Aetna Medicare Value (PPO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by Aetna Medicare
Additional Coverage
Hearing Vision Dental
Overall Government Star Rating
 4.0
out of 5 stars

State: Indiana

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
$9,500 In and Out-of-network
$5,950 In-network
No
Yes
Yes
Yes

Medical Benefits

Doctor Services

In-network: $0 copay
Out-of-network: $30 copay per visit
In-network: $45 copay per visit
Out-of-network: $65 copay per visit

Tests, labs, & imaging

In-network: $0-75 copay
Out-of-network: 50% coinsurance
In-network: $0-15 copay
Out-of-network: $25 copay
In-network: $0-275 copay
Out-of-network: 50% coinsurance
In-network: $20 copay
Out-of-network: 50% coinsurance
$90 copay per visit (always covered)
$65 copay per visit (always covered)

Hospital Services

In-network: $290 per day for days 1 through 7
$0 per day for days 8 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
$184 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: $295 copay
Out-of-network: $295 copay

Therapy services

In-network: $40 copay
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance

Mental health services

In-network: $40 copay
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance
In-network: $40 copay
Out-of-network: 50% coinsurance

Opioid treatment services

Covered

Other services

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

TiersInitial coverage phaseGap coverage phase1Catastrophic 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 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

Extra Benefits

Hearing

In-network: $45 copay
Out-of-network: $65 copay
In-network: $0 copay
Out-of-network: $65 copay
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

In-network: $0 copay
Out-of-network: 30% coinsurance
In-network: $0 copay
Out-of-network: 30% coinsurance
Not covered
In-network: $0 copay
Out-of-network: 30% coinsurance

Comprehensive dental

In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Not covered
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Not covered

Vision

In-network: $0 copay
Out-of-network: $65 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

Other benefits

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

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