Aetna Medicare Elite (PPO)

Medicare Plan Details (2023 Plan)


Monthly Premium

 

by Aetna Medicare
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 3.5
out of 5 stars

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Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B + Part D

 

$0
$0
$0
$750 annual deductible
$8,950 In and Out-of-network
$5,850 In-network
No
Yes
Yes
Yes

Doctor Services

In-network: $0 copay
Out-of-network: 50% coinsurance per visit
In-network: $35 copay per visit
Out-of-network: 50% coinsurance per visit

Tests, labs, & imaging

In-network: $0-35 copay
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: 50% coinsurance
In-network: $0-160 copay
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: 50% coinsurance
$90 copay per visit (always covered)
$35 copay per visit (always covered)

Hospital Services

In-network: $300 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 50% per stay
In-network: $0-325 copay per visit
Out-of-network: 50% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$188 per day for days 21 through 100
Out-of-network: 50% per stay

Preventive services

In-network: $0 copay
Out-of-network: 0-50% coinsurance

Ambulance

In-network: $330 copay
Out-of-network: $330 copay

Therapy services

In-network: $35 copay
Out-of-network: 50% coinsurance
In-network: $35 copay
Out-of-network: 50% coinsurance

Mental health services

In-network: $35 copay
Out-of-network: 50% coinsurance
In-network: $35 copay
Out-of-network: 50% coinsurance
In-network: $35 copay
Out-of-network: 50% coinsurance
In-network: $35 copay
Out-of-network: 50% coinsurance

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 20% coinsurance per item
In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$3.00 copay$3.00 copay


Generic drugs :
$4.15 copay or 5% (whichever costs more)

Brand-name drugs :
$10.35 copay or 5% (whichever costs more)

Generic$7.00 copay$7.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier33%
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

In-network: 20% coinsurance
Out-of-network: 50% coinsurance
In-network: 20% coinsurance
Out-of-network: 50% coinsurance

Hearing

In-network: $35 copay
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance

Comprehensive dental

In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance
In-network: $0 copay
Out-of-network: 20% coinsurance

Vision

In-network: $0 copay
Out-of-network: 50% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Other benefits

Limited coverage
Limited coverage
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 3.5
 3
 3
 4
 3
 5
 3
 5
 3
 3
 3

When Can I Sign Up for Medicare?

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