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

3.5

out 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

Monthly Premium

$51

Health Portion of Premium

$17

Drug Portion of Premium

$34

Health Plan Deductible

Health Plan Max Out-of-Pocket

$7,550 In and Out-of-network
$7,550 In-network

Nationwide Coverage included

Hearing Coverage included

Yes

Vision Coverage included

Yes

Dental Coverage included

Yes

Doctor Lookup Link

http://www.aetnamedicare.com

Plan Link

http://www.aetnamedicare.com

Medical Benefits

Doctor Services

Primary doctor visit

In-network: $15 copay per visit
Out-of-network: 30% coinsurance per visit

Specialist visit

In-network: $45 copay per visit
Out-of-network: 30% coinsurance per visit

Tests, labs, & imaging

Diagnostic tests & procedures

In-network: $0-45 copay
Out-of-network: 30% coinsurance

Lab services

In-network: $0 copay
Out-of-network: 30% coinsurance

Diagnostic radiology services (like MRI)

In-network: $0-110 copay
Out-of-network: 30% coinsurance

Outpatient x-rays

In-network: $0 copay
Out-of-network: 30% coinsurance

Emergency care

$90 copay per visit (always covered)

Urgent care

$45 copay per visit (always covered)

Hospital Services

Inpatient hospital coverage

In-network: $315 per day for days 1 through 6
$0 per day for days 7 through 90
Out-of-network: 30% per stay

Outpatient hospital coverage

In-network: $0-275 copay 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

Preventive services

In-network: $0 copay
Out-of-network: 0-30% coinsurance

Ambulance

Ground ambulance

In-network: $300 copay
Out-of-network: $300 copay

Therapy services

Occupational therapy visit

In-network: $30 copay
Out-of-network: 30% coinsurance

Physical therapy & speech & language therapy visit

In-network: $30 copay
Out-of-network: 30% coinsurance

Mental health services

Outpatient group therapy with a psychiatrist

In-network: $10 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy with a psychiatrist

In-network: $30 copay
Out-of-network: 30% coinsurance

Outpatient group therapy visit

In-network: $10 copay
Out-of-network: 30% coinsurance

Outpatient individual therapy visit

In-network: $30 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Covered

Other services

Durable medical equipment (like wheelchairs & oxygen)

In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item

Prosthetics (like braces, artificial limbs)

In-network: 20% coinsurance per item
Out-of-network: 25% coinsurance per item

Diabetes supplies

In-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	Generic drugs : $3.70 copay or 5% (whichever costs more) Brand-name drugs : $9.20 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 Tier	29%
¹ For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs.

Part B Drugs

Chemotherapy drugs

In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Other Part B drugs

In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Extra Benefits

Hearing

Hearing exam

In-network: $45 copay
Out-of-network: 30% coinsurance

Fitting/evaluation

In-network: $0 copay
Out-of-network: 30% coinsurance

Hearing aids - All types