services / Surgery | Ambulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $245 All other in network ASC services, for more information see Evidence of Coverage |
Outpatient Substance Abuse Care | In-Network: |
Over-the-counter (OTC) Items | In Network: |Over-the-counter (OTC) items:|$105 quarterly amount (allowance) to purchase approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers and more. Approved items can be purchased online, in store, or by phone. |Be sure to use the full benefit amount quarterly, because any unused amount will not rollover.|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit.|Seasonal over-the-counter (OTC) kit of preselected OTC items mailed twice a year, for more information see Evidence of Coverage |
Podiatry Services | In-Network: |
Skilled Nursing Facility Care | $10 per day, days 1-20 |
Dental Benefits
The following dental services are covered from in-network providers.
Coverage | Cost |
---|---|
Dental Care | In Network Dental Coverage |Preventive dental services:|Oral exams: $0 copay (four visits every year) |Cleanings: $0 copay (two visits every year) |Bitewing x-rays: $0 copay (one visit every year) |Comprehensive dental services:|Non-routine services: 20%-50% coinsurance (see Evidence of Coverage) |Diagnostic services: $0 copay (see Evidence of Coverage) |Restorative services: 20%-50% coinsurance (see Evidence of Coverage) |Endodontics: 20% coinsurance (see Evidence of Coverage) |Periodontics: 20%-50% coinsurance (see Evidence of Coverage) |Extractions: 20%-50% coinsurance (see Evidence of Coverage) |Prosthodontics and maxillofacial services: 50% coinsurance (see Evidence of Coverage) |$2,500 maximum benefit for comprehensive dental services - see Evidence of Coverage. |
Vision Benefits
The following vision services are covered from in-network providers.
Coverage | Cost |
---|---|
Vision Benefits | In-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0|Copayment for Routine Eye Exams $0 |(Maximum one exam every year)|Eyewear:|Copayment for Medicare Covered Benefits $0|Copayment for Contacts $0|Copayment for Eyeglasses $0|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $300 every year. See the Evidence of Coverage |
Hearing Benefits
The following hearing services are covered from in-network providers.
Coverage | Cost |
---|---|
Hearing Benefits | In-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $30|Referral Required for Hearing Exams|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Copayment for Fitting/Evaluation for Hearing Aid $0|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year)|$1,250 per ear every year, for more information see the Evidence of Coverage |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
Coverage | Cost |
---|---|
Preventive Services and Health/Wellness Education Programs | $0 copay for all preventive services covered under Original Medicare at zero cost sharing |
Prescription Drug Costs and Coverage
The Aetna Medicare Premier Plan (HMO) plan offers the following prescription drug coverage, with an annual drug deductible of $150 (excludes Tiers 1 and 2) per year.
Coverage | Cost |
---|---|
Coverage & Cost | |
Annual Drug Deductible | $150 (excludes Tiers 1 and 2) |
Preferred Generic |
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Generic |
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Annual Drug Deductible | $150 (excludes Tiers 1 and 2) |
Preferred Generic |
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Generic |
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Annual Drug Deductible | $150 (excludes Tiers 1 and 2) |
Preferred Generic |
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Generic |
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