Aetna Medicare SmartFit (PPO)
Missouri Medicare Advantage Plan (2024 Plan)
Monthly Premium
Additional Coverage
Overall Government Star Rating
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Plan Overview
Aetna Medicare SmartFit (PPO) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Missouri and offered by the health insurance company Aetna Medicare. This plan’s network type is PPO which determines in-network doctors who accept the health plan and whether a referral is needed.
Cost Summary
Aetna Medicare SmartFit (PPO) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $5,900 In and Out-of-network $3,900 In-network. The most common benefit costs which people evaluate when choosing a plan are costs for a primary doctor visit, specialist doctor visit, emergency room visit, and ambulance. These costs are listed in this summary section and a full list of benefit costs for Aetna Medicare SmartFit (PPO) are defined below.
Additional Benefits and Coverage
Aetna Medicare SmartFit (PPO) is a Medicare Advantage plan which does include Medicare Part D Prescription Drug coverage. Other common benefits included with Medicare Advantage plans are coverage for dental, vision, and hearing. Aetna Medicare SmartFit (PPO) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Aetna Medicare SmartFit (PPO) includes coverage for the following additional benefits:
Other benefits
Comparing the Quality Score of Aetna Medicare SmartFit (PPO) to Other Plans in Missouri
Each year the federal government evaluates the quality of Medicare Advantage and Part D Prescription Drug plans based on a 5-star scoring system. For 2024, Aetna Medicare SmartFit (PPO) received an overall government quality rating of 4.0 stars out of 5 stars.
Aetna Medicare SmartFit (PPO) performed better than Missouri’s State average overall quality score of 3.9 stars.
The government calculates an “Overall star rating” based on ratings for sub components including “Health plan star rating” and “Drug plan star rating”, which includes further subcomponents of each.
Aetna Medicare SmartFit (PPO) received 4 stars for its health plan quality score which is better than the Missouri State average health plan quality score of 3.8 stars.
Aetna Medicare SmartFit (PPO) received 4 stars for its drug plan quality score which is better than the Missouri State average drug plan quality score of 3.8 stars.
Plan Benefits and Coverage Details
$3,900 In-network
Medical Benefits
Doctor Services
Out-of-network: 45% coinsurance per visit
Out-of-network: 45% coinsurance per visit
Tests, labs, & imaging
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Hospital Services
$0 per day for days 7 through 90
Out-of-network: 45% per stay
Out-of-network: 45% coinsurance per visit
Skilled nursing facility
$203 per day for days 21 through 100
Out-of-network: 45% per stay
Preventive services
Out-of-network: 0-45% coinsurance
Ambulance
Out-of-network: $300 copay
Therapy services
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Mental health services
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Opioid treatment services
Other services
Out-of-network: 25% coinsurance per item
Out-of-network: 25% 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 | $5.00 copay | $5.00 copay |
Brand-name drugs :
|
| Generic | $10.00 copay | $10.00 copay | |
| Preferred Brand | 25% | ||
| Non-Preferred Drug | 50% | ||
| Specialty Tier | 33% | ||
| 1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. | |||
Part B Drugs
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Extra Benefits
Hearing
Out-of-network: 45% coinsurance
Out-of-network: 45% coinsurance
Out-of-network: $0 copay
Preventive Dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Comprehensive dental
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Vision
Out-of-network: 45% coinsurance
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
Out-of-network: $0 copay
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