Aetna Medicare Premier (HMO-POS)
Wisconsin Medicare Advantage Plan (2024 Plan)
Additional Coverage
HearingVisionDental
Overall Government Star Rating
No Rating (new plan)
Plan Name
Aetna Medicare Premier (HMO-POS)
Plan Type
Medicare Advantage Plan With Part D Prescription Drug Coverage
Aetna Medicare Premier (HMO-POS) is a Medicare Advantage Plan With Part D Prescription Drug Coverage, which is available in Wisconsin and offered by the health insurance company Aetna Medicare. This plan’s network type is HMO which determines in-network doctors who accept the health plan and whether a referral is needed.
Primary doctor visit
$0 copay
Specialist visit
$30 copay per visit
ER visit
$110 copay per visit (always covered)
Aetna Medicare Premier (HMO-POS) has a monthly premium cost of $0 per month, with an annual deductible of $0 and a maximum out of pocket cost sharing of $4,200 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 Premier (HMO-POS) are defined below.
Yes
Part D Prescription Drug Coverage
Aetna Medicare Premier (HMO-POS) 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 Premier (HMO-POS) includes coverage for hearing, vision, dental.
Medicare Advantage health plans can offer even more additional benefits. Aetna Medicare Premier (HMO-POS) includes coverage for the following additional benefits:
Other benefits
Over the counter drug benefits
Home and bathroom safety devices
Health Portion of Premium
Health Plan Max Out-of-Pocket
Nationwide Coverage included
Hearing Coverage included
Doctor Services
Primary doctor visit
In-network: $0 copay
Out-of-network: No Data
Specialist visit
In-network: $30 copay per visit
Out-of-network: No Data
Tests, labs, & imaging
Diagnostic tests & procedures
In-network: $0-100 copay
Out-of-network: No Data
Lab services
In-network: $0 copay
Out-of-network: No Data
Diagnostic radiology services (like MRI)
In-network: $0-250 copay
Out-of-network: No Data
Outpatient x-rays
In-network: $20 copay
Out-of-network: No Data
Emergency care
$110 copay per visit (always covered)
Urgent care
$40 copay per visit (always covered)
Hospital Services
Inpatient hospital coverage
In-network: $300 per day for days 1 through 7
$0 per day for days 8 through 90
Out-of-network: $0 copay
Outpatient hospital coverage
In-network: $0-315 copay per visit
Out-of-network: No Data
Skilled nursing facility
Skilled nursing facility
In-network: $10 per day for days 1 through 20
$200 per day for days 21 through 41
$0 per day for days 42 through 100
Out-of-network: Not Applicable
Preventive services
Preventive services
In-network: $0 copay
Out-of-network: No Data
Ambulance
Ground ambulance
In-network: $285 copay
Out-of-network: No Data
Therapy services
Occupational therapy visit
In-network: $40 copay
Out-of-network: No Data
Physical therapy & speech & language therapy visit
In-network: $40 copay
Out-of-network: No Data
Mental health services
Outpatient group therapy with a psychiatrist
In-network: $40 copay
Out-of-network: No Data
Outpatient individual therapy with a psychiatrist
In-network: $40 copay
Out-of-network: No Data
Outpatient group therapy visit
In-network: $40 copay
Out-of-network: No Data
Outpatient individual therapy visit
In-network: $40 copay
Out-of-network: No Data
Opioid treatment services
Opioid treatment services
Other services
Durable medical equipment (like wheelchairs & oxygen)
In-network: 20% coinsurance per item
Out-of-network: No Data
Prosthetics (like braces, artificial limbs)
In-network: 20% coinsurance per item
Out-of-network: No Data
Diabetes supplies
In-network: 0-20% coinsurance per item
Out-of-network: No Data
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 |
Generic drugs :
$0 copay Brand-name drugs :
$0 copay |
Generic | $10.00 copay | $10.00 copay |
Preferred Brand | $47.00 copay | |
Non-Preferred Drug | $100.00 copay | |
Specialty Tier | 30% | |
1 For all other drugs, you pay 25% for generic drugs and 25% for brand-name drugs. |
Part B Drugs
Chemotherapy drugs
In-network: 0-20% coinsurance
Out-of-network: No Data
Other Part B drugs
In-network: 0-20% coinsurance
Out-of-network: No Data
Hearing
Hearing exam
In-network: $30 copay
Out-of-network: No Data
Fitting/evaluation
In-network: $0 copay
Out-of-network: No Data
Hearing aids - All types
In-network: $0 copay
Out-of-network: No Data
Preventive Dental
Oral exam
In-network: $0 copay
Out-of-network: 20% coinsurance
Cleaning
In-network: $0 copay
Out-of-network: 20% coinsurance
Fluoride treatment
In-network: $0 copay
Out-of-network: 20% coinsurance
Dental x-rays
In-network: $0 copay
Out-of-network: 20% coinsurance
Comprehensive dental
Non-routine services
In-network: $0 copay
Out-of-network: 20% coinsurance
Diagnostic services
In-network: $0 copay
Out-of-network: 20% coinsurance
Restorative services
In-network: $0 copay
Out-of-network: 20% coinsurance
Endodontics
In-network: $0 copay
Out-of-network: 20% coinsurance
Periodontics
In-network: $0 copay
Out-of-network: 20% coinsurance
Extractions
In-network: $0 copay
Out-of-network: 20% coinsurance
Prosthodontics, other oral/maxillofacial surgery, other services
In-network: $0 copay
Out-of-network: 20% coinsurance
Vision
Routine eye exam
In-network: $0 copay
Out-of-network: No Data
Contact lenses
In-network: $0 copay
Out-of-network: No Data
Eyeglasses (frames & lenses)
In-network: $0 copay
Out-of-network: No Data
Eyeglass frames (only)
In-network: $0 copay
Out-of-network: No Data
Eyeglass lenses (only)
In-network: $0 copay
Out-of-network: No Data
Upgrades
In-network: $0 copay
Out-of-network: No Data
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