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Aetna Medicare Advantra Plan (HMO)
The Centers for Medicare & Medicaid Services (CMS) publishes annual Star Ratings that reflect how each Medicare Advantage plan performs across a range of metrics, using a system of one to five stars.
$28.00
Monthly Premium
Aetna Medicare Advantra Plan (HMO) is a HMO plan offered by Aetna Inc.
Plan ID: H3928-002
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Medicare beneficiaries may find it helpful to review available Medicare Advantage plans in their area. Medicare Advantage plans are designed to combine the coverage offered from Original Medicare (Medicare Part A and Part B) while also offering additional benefits.
Many Medicare Advantage plans may cover prescription drug coverage as well as additional benefits such as Dental, Vision and Hearing.
Learn more about Medicare Advantage plans such as Aetna Medicare Advantra Plan (HMO) - H3928-002 by Aetna Inc. as well as other Medicare Advantage plans available in your area.
$28.00
Monthly Premium
Louisiana Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $150 |
| Out of Pocket Max |
In-Network: $6000 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $7400 |
| Primary Care Doctor Visit | $5 |
| Specialty Doctor Visit | $35 |
| Inpatient Hospital Care | $145 per day, days 1-10; $0 per day, days 11-90 |
| Urgent Care | Urgent Care: Copayment for Urgent Care $35.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110.00 Maximum Plan Benefit of $250000.00 |
| Emergency Room Visit | $110 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 | $250 |
Health Care Services and Medical Supplies
Aetna Medicare Advantra Plan (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: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $20.00 Prior Authorization Required for Chiropractic Services |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | 0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies. |
| Durable Medical Equipment (DME) | 20% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: Lab Services: $0 in-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $5 for services provided by your primary care physician in their office in-network; $95 for services performed by a provider other than your primary care physician in-network, for more information see Evidence of Coverage Imaging: Xray: $5 for services provided by your primary care physician in their office in-network; $35 for services performed by a provider other than your primary care physician in-network / CT Scans: $190 in-network / Diagnostic Radiology other than CT Scans: $190 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: $295.00 per day for days 1 to 5 $0.00 per day for days 6 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental Health Outpatient Care | Mental Health - Group Sessions: $30 in-network/ Mental Health - Individual Sessions: $30 in-network, for more information see Evidence of Coverage
Psychiatric Services - Group Sessions: $30 in-network/ Psychiatric Services - Individual Sessions: $30 in-network, for more information see Evidence of Coverage |
| Outpatient Services / Surgery | Ambulatory Surgical Center: $150 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network, for more information see Evidence of Coverage |
| Outpatient Substance Abuse Care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $30.00 Copayment for Medicare-covered Group Sessions $30.00 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter (OTC) Items | In-Network:
Over-The-Counter (OTC) items:
Copayment for Over-The-Counter (OTC) items $0
Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit
$105 quarterly OTC allowance, for more information see Evidence of Coverage |
| Podiatry Services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $35.00 |
| Skilled Nursing Facility Care | $0 per day, days 1-20; $196 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 | In Network Dental Coverage
This benefit covers most dental treatments with the exception of cosmetic services.
Preventive dental services:
• Oral exams: $0 copay
• Cleanings: $0 copay
• Fluoride treatments: $0 copay
• Dental 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
Preventive and comprehensive dental services are not covered out-of-network.
$750 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:
Copayment for Medicare Covered Benefits $0-$35
Copayment for Routine Eye Exams $0
- Maximum one exam every year
Eyewear:
Copayment 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 $250 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:
Copayment for Medicare Covered Benefits $35
Copayment for Routine hearing Exams $0
- Maximum one exam every year
Copayment 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
$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 |
Prescription Drug Costs and Coverage
The Aetna Medicare Advantra Plan (HMO) plan offers the following prescription drug coverage, with an annual drug deductible of $150 (excludes Tiers 1, 2 and 3) per year.
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual Drug Deductible | $150 (excludes Tiers 1, 2 and 3) |
| Preferred Generic |
|
| Generic |
|
| Preferred Brand |
|
| Annual Drug Deductible | $150 (excludes Tiers 1, 2 and 3) |
| Preferred Generic |
|
| Generic |
|
| Preferred Brand |
|
| Annual Drug Deductible | $150 (excludes Tiers 1, 2 and 3) |
| Preferred Generic |
|
| Generic |
|
| Preferred Brand |
|