Aetna Medicare Advantra Eagle (HMO)

Aetna Inc.
Aetna Medicare Advantra Eagle (HMO) H1692-006 Plan Details
3.5 out of 5 stars

Aetna Medicare Advantra Eagle (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1692-006.

$0.00
Monthly Premium

Aetna Medicare Advantra Eagle (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1692-006.

Aetna Inc.
Aetna Medicare Advantra Eagle (HMO) H1692-006 Plan Details
3.5 out of 5 stars

Aetna Medicare Advantra Eagle (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1692-006.

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $-1
Out of Pocket Max In-Network: $6900
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $7,050
Primary Care Doctor Visit
$0
Specialty Doctor Visit
$35
Inpatient Hospital Care
$300 per stay
Urgent Care
Copayment for Urgent Care $50.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $90.00
Emergency Room Visit
$90 If you are admitted to the hospital within 24 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance Transportation
$235

Health Care Services and Medical Supplies

Aetna Medicare Advantra Eagle (HMO) 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 $20.00
Prior Authorization Required for Chiropractic Services
Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable Medical Eqipment (DME)
20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: Lab Services: $0 in-network/ $0 Lab Services: $0 in-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $0 in-network/ $0 Diagnostic Procedures/Tests: $0 in-network, for more information see Evidence of Coverage
Imaging: Xray: $15 in-network / CT Scans: $0 for services provided by your primary care physician in their office in-network; $275 for services performed by a provider other than your primary care physician in-network / Diagnostic Radiology other than CT Scans: $0 for services provided by your primary care physician in their office in-network; $275 for services performed by a provider other than your primary care physician in-network / Diagnostic Radiology Mammogram: $0 in-network, for more information see Evidence of Coverage
Home Health Care
$0
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$176.00 per day for days 1 to 9
$0.00 per day for days 10 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
Mental Health:
Group Sessions: $40 in-network/
Individual Sessions: $40 in-network, for more information see Evidence of Coverage

Psychiatric Services:
Group Sessions: $40 in-network/
Individual Sessions: $40 in-network, for more information see Evidence of Coverage
Outpatient Services / Surgery
Ambulatory Surgical Center: $200 in-network / ASC Screening Colonoscopy Polyp Removal: $0 in-network, for more information see Evidence of Coverage
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $45.00
Copayment for Medicare-covered Group Sessions $45.00
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Over-the-counter (OTC) Items
$60 every three months
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $35.00
Copayment for Routine Foot Care $35.00
  • Maximum 1 visit every three months
Skilled Nursing Facility Care
$0 per day, days 1-20
$188 per day, days 21-100 in-network, for more information see Evidence of Coverage

Dental Benefits

The following dental services are covered from in-network providers.

Coverage Cost
Dental Care
$2,000 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
$200 every year, see the Evidence of Coverage

Hearing Benefits

The following hearing services are covered from in-network providers.

Coverage Cost
Hearing Benefits
$1,250 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