Aetna No Copay

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Applicable plans: Applies to all Aetna plans; self-insured plan sponsors can opt out. Description: Until at least June 4th, 2020, Aetna will waive member cost sharing for any covered telemedicine visits — regardless of diagnosis. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. Second opinion: $0 copay No limit. Telehealth: $0 copay No limit. Renal dialysis and hemodialysis services (outpatient): $0 copay No limit. Notes: All benefits provided must be medically necessary. Copays apply to all members, unless they are exempt. Copays are limited to no more than 5% of your family’s total income every three months. 100%, no copay Not covered Routine eye exam and/or contact lenses fitting (one each per calendar year) 100%, no copay Not covered Prescription eyewear – lenses, frames and contacts. You are also eligible to use Aetna ® vision discounts. 100%, no copay, up to a $150 maximum benefit per person per calendar year 100%, no copay, up to a $150. Aetna Better Health of Kentucky is part of Aetna ®, one of the nation's leading health care providers and a part of the CVS Health ® family. We have over 30 years of experience serving Medicaid populations including children, adults and people with disabilities or other serious health conditions.

This Aetna Medicare plan does offer additional coverage through the gap. H1608-040 Formulary or Drug Coverage. Aetna Medicare Advantra Value (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.


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Aetna Medicare Advantra Value (PPO) H1608-040 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in West Virginia. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Advantra Value (PPO) has a monthly premium of $0 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 Advantra Value (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 Advantra Value (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.



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2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:
H1608-040
Provider:Aetna Medicare
Year:2021
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $7,550
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
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:H1608-041

Aetna Medicare Advantra Value (PPO) Part-C Premium

Aetna Medicare plan charges a $0 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.


H1608-040 Part-D Deductible and Premium

Aetna Medicare Advantra Value (PPO) has a monthly drug premium of $0 and a $0 drug deductible. This Aetna Medicare plan offers a $0 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 $0 . Document inspector. 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.


H1608-040 Formulary or Drug Coverage

Aetna Medicare Advantra Value (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 Advantra Value (PPO) Summary of Benefits



Additional Benefits


No


Comprehensive Dental


Diagnostic services$0 copay
Diagnostic services$0 copay (Out-of-Network)
Endodontics$0 copay (Out-of-Network)
Endodontics$0 copay
Extractions$0 copay
Extractions$0 copay (Out-of-Network)
Non-routine services$0 copay (Out-of-Network)
Non-routine services$0 copay
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 (Out-of-Network)
Restorative services$0 copay


Deductible


Aetna not payable remark codes
$950 annual deductible


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-325 copay
Diagnostic radiology services (e.g., MRI)40% coinsurance (Out-of-Network)
Diagnostic tests and procedures40% coinsurance (Out-of-Network)
Diagnostic tests and procedures$0-20 copay
Lab services40% coinsurance (Out-of-Network)
Lab services$0-10 copay
Outpatient x-rays40% coinsurance (Out-of-Network)
Outpatient x-rays$25 copay


Doctor Visits


Primary$10 copay per visit
Primary40% coinsurance per visit (Out-of-Network)
Specialist$45 copay per visit
Specialist40% coinsurance per visit (Out-of-Network)


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$30 copay
Foot exams and treatment40% coinsurance (Out-of-Network)
Routine foot care$30 copay
Routine foot care40% coinsurance (Out-of-Network)


Ground Ambulance


$275 copay (Out-of-Network)
$275 copay


Hearing


Fitting/evaluation$0 copay
Fitting/evaluation40% coinsurance (Out-of-Network)
Hearing aids$0 copay
Hearing aids$0 copay (Out-of-Network)
Hearing exam$40 copay
Hearing exam40% coinsurance (Out-of-Network)


Inpatient Hospital Coverage


$195 per day for days 1 through 9
$0 per day for days 10 through 90
40% per stay (Out-of-Network)


Medical Equipment/Supplies


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


Medicare Part B Drugs


Chemotherapy40% coinsurance (Out-of-Network)
Chemotherapy20% coinsurance
Other Part B drugs20% coinsurance
Other Part B drugs40% coinsurance (Out-of-Network)


Mental Health Services


Inpatient hospital - psychiatric40% per stay (Out-of-Network)
Inpatient hospital - psychiatric$1,590 per stay
Outpatient group therapy visit45% coinsurance (Out-of-Network)
Outpatient group therapy visit$40 copay
Outpatient group therapy visit with a psychiatrist$40 copay
Outpatient group therapy visit with a psychiatrist45% coinsurance (Out-of-Network)
Outpatient individual therapy visit45% coinsurance (Out-of-Network)
Outpatient individual therapy visit$40 copay
Outpatient individual therapy visit with a psychiatrist45% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist$40 copay


MOOP


$11,300 In and Out-of-network
$7,550 In-network


Option


No


Optional supplemental benefits


Aetna No Copay
No


Outpatient Hospital Coverage


40% coinsurance per visit (Out-of-Network)
$0-325 copay per visit


Preventive Care


0-40% coinsurance (Out-of-Network)
$0 copay


Preventive Dental


Cleaning$0 copay
Cleaning$0 copay (Out-of-Network)
Dental x-ray(s)$0 copay (Out-of-Network)
Dental x-ray(s)$0 copay
Fluoride treatment$0 copay (Out-of-Network)
Fluoride treatment$0 copay
Oral exam$0 copay
Oral exam$0 copay (Out-of-Network)


Rehabilitation Services


Occupational therapy visit40% coinsurance (Out-of-Network)
Occupational therapy visit$30 copay
Physical therapy and speech and language therapy visit$30 copay
Physical therapy and speech and language therapy visit40% coinsurance (Out-of-Network)

Aetna Copay Plans



Skilled Nursing Facility


40% per stay (Out-of-Network)
$0 per day for days 1 through 20
$184 per day for days 21 through 100

Aetna No Copay Assistance


Transportation


Aetna Copay For Specialist

Not covered


Vision


Contact lensesNot covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
Eyeglasses (frames and lenses)Not covered
Other$40 copay
Other40% coinsurance (Out-of-Network)
Routine eye exam$0 copay
Routine eye exam40% coinsurance (Out-of-Network)
UpgradesNot covered


Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for Aetna Medicare Advantra Value (PPO) H1608


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
Plans

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

Aetna No Copay Telemedicine


Member Complaints and Changes in Aetna Medicare Advantra Value (PPO) Plans Performance

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

Aetna Prescription Copays


Health Plan Customer Service Rating for Aetna Medicare Advantra Value (PPO)

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

Aetna Medicare Advantra Value (PPO) Drug Plan Customer Service Ratings

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

Aetna No Pay Rap


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


Ready to Enroll?


Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST



Coverage Area for Aetna Medicare Advantra Value (PPO)

(Click county to compare all available Advantage plans)

State: West Virginia
County:Boone,Braxton,Cabell,Calhoun,Clay,
Fayette,Gilmer,Greenbrier,Jackson,
Kanawha,Lincoln,Logan,Mason,
McDowell,Mercer,Mingo,Monroe,
Nicholas,Pendleton,Pleasants,Pocahontas,
Putnam,Raleigh,Ritchie,Roane,
Summers,Wayne,Webster,Wirt,
Wood,Wyoming,

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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.





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