Aetna Medicare Essential Plan (PPO)
Medicare Plan Details (2023 Plan)
Monthly Premium

by Aetna Medicare
Additional Coverage
Overall Government Star Rating
3.5Ready to Enroll Online?
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
$7,500 In-network
Medical Benefits
Doctor Services
Out-of-network: $55 copay per visit
Out-of-network: $60 copay per visit
Tests, labs, & imaging
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Hospital Services
$0 per day for days 6 through 90
Out-of-network: 50% per stay
Out-of-network: 50% coinsurance per visit
Skilled nursing facility
$196 per day for days 21 through 100
Out-of-network: 50% per stay
Preventive services
Out-of-network: $0 copay
Ambulance
Out-of-network: $260 copay
Therapy services
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Mental health services
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Opioid treatment services
Other services
Out-of-network: 45% coinsurance per item
Out-of-network: 45% 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
Out-of-network: 50% coinsurance
Out-of-network: 50% coinsurance
Extra Benefits
Hearing
Out-of-network: $60 copay
Out-of-network: $60 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: $60 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
Other benefits
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)
When Can I Sign Up for Medicare?
Enter your birthday month and year to learn when you can sign up for different Medicare plan options.
Medicare Health Plans
Get Advice & Sign Up Help
Speak with a Licensed Insurance Agent
No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! Plan availability depends on your location. Licensed agents may not be able to provide assistance for all plans shown on this site.
Best North Carolina Medicare Advantage Health Insurance Companies for 2023
In this article we rank North Carolina Medicare Advantage plans based on our evaluation of government 5-star quality scores. Each year the government rates the quality of Medicare Advantage health insurance plans with a 5-star quality score. An overall quality score is assigned to each plan which is based on the scores of various quality metrics.
New North Carolina Medicare Advantage Health Insurance Companies for 2023
The Medicare landscape in North Carolina is constantly changing. In this article we show a summary of new and returning health insurance companies offering Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D) in North Carolina.