Aetna Medicare Premier Plan (PPO) Benefits

Aetna Medicare | PPO
Plan website: www.aetnamedicare.com
Plan Phone Number: (800) 832-2640
U.S. News Preferred Broker Phone: (888) 245-3931

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Inpatient Care

Hospital Care

No limit to the number of days covered by the plan each hospital stay.

For Medicare-covered hospital stays:

Days 1 - 6: $275 copay per day

Days 7 - 90: $0 copay per day

$0 copay for additional non-Medicare-covered hospital days

35% of the cost for each Medicare-covered hospital stay.

Outpatient Care

Doctor Office Visits

$15 copay for each Medicare-covered primary care doctor visit.

$45 copay for each Medicare-covered specialist visit.

35% of the cost for each Medicare-covered primary care doctor visit

35% of the cost for each Medicare-covered specialist visit

Doctor and Hospital Choice

No referral required for network doctors specialists and hospitals.

You can go to doctors specialists and hospitals in or out of the network. It will cost more to get out of network benefits.

Diagnostic Tests, X-Rays, Lab Services and Radiology Services

$15 to $45 copay for Medicare-covered lab services

$15 to $45 copay for Medicare-covered diagnostic procedures and tests

$15 to $45 copay for Medicare-covered X-rays

20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays)

20% of the cost for Medicare-covered therapeutic radiology services

If the doctor provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $15 to $45 may apply

35% of the cost for Medicare-covered therapeutic radiology services

35% of the cost for Medicare-covered outpatient X-rays

35% of the cost for Medicare-covered diagnostic radiology services

35% of the cost for Medicare-covered diagnostic procedures and tests

35% of the cost for Medicare-covered lab services

Emergency Care

$65 copay for Medicare-covered emergency room visits

Worldwide coverage.

If you are immediately admitted to the hospital you pay $0 for the emergency room visit.

Durable Medical Equipment

Authorization rules may apply.

20% of the cost for Medicare-covered durable medical equipment

35% of the cost for Medicare-covered durable medical equipment

Diabetes Programs and Supplies

$0 copay for Medicare-covered Diabetes self-management training

$0 copay for Medicare-covered Diabetes monitoring supplies

$0 copay for Medicare-covered Therapeutic shoes or inserts

If the doctor provides you services in addition to Diabetes self-management training separate cost sharing of $15 to $45 may apply

35% of the cost for Medicare-covered Diabetes self-management training

35% of the cost for Medicare-covered Diabetes monitoring supplies

35% of the cost for Medicare-covered Therapeutic shoes or inserts

Ambulance Services

$300 copay for Medicare-covered ambulance benefits.

$300 copay for Medicare-covered ambulance benefits.

Urgently Needed Care

$55 copay for Medicare-covered urgently-needed-care visits

Outpatient Services

$275 copay for each Medicare-covered ambulatory surgical center visit

$0 to $275 copay for each Medicare-covered outpatient hospital facility visit

35% of the cost for Medicare-covered outpatient hospital facility visits

35% of the cost for Medicare-covered ambulatory surgical center visits

Chiropractic Services

$20 copay for each Medicare-covered chiropractic visit

Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part).

35% of the cost for Medicare-covered chiropractic visits.

Outpatient Mental Health Care

$40 copay for each Medicare-covered individual therapy visit

$40 copay for each Medicare-covered group therapy visit

$40 copay for each Medicare-covered individual therapy visit with a psychiatrist

$40 copay for each Medicare-covered group therapy visit with a psychiatrist

$55 copay for Medicare-covered partial hospitalization program services

35% of the cost for Medicare-covered Mental Health visits with a psychiatrist

35% of the cost for Medicare-covered Mental Health visits

35% of the cost for Medicare-covered partial hospitalization program services

Podiatry Services

$45 copay for each Medicare-covered podiatry visit

Medicare-covered podiatry visits are for medically necessary foot care.

35% of the cost for Medicare-covered podiatry visits

Substance Abuse Care

$50 copay for Medicare-covered individual substance abuse outpatient treatment visits

$50 copay for Medicare-covered group substance abuse outpatient treatment visits

35% of the cost for Medicare-covered substance abuse outpatient treatment visits

Outpatient Rehabilitation Services

Medically necessary physical therapy occupational therapy and speech and language pathology services are covered.

