Aetna Medicare Credit Plan (PPO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by Aetna Medicare
Additional Coverage
HearingVision
Overall Government Star Rating
 4.5
out of 5 stars

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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
$11,300 In and Out-of-network
$7,550 In-network
No
Yes
Yes
No

Doctor Services

In-network: $15 copay per visit
Out-of-network: $50 copay per visit
In-network: $45 copay per visit
Out-of-network: $60 copay per visit

Tests, labs, & imaging

In-network: $0-45 copay
Out-of-network: 30% coinsurance
In-network: $0-10 copay
Out-of-network: 30% coinsurance
In-network: $0-450 copay
Out-of-network: 30% coinsurance
In-network: $50 copay
Out-of-network: 30% coinsurance
$90 copay per visit (always covered)
$50 copay per visit (always covered)

Hospital Services

In-network: $395 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $500 per day for days 1 through 20
$0 per day for days 21 through 90
In-network: $0-395 copay per visit
Out-of-network: 30% coinsurance per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$188 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

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

Therapy services

In-network: $40 copay
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance

Mental health services

In-network: $40 copay
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance
In-network: $40 copay
Out-of-network: 30% coinsurance

Opioid treatment services

Covered

Other services

In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 20% coinsurance per item
Out-of-network: 30% coinsurance per item
In-network: 0-20% coinsurance per item
Out-of-network: 0-20% coinsurance per item

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 :
$3.95 copay or 5% (whichever costs more)

Brand-name drugs :
$9.85 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 Tier27%
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
In-network: 20% coinsurance
Out-of-network: 30% coinsurance

Hearing

In-network: $45 copay
Out-of-network: $60 copay
In-network: $0 copay
Out-of-network: $60 copay
In-network: $0 copay
Out-of-network: $0 copay

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

In-network: $0 copay
Out-of-network: $60 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
Not covered
Not covered
Not covered
Limited coverage
Limited coverage
Limited coverage
 4.5
 5
 4
 4
 4
 5
 4.5
 5
 5
 4
 4

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