Health Net Aqua (PPO)


Medicare Plan Details

2020 Plan
Monthly Premium
(select county for price)

 

by Health Net Life Insurance Company
Additional Coverage
Vision
Overall Government Star Rating
 3.5
out of 5 stars

State: Oregon

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$0
$0
$0
$125 annual deductible
$5,100 In and Out-of-network
$2,500 In-network
No
No
Yes
No

Medical Benefits

Doctor Services

In-network: $12 per visit
Out-of-network: $20 per visit
In-network: $25 per visit
Out-of-network: $40 per visit

Tests, labs, & imaging

In-network: 0-15%
Out-of-network: 0-20%
In-network: $0 copay
Out-of-network: $0 copay
In-network: 15%
Out-of-network: 20%
In-network: $12
Out-of-network: $20
$120 per visit (always covered)
$25 per visit (always covered)

Hospital Services

In-network: $175 per day for days 1 through 8
$0 per day for days 9 through 90
Out-of-network: $200 per day for days 1 through 8
$0 per day for days 9 and beyond
In-network: $175 per visit
Out-of-network: $200 per visit

Skilled nursing facility

In-network: $0 per day for days 1 through 20
$170 per day for days 21 through 100
Out-of-network: $0 per day for days 1 through 20
$220 per day for days 21 through 100

Preventive services

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

Ambulance

In-network: $100
Out-of-network: $100

Therapy services

In-network: $25
Out-of-network: $40
In-network: $25
Out-of-network: $40

Mental health services

In-network: $25
Out-of-network: $40
In-network: $25
Out-of-network: $40
In-network: $25
Out-of-network: $40
In-network: $25
Out-of-network: $40

Opioid treatment services

Covered

Other services

In-network: 15% per item
Out-of-network: 20% per item
In-network: 15% per item
Out-of-network: 20% per item
In-network: $0 copay
Out-of-network: $0 or 20% per item

Prescription Drug Benefits

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

In-network: 15%
Out-of-network: 20%
In-network: 15%
Out-of-network: 20%

Extra Benefits

Hearing

In-network: $25
Out-of-network: $40
Not covered
Not covered
Not covered
Not covered

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: $10
Out-of-network: $10
In-network: $0 copay
Out-of-network: $0 copay
In-network: $0 copay
Out-of-network: $0 copay
Not covered
Not covered
Not covered

Other benefits

Limited coverage
Not covered
Not covered
Not covered
Not covered
Limited coverage
Not covered
 3.5
 3
 3
 2
 5
 4

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