$45 copay for Medicare-covered Occupational Therapy visits

$45 copay for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

35% of the cost for Medicare-covered Physical Therapy and/or Speech and Language Pathology visits

35% of the cost for Medicare-covered Occupational Therapy visits.

Prosthetic Devices

20% of the cost for Medicare-covered prosthetic devices

$15 to $45 copay for Medicare-covered medical supplies related to prosthetics splints and other devices

35% of the cost for Medicare-covered prosthetic devices.

Preventive Services

$0 copay for all preventive services covered under Original Medicare at zero cost sharing. Any additional preventive services approved by Medicare mid-year will be covered by the plan or by Original Medicare.

$0 copay for a supplemental annual physical exam

35% of the cost for Medicare-covered preventive services

35% of the cost for a supplemental annual physical exam

Cardiac and Pulmonary Rehabilitation Services

$45 copay for Medicare-covered Cardiac Rehabilitation Services

$45 copay for Medicare-covered Intensive Cardiac Rehabilitation Services

$45 copay for Medicare-covered Pulmonary Rehabilitation Services

35% of the cost for Medicare-covered Cardiac Rehabilitation Services

35% of the cost for Medicare-covered Intensive Cardiac Rehabilitation Services

35% of the cost for Medicare-covered Pulmonary Rehabilitation Services

Kidney Disease and Conditions

20% of the cost for Medicare-covered renal dialysis

$15 to $45 copay for Medicare-covered kidney disease education services

35% of the cost for Medicare-covered kidney disease education services

20% of the cost for Medicare-covered renal dialysis

Additional Benefits

Dental Services

In general preventive dental benefits (such as cleaning) not covered.

$45 copay for Medicare-covered dental benefits

35% of the cost for Medicare-covered comprehensive dental benefits

Hearing Services

Hearing aids not covered.

$45 copay for Medicare-covered diagnostic hearing exams

$0 copay for up to 1 supplemental routine hearing exam(s) every year

35% of the cost for Medicare-covered diagnostic hearing exams.

35% of the cost for supplemental hearing exams.

Vision Services

$0 to $45 copay for Medicare-covered exams to diagnose and treat diseases and conditions of the eye including an annual glaucoma screening for people at risk

$0 copay for up to 1 supplemental routine eye exam(s) every year

$0 copay for one pair of Medicare-covered eyeglasses (lenses and frames) or contact lenses after cataract surgery.

If the doctor provides you services in addition to eye exams separate cost sharing of $15 to $45 may apply

35% of the cost for Medicare-covered eye exams

35% of the cost for supplemental routine eye exams

35% of the cost for Medicare-covered eyewear

Over-the-Counter Items

The plan does not cover Over-the-Counter items.

Mental Health Care

You get up to 190 days of inpatient psychiatric hospital care in a lifetime. Inpatient psychiatric hospital services count toward the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric services furnished in a general hospital.

For Medicare-covered hospital stays:

Days 1 - 5: $295 copay per day

Days 6 - 90: $0 copay per day

Plan covers 60 lifetime reserve days. $0 copay per lifetime reserve day.

35% of the cost for each Medicare-covered hospital stay.

Skilled Nursing Facility (SNF)

Plan covers up to 100 days each benefit period

No prior hospital stay is required.

For SNF stays:

Days 1 - 20: $25 copay per day

Days 21 - 100: $152 copay per day

35% of the cost for each Medicare-covered SNF stay.

Home Health Care

$0 copay for each Medicare-covered home health visit

35% of the cost for Medicare-covered home health visits

Hospice

You must get care from a Medicare-certified hospice. You must consult with your plan before you select hospice.

Transportation

This plan does not cover supplemental routine transportation.

Acupuncture

This plan does not cover Acupuncture and other alternative therapies.

Wellness/Education & Other Benefits

The plan covers the following supplemental education/wellness programs:

Health Club Membership/Fitness Classes

Nursing Hotline

Tele-monitoring

$0 copay for supplemental education/wellness programs

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