Aetna Medicare Premier Advantra (PPO)
Medicare Plan Details
2021 Plan
Monthly Premium
(select county for price) |

by Aetna Medicare
Additional Coverage
Hearing
Vision
Dental
Overall Government Star Rating
3.5out of 5 stars
State: Illinois
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
Plan Details
$51
$17
$34
$0
$7,550 In and Out-of-network
$7,550 In-network
$7,550 In-network
No
Yes
Yes
Yes
Medical Benefits
Doctor Services
In-network: $15 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
In-network: $45 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
Tests, labs, & imaging
In-network: $0-45 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0-110 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
$90 copay per visit (always covered)
$45 copay per visit (always covered)
Hospital Services
In-network: $315 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 30% per stay
$0 per day for days 7 through 90
Out-of-network: 30% per stay
In-network: $0-275 copay per visit
Out-of-network: 30% coinsurance per visit
Out-of-network: 30% coinsurance per visit
Skilled nursing facility
In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100
Out-of-network: 30% per stay
$184 per day for days 21 through 100
Out-of-network: 30% per stay
Preventive services
In-network: $0 copay
Out-of-network: 0-30% coinsurance
Out-of-network: 0-30% coinsurance
Ambulance
In-network: $300 copay
Out-of-network: $300 copay
Out-of-network: $300 copay
Therapy services
In-network: $30 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $30 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Mental health services
In-network: $10 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $30 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $10 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $30 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Opioid treatment services
Covered
Other services
In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item
Out-of-network: 25% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item
Out-of-network: 25% coinsurance per item
In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item
Prescription Drug Benefits
Tier drug costs for: Standard retail pharmacy drug cost for 1-month
Tiers | Initial coverage phase | Gap coverage phase1 | Catastrophic coverage phase |
---|---|---|---|
Preferred Generic | $15.00 copay | $15.00 copay |
Brand-name drugs :
|
Generic | $20.00 copay | $20.00 copay | |
Preferred Brand | $47.00 copay | ||
Non-Preferred Drug | $100.00 copay | ||
Specialty Tier | 29% | ||
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: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: 20% coinsurance
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
Extra Benefits
Hearing
In-network: $45 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Preventive Dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
In-network: $0 copay
Out-of-network: 30% coinsurance
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Other benefits
Limited coverage
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
Health Plan Star Ratings
(government star ratings are out of 5 stars)
Prescription Drug Plan Star Ratings
(government star ratings are out of 5 stars)
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