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Aetna Medicare Choice Plan (PPO) H3288-008 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Texas. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Choice Plan (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 Choice Plan (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.
This Aetna Medicare plan does offer additional coverage through the gap. H3288-008 Formulary or Drug Coverage. Aetna Medicare Choice Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. For Individual Aetna Medicare Advantage members, we’re waiving copays for in-network primary care telehealth through the end of the Public Health Emergency. For Medicare Advantage members covered under an employer group sponsored plan, cost shares for these services may have been waived but will resume on February 15, 2021. Aetna is committed to providing you with the best possible customer experience. We value you and are looking forward to helping you improve your health and well-being, one healthy day at a time. Aetna administers the following health plan options for the State of Illinois: Aetna HMO (Formerly Coventry HMO) Aetna OAP (Formerly Coventry OAP).
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 Choice Plan (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: | H3288-008 |
| 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: | $300.0 |
| Tiers with No Deductible: | 1 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H3288-009 |
Aetna Medicare Choice Plan (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.
H3288-008 Part-D Deductible and Premium
Aetna Medicare Choice Plan (PPO) has a monthly drug premium of $0 and a $300.0 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 . 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.
H3288-008 Formulary or Drug Coverage
Aetna Medicare Choice Plan (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 Choice Plan (PPO) Summary of Benefits
Additional Benefits
| No |
|---|
Comprehensive Dental
| Diagnostic services | Not covered |
|---|---|
| Endodontics | Not covered |
| Extractions | Not covered |
| Non-routine services | Not covered |
| Periodontics | Not covered |
| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
| Restorative services | Not covered |
Deductible
| $0 |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-325 copay |
|---|---|
| Diagnostic radiology services (e.g., MRI) | 50% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | 50% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | $0-50 copay |
| Lab services | $0 copay |
| Lab services | 50% coinsurance (Out-of-Network) |
| Outpatient x-rays | $50 copay |
| Outpatient x-rays | 50% coinsurance (Out-of-Network) |
Doctor Visits
| Primary | 50% coinsurance per visit (Out-of-Network) |
|---|---|
| Primary | $0 copay |
| Specialist | $50 copay per visit |
| Specialist | 50% coinsurance per visit (Out-of-Network) |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $0-65 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | 50% coinsurance (Out-of-Network) |
|---|---|
| Foot exams and treatment | $50 copay |
| Routine foot care | Not covered |
Ground Ambulance
| $280 copay |
|---|
| $280 copay (Out-of-Network) |
Hearing
| Fitting/evaluation | Not covered |
|---|---|
| Hearing aids - inner ear | Not covered |
| Hearing aids - outer ear | Not covered |
| Hearing aids - over the ear | Not covered |
| Hearing exam | 50% coinsurance (Out-of-Network) |
| Hearing exam | $50 copay |
Inpatient Hospital Coverage
| $315 per day for days 1 through 7 $0 per day for days 8 through 90 |
|---|
| 50% per stay (Out-of-Network) |
Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
|---|---|
| Diabetes supplies | 0-20% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 45% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
| Prosthetics (e.g., braces, artificial limbs) | 45% coinsurance per item (Out-of-Network) |
Aetna Copay Plans
Medicare Part B Drugs
| Chemotherapy | 50% coinsurance (Out-of-Network) |
|---|---|
| Chemotherapy | 20% coinsurance |
| Other Part B drugs | 20% coinsurance |
| Other Part B drugs | 50% coinsurance (Out-of-Network) |
Mental Health Services
| Inpatient hospital - psychiatric | 50% per stay (Out-of-Network) |
|---|---|
| Inpatient hospital - psychiatric | $1,871 per stay |
| Outpatient group therapy visit | $40 copay |
| Outpatient group therapy visit | 50% coinsurance (Out-of-Network) |
| Outpatient group therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
| Outpatient group therapy visit with a psychiatrist | $40 copay |
| Outpatient individual therapy visit | $40 copay |
| Outpatient individual therapy visit | 50% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
| Outpatient individual therapy visit with a psychiatrist | 50% coinsurance (Out-of-Network) |
MOOP
| $11,300 In and Out-of-network $7,550 In-network |
|---|
Option
| No |
|---|
Optional supplemental benefits
| No |
|---|
Aetna Copay Waived
Outpatient Hospital Coverage
| $0-275 copay per visit |
|---|
| 50% coinsurance per visit (Out-of-Network) |
Preventive Care
| $0 copay |
|---|
| 0-50% coinsurance (Out-of-Network) |
Preventive Dental
| Cleaning | 30% coinsurance (Out-of-Network) |
|---|---|
| Cleaning | $0 copay |
| Dental x-ray(s) | $0 copay |
| Dental x-ray(s) | 30% coinsurance (Out-of-Network) |
