Aetna Medicare Plus Plan (PPO) - 2022 Aetna Medicare (2024)

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H3288 - 010 - 0

Aetna Medicare Plus Plan (PPO) - 2022 Aetna Medicare (1) (3 / 5)

Aetna Medicare Plus Plan (PPO) - 2022 Aetna Medicare (2)

Aetna Medicare Plus Plan (PPO)is a Medicare Advantage (Part C) Plan by Aetna Medicare.

This page features plan details for 2022 Aetna Medicare Plus Plan (PPO)H3288 – 010 – 0 available in El Paso County.

IMPORTANT: This page features the 2022 version of this plan. See the 2024 version using the link below:

No 2024 version found. You can use the location links below to find 2024 plans in your area.

Locations

Aetna Medicare Plus Plan (PPO)is offered in the following locations.

Click to see more locations

Plan Overview

Aetna Medicare Plus Plan (PPO)offers the following coverage and cost-sharing.

Insurer:Aetna Medicare
Health Plan Deductible:$0
MOOP:$7,550.00
Drugs Covered:Yes

Please Note:

  • This plan does not charge an annual deductible for all drugs. The $300.00 annual deductible only applies to drugs on certain tiers.

Ready to sign up for Aetna Medicare Plus Plan (PPO)?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

Aetna Medicare Plus Plan (PPO)qualifies for a monthly Medicare Give Back Benefit of $105.00.

Premium Reduction:$105.00

Premium Breakdown

Aetna Medicare Plus Plan (PPO)has a monthly premium of $0. This amount includes your Part C and D premiums but does not include your Part B premium.The following is a breakdown of your monthly premium with Part B costs included.

Part BPart CPart DPart B Give BackTotal
$170.10$0.00$0.00$105.00$65.10

Please Note:

  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

Aetna Medicare Plus Plan (PPO)provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible:$300.00
Initial Coverage Limit:$4,430.00
Catastrophic Coverage Limit:$7,050.00
Drug Benefit Type:Enhanced
Gap Coverage:Yes
Formulary Link:Formulary Link

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS 25%LIS 50%LIS 75%LIS Full
$0.00$0.00$0.00$0.00$0.00

Initial Coverage Phase

After you pay your $300.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00. Once you reach that amount, you will enter the next coverage phase.

30 Day

60 Day

90 Day

30 Day

60 Day

90 Day

Gap Coverage Phase

After your total drug costs (including what this plan has paid and what you have paid) reach $4,430.00, you will pay no more than the amounts below for any drug tier until you reach $7,050.00.

30 Day

90 Day

30 Day

90 Day

Tier Cost
All other tiers (Generic)25%
All other tiers (Brand-name)25%

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,050.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.

TierCost
Generic$4.15 copay or 5% (whichever costs more)
Brand-name$10.35 copay or 5% (whichever costs more)

Additional Benefits

Aetna Medicare Plus Plan (PPO)also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services: Not covered
Endodontics: Not covered
Extractions: Not covered
Non-routine services: Not covered
Periodontics: Not covered
Prosthodontics, other oral/maxillofacial surgery, other services: Not covered
Restorative services: Not covered

Dental (preventive)

Cleaning:In-Network: $0 copay (limits may apply)
Cleaning:Out-of-Network: 30% coinsurance (limits may apply)
Dental x-ray(s):In-Network: $0 copay (limits may apply)
Dental x-ray(s):Out-of-Network: 30% coinsurance (limits may apply)
Fluoride treatment: Not covered
Oral exam:In-Network: $0 copay (limits may apply)
Oral exam:Out-of-Network: 30% coinsurance (limits may apply)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):In-Network: $0-375 copay (authorization required)
Diagnostic radiology services (e.g., MRI):Out-of-Network: 50% coinsurance (authorization required)
Diagnostic tests and procedures:In-Network: $0-50 copay (authorization required)
Diagnostic tests and procedures:Out-of-Network: 50% coinsurance (authorization required)
Lab services:In-Network: $0 copay (authorization required)
Lab services:Out-of-Network: 50% coinsurance (authorization required)
Outpatient x-rays:In-Network: $50 copay (authorization required)
Outpatient x-rays:Out-of-Network: 50% coinsurance (authorization required)

Doctor visits

Primary:In-Network: $0 copay
Primary:Out-of-Network: 50% coinsurance per visit
Specialist:In-Network: $50 copay per visit
Specialist:Out-of-Network: 50% coinsurance per visit

Emergency care/Urgent care

Emergency: $90 copay per visit (always covered)
Urgent care: $0-65 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:In-Network: $50 copay
Foot exams and treatment:Out-of-Network: 50% coinsurance
Routine foot care: Not covered

