Aetna Medicare Premier Advantra (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Aetna Medicare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 3.5
out of 5 stars

State: Iowa

Select your county to view the price for this plan

 


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
$0
$10,000 In and Out-of-network
$3,900 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $10 per visit
Out-of-network: 40% per visit
In-network: $40 per visit
Out-of-network: 40% per visit

Tests, labs, & imaging

In-network: $35
Out-of-network: 40%
In-network: $0 copay
Out-of-network: 40%
In-network: $300
Out-of-network: 40%
In-network: $20
Out-of-network: 40%
$90 per visit (always covered)
$65 per visit (always covered)

Hospital Services

In-network: $325 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 40% per day for days 1 and beyond
In-network: $400 per visit
Out-of-network: 40% per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 40% per day for days 1 through 100

Preventive services

In-network: $0 copay
Out-of-network: 0-40%

Ambulance

In-network: $350
Out-of-network: $350

Therapy services

In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%

Mental health services

In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%
In-network: $40
Out-of-network: 40%

Opioid treatment services

Covered

Other services

In-network: 20% per item
Out-of-network: 40% per item
In-network: 20% per item
Out-of-network: 40% per item
In-network: 0-20% per item
Out-of-network: 0-20% per item

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phase1Catastrophic coverage phase
Preferred Generic$15.00 copay$15.00 copay


Generic drugs :
$3.60 copay or 5% (whichever costs more)

Brand-name drugs :
$8.95 copay or 5% (whichever costs more)

Generic$20.00 copay$20.00 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%
Out-of-network: 40%
In-network: 20%
Out-of-network: 40%

Extra Benefits

Hearing

In-network: $40
Out-of-network: 40%
In-network: $0 copay
Out-of-network: 40%
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

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

Comprehensive dental

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
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay

Vision

In-network: $0 copay
Out-of-network: 40%
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
Not covered
 3
 3
 3
 3
 4
 5
 4.5
 5
 5
 3
 4

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