| Fluoride treatment | Not covered |
| Oral exam | 30% coinsurance (Out-of-Network) |
| Oral exam | $0 copay |
Rehabilitation Services
| Occupational therapy visit | 50% coinsurance (Out-of-Network) |
|---|---|
| Occupational therapy visit | $40 copay |
| Physical therapy and speech and language therapy visit | 50% coinsurance (Out-of-Network) |
| Physical therapy and speech and language therapy visit | $40 copay |
Skilled Nursing Facility
| 50% per stay (Out-of-Network) |
|---|
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
Transportation
| Not covered |
|---|
Vision
| Contact lenses | $0 copay |
|---|---|
| Contact lenses | $0 copay (Out-of-Network) |
| Eyeglass frames | $0 copay |
| Eyeglass frames | $0 copay (Out-of-Network) |
| Eyeglass lenses | $0 copay (Out-of-Network) |
| Eyeglass lenses | $0 copay |
| Eyeglasses (frames and lenses) | $0 copay (Out-of-Network) |
| Eyeglasses (frames and lenses) | $0 copay |
| Other | 50% coinsurance (Out-of-Network) |
| Other | $50 copay |
| Routine eye exam | $0 copay |
| Routine eye exam | 50% coinsurance (Out-of-Network) |
| Upgrades | $0 copay |
| Upgrades | $0 copay (Out-of-Network) |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Coverage Area for Aetna Medicare Choice Plan (PPO)
(Click county to compare all available Advantage plans)
| State: | Texas |
|---|---|
| County: | Anderson,Bell,Bosque,Cherokee,Cooke, Ellis,Fannin,Grayson,Gregg, Harrison,Henderson,Hill,Hood, Hunt,Johnson,Kaufman,Limestone, Marion,McLennan,Montague,Nacogdoches, Navarro,Parker,Rains,Rockwall, Rusk,Smith,Somervell,Upshur, Van Zandt,Wise,Wood, |
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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.
Published April 2, 2020
Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.
The Centers for Medicare & Medicaid Services (CMS) mandated in early March that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers. A COVID-19 vaccine will also be covered if and when one becomes available.
Now, some private insurance carriers are going a step further by eliminating cost-sharing for COVID-19 treatment protocols as well.
Cigna, Humana and Aetna have each taken measures to reduce out-of-pocket spending for their Medicare plan members who undergo treatment for the disease. These out-of-pocket costs can include plan deductibles, coinsurance and copayments.
COVID-19 treatment can potentially include inpatient hospital stays, doctor’s office appointments, inpatient skilled nursing facility stays, home health visits and emergency ambulance transportation.
These services can typically come with costs such as copays and deductibles.
With waived coinsurance and deductibles for COVID-19 treatment, savings can add up
Cigna and Humana both waived COVID-19-related cost-sharing for their Medicare Advantage (Medicare Part C) plans.
Medicare Advantage plans cover the same inpatient and outpatient services and items that are covered by Original Medicare (Medicare Part A and Part B).
While Original Medicare is provided by the federal government, private insurance companies administer Medicare Advantage plans.
Aetna Copay
Some of the out-of-pocket costs that a beneficiary who has Original Medicare may face if they receive covered COVID-19 treatment include:
- Beneficiaries who have Original Medicare and who receive inpatient hospital treatment for COVID-19 will typically have to pay the 2020 Medicare Part A deductible of $1,408 for each benefit period that they receive inpatient care.
There are also Part A daily coinsurance costs for lengthy hospital stays that last longer than 60 days. - Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care.
After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay for covered services and items.
For members of Medicare Advantage plans from Cigna and Humana, however, those costs will be waived for covered COVID-19 treatment.
“Our customers with COVID-19 should focus on fighting this virus and preventing its spread,” David M. Cordani, President and CEO of Cigna1
“While our customers focus on regaining their health, we have their backs,” David Cordani, President and CEO of Cigna, said in a statement.
Cigna’s cost-sharing waiver expires May 31, 2020.
“We know we’re uniquely positioned to help our members during this unprecedented health crisis,” said Bruce Broussard, President and CEO of Humana. “It’s why we’re taking this significant action to help ease the burden on seniors and others who are struggling right now.”2
Humana’s waivers includes costs related to COVID-19 treatment by both in-network and out-of-network facilities or physicians.
Humana’s cost sharing waivers currently have no end date, as the company plans to readdress the situation as needed.
Aetna, a CVS Health company, is also dismissing COVID-19-related inpatient cost-sharing for its members.
“The additional steps we’re announcing today are consistent with our commitment to delivering timely and seamless access to care as we navigate the spread of COVID-19,” said Karen S. Lynch, president of Aetna Business Unit. “We are doing everything we can to make sure our members have simple and affordable access to the treatment they need as we face the pandemic together.”3
Aetna’s cost-sharing waiver for inpatient admissions to any in-network facility for treatment of COVID-19 is currently in effect until June 1, 2020.