Ground ambulance

In-Network: $255 copay
Out-of-Network: $255 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation: Not covered
Hearing aids – inner ear: Not covered
Hearing aids – outer ear: Not covered
Hearing aids – over the ear: Not covered
Hearing exam:In-Network: $50 copay
Hearing exam:Out-of-Network: 50% coinsurance

Hospital coverage (inpatient)

In-Network: $335 per day for days 1 through 6
$0 per day for days 7 through 90 (authorization required)
Out-of-Network: 50% per stay (authorization required)

Hospital coverage (outpatient)

In-Network: $0-325 copay per visit (authorization required)
Out-of-Network: 50% coinsurance per visit (authorization required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$11,300 In and Out-of-network
$7,550 In-network

Medical equipment/supplies

Diabetes supplies:In-Network: 0-20% coinsurance per item (authorization required)
Diabetes supplies:Out-of-Network: 0-20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):In-Network: 20% coinsurance per item (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):Out-of-Network: 35% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):In-Network: 20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):Out-of-Network: 35% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:In-Network: 20% coinsurance (authorization required)
Chemotherapy:Out-of-Network: 50% coinsurance (authorization required)
Other Part B drugs:In-Network: 20% coinsurance (authorization required)
Other Part B drugs:Out-of-Network: 50% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:In-Network: $1,871 per stay (authorization required)
Inpatient hospital – psychiatric:Out-of-Network: 50% per stay (authorization required)
Outpatient group therapy visit with a psychiatrist:In-Network: $40 copay (authorization required)
Outpatient group therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required)
Outpatient group therapy visit:In-Network: $40 copay (authorization required)
Outpatient group therapy visit:Out-of-Network: 50% coinsurance (authorization required)
Outpatient individual therapy visit with a psychiatrist:In-Network: $40 copay (authorization required)
Outpatient individual therapy visit with a psychiatrist:Out-of-Network: 50% coinsurance (authorization required)
Outpatient individual therapy visit:In-Network: $40 copay (authorization required)
Outpatient individual therapy visit:Out-of-Network: 50% coinsurance (authorization required)

Optional supplemental benefits

No

Preventive care

In-Network: $0 copay
Out-of-Network: 0-50% coinsurance

Rehabilitation services

Occupational therapy visit:In-Network: $40 copay (authorization required)
Occupational therapy visit:Out-of-Network: 50% coinsurance (authorization required)
Physical therapy and speech and language therapy visit:In-Network: $40 copay (authorization required)
Physical therapy and speech and language therapy visit:Out-of-Network: 50% coinsurance (authorization required)

Skilled Nursing Facility

In-Network: $0 per day for days 1 through 20
$188 per day for days 21 through 100 (authorization required)
Out-of-Network: 40% per stay (authorization required)

Transportation

Not covered

Vision

Contact lenses:In-Network: $0 copay (limits may apply)
Contact lenses:Out-of-Network: $0 copay (limits may apply)
Eyeglass frames:In-Network: $0 copay (limits may apply)
Eyeglass frames:Out-of-Network: $0 copay (limits may apply)
Eyeglass lenses:In-Network: $0 copay (limits may apply)
Eyeglass lenses:Out-of-Network: $0 copay (limits may apply)
Eyeglasses (frames and lenses):In-Network: $0 copay (limits may apply)
Eyeglasses (frames and lenses):Out-of-Network: $0 copay (limits may apply)
Other:In-Network: $0 copay
Other:Out-of-Network: 50% coinsurance
Routine eye exam:In-Network: $0 copay (limits may apply)
Routine eye exam:Out-of-Network: 50% coinsurance (limits may apply)
Upgrades:In-Network: $0 copay (limits may apply)
Upgrades:Out-of-Network: $0 copay (limits may apply)

Wellness programs (e.g., fitness, nursing hotline)

Covered

Ready to sign up for Aetna Medicare Plus Plan (PPO)?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Table of Contents

Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.

SMID: MULTIPLAN_HCIHNDOGMED01_M

Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.

This is a promotional communication.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B Premium give-back is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov.We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period

We do not feature every plan available in your area. Any information we provide is limited to those plans we do feature in your area. Enrollment is offered through our partners including HealthCompare Insurance Services.

HealthCompare Insurance Services does not offer every plan available in your area. Currently, HealthCompare Insurance Services represents 18 organizations, which offer 52,101 products in your area.

HealthCompare Insurance Services represents Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

Please contactMedicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

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Aetna Medicare Plus Plan (PPO) - 2022 Aetna Medicare (2024)

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