Aetna Medicare Advantra Cares (HMO D-SNP)
Aetna Medicare Advantra Cares (HMO D-SNP) H3959-035 Plan Details
Aetna Medicare Advantra Cares (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3959-035
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$0.00
Monthly Premium
Aetna Medicare Advantra Cares (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3959-035
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Aetna Medicare Advantra Cares (HMO D-SNP) H3959-035 Plan Details
Aetna Medicare Advantra Cares (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3959-035
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
$0.00
Monthly Premium
Pennsylvania Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $8850 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $8,000 |
| Primary Care Doctor Visit | $0 |
| Specialty Doctor Visit | $0 |
| Inpatient Hospital Care | $0 |
| Urgent Care | Copayment for Urgent Care $0.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0.00 Maximum Plan Benefit of $50,000 |
| Emergency Room Visit | $0 |
| Ambulance Transportation | $0 |
Health Care Services and Medical Supplies
Aetna Medicare Advantra Cares (HMO D-SNP) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).
| Coverage | Cost |
|---|---|
| Chiropractic Services | In-Network: Copayment for Medicare-covered Chiropractic Services $0.00 Copayment for Routine Care $0.00
Prior authorization required |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | 0% |
| Durable Medical Eqipment (DME) | $0 |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: $0, for more information see Evidence of Coverage Diagnostic Procedures: $0 Imaging: Xray: $0 | CT Scans: $0 | Diagnostic Radiology other than CT Scans: $0| Diagnostic Radiology Mammogram: $0 |
| Home Health Care | 0% |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0.00 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required |
| Mental Health Outpatient Care | $0 for Mental Health Group and Individual Sessions, for more information see Evidence of Coverage |$0 for Psychiatric Services Group and Individual Sessions, for more information see Evidence of Coverage |
| Outpatient Services / Surgery | Ambulatory Surgical Center: $0 |
| Outpatient Substance Abuse Care | In-Network: Copayment for Medicare-covered Individual Sessions $0.00 Copayment for Medicare-covered Group Sessions $0.00 Prior Authorization Required for Outpatient Substance Abuse Services Prior authorization required |
| Over-the-counter (OTC) Items | Over the counter (OTC) items are covered under the Extra Benefits Card, for more information see Evidence of Coverage|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit.|Seasonal over-the-counter (OTC) kit of preselected OTC items mailed twice a year, for more information see Evidence of Coverage |
| Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $0.00 Copayment for Routine Foot Care $0.00
|
| Skilled Nursing Facility Care | $0, for more information see Evidence of Coverage. |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In Network Dental Coverage|For covered services: ADA recognized dental services are covered excluding only cosmetic services, those considered medical in nature, and administrative changes.|Preventive dental services: |Oral exams: $0 copay |Cleanings: $0 copay |Fluoride treatment: $0 copay |Bitewing x-rays: $0 copay |Comprehensive dental services:|Non-routine services: $0 copay |Diagnostic services: $0 copay |Restorative services: $0 copay |Endodontics: $0 copay |Periodontics: $0 copay |Extractions: $0 copay |Prosthodontics and maxillofacial services: $0 copay |$6,000 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network:|Eye Exams:|Coinsurance for Medicare Covered Benefits 0%|Copayment for Routine Eye Exams $0 |(Maximum one exam every year)|Eyewear:|Coinsurance for Medicare Covered Benefits 0%|Copayment for Contacts $0|Copayment for Eyeglasses $0|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $500 every year. See the Evidence of Coverage |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network:|Hearing Exams:|Coinsurance for Medicare Covered Benefits 0%|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Coinsurance for Fitting/Evaluation for Hearing Aid 0%|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year)|$2,500 per ear every year, for more information see the Evidence of Coverage |
Preventive Services and Health/Wellness Education Programs
The following services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Preventive Services and Health/Wellness Education Programs | $0 copay for all preventive services covered under Original Medicare at zero cost sharing |
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