Luckily, his health plan has some fixed costs and only requires $30 copays for visits to his regular doctor and $50 copays to see specialists like an orthopedist. (He also once paid a $150 copay the night he landed in the emergency room when his knee was so swollen he couldn’t bend it.). Aetna Medicare Advantra Gold (HMO) H3959-002 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Pennsylvania. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Advantra Gold (HMO) has a monthly premium of $49.00 and has an in-network Maximum Out-of-Pocket limit of $4,900 (MOOP).

Specialist visit $55 copay/visit Not covered None Preventive care/screening/ immunization No charge Not covered You may have to pay for services that aren’t. Aetna Specialty Pharmacy Network. 2 of 6 -$3 Physician/surgeon fees copay Inpatient services. Health, behavioral. Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD). PPO - After a $20 deductible per member, cleanings, fillings. . Aetna directly by calling the toll free number on your Medical ID Card, or by calling our general toll free number at 1-888-982-3862. If your group health coverage is subject to ERISA, you may also contact the Department of Labor's Employee Benefits Security Administration at 1-866-444-EBSA.

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Aetna Medicare Select (HMO) H1609-021 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Select (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,450 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,450 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Select (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

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 Select (HMO) 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

Aetna Medicare Select (HMO) 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.

H1609-021 Part-D Deductible and Premium

Aetna Medicare Select (HMO) 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 . 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.

H1609-021 Formulary or Drug Coverage

Aetna Medicare Select (HMO) 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 Select (HMO) Summary of Benefits

Additional Benefits

Comprehensive Dental

Deductible

Diagnostic Tests and Procedures

Doctor Visits

Emergency care/Urgent Care

Foot Care (podiatry services)

Ground Ambulance

Hearing

Inpatient Hospital Coverage

Medical Equipment/Supplies

Medicare Part B Drugs

Mental Health Services

MOOP

Option

Optional supplemental benefits

Outpatient Hospital Coverage

Preventive Care

Preventive Dental

Rehabilitation Services

Skilled Nursing Facility

Transportation

Vision

Wellness Programs (e.g. fitness nursing hotline)

Reviews for Aetna Medicare Select (HMO) H1609

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Aetna Medicare Select (HMO) Plans Performance

Health Plan Customer Service Rating for Aetna Medicare Select (HMO)

Aetna Medicare Select (HMO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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Sun 9am-6pm EST

Coverage Area for Aetna Medicare Select (HMO)

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Specialist Copay On Aetna

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.