Aetna Medicare Advantra Prime Plus (HMO-POS)

4 out of 5 stars
$0.00
Monthly Premium

Aetna Medicare Advantra Prime Plus (HMO-POS) is a HMO-POS plan offered by Aetna Inc.

Plan ID: H3959-053

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 Prime Plus (HMO-POS) - H3959-053 by Aetna Inc. as well as other Medicare Advantage plans available in your area.

$0.00
Monthly Premium

Pennsylvania Counties Served

Philadelphia

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $615
Out of Pocket Max In-Network: $6900
Out-of-Network: N/A
Initial Coverage Limit $0
Catastrophic Coverage Limit $2100
Primary Care Doctor Visit
In-Network|$0
Specialty Doctor Visit
In-Network|$45
Inpatient Hospital Care
In-Network|$350 per day, days 1-7; $0 per day, days 8-90
Urgent Care

Urgent Care:
Copayment for Urgent Care $40

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $115
Maximum Plan Benefit of $250,000
Emergency Room Visit
$115 If you are admitted to the hospital within 24 hours your cost share may be waived
Ambulance Transportation
In-Network|$285

Health Care Services and Medical Supplies

Aetna Medicare Advantra Prime Plus (HMO-POS) 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 $15
Copayment for Routine Care $15
  • Maximum 12 Routine Care every year
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network|0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies|20% for other covered diabetic supplies
Durable Medical Equipment (DME)
In-Network|0% for continuous glucose monitors|20% for all other Medicare-covered DME items
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: In-Network|$0
Diagnostic Procedures: In-Network|$0
Imaging: In-Network|Xray: $20|CT Scans: $0 for services provided by your primary care provider in their office; $250 for services performed by a provider other than your primary care provider|Diagnostic Radiology other than CT Scans: $0 for services provided by your primary care provider in their office; $250 for services performed by a provider other than your primary care provider|Diagnostic Radiology Mammogram: $0
Home Health Care
In-Network|$0
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$350 per day for days 1 to 5
$0 per day for days 6 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental Health Outpatient Care
In-Network|$45 for Mental Health - Group Sessions|$45 for Mental Health - Individual Sessions|$45 for Psychiatric Services - Group Sessions|$45 for Psychiatric Services - Individual Sessions
Outpatient Services / Surgery
Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$300 all other ambulatory surgical center services
Outpatient Substance Abuse Care
In-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $45
Copayment for Medicare-covered Group Sessions $45
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter (OTC) Items
CVS Over-the-Counter (OTC) Wallet with a $25 quarterly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions.
Podiatry Services
In-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $45
Copayment for Routine Foot Care $45
  • Maximum 6 visits every year
Skilled Nursing Facility Care
In-Network|$0 per day, days 1-20; $150 per day, days 21-100

Dental Benefits

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

Coverage Cost
Dental Care
In-Network||Preventive dental services:|$0 for oral exams|$0 for cleanings|$0 for x-rays||Comprehensive dental services:|20%-50% for restorative services|20% for endodontic services|20%-50% for periodontic services|50% for removeable prosthodontics|50% for fixed prosthodontics|20% - 50% for oral and maxillofacial surgery|20% - 50% for adjunctive services

Vision Benefits

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

Coverage Cost
Vision Benefits
In-Network||Eye Exams:|$0 for Diabetic eye exams|$45 for all other Medicare-covered eye exams|$0 for non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year with an EyeMed provider||Eyewear:|$0 for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||$100 annual benefit amount (allowance) for non-Medicare covered prescription eyewear.

Hearing Benefits

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

Coverage Cost
Hearing Benefits
In-Network||Hearing Exams:|$45 for Medicare-covered hearing exams|$0 for non-Medicare covered hearing exams|(Maximum one non-Medicare covered hearing exam every year)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$500 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year)

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
In-Network|$0 for all preventive services covered under Original Medicare

Prescription Drug Costs and Coverage

The Aetna Medicare Advantra Prime Plus (HMO-POS) plan offers the following prescription drug coverage, with an annual drug deductible of $615 (excludes Tiers 1 and 2) per year.

Coverage Cost
Coverage & Cost
Annual Drug Deductible $615 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $2.00
  • Standard mail order $2.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $12.00
  • Standard mail order $12.00
  • Preferred cost-share retail $0.00
Annual Drug Deductible $615 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $4.00
  • Standard mail order $4.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $24.00
  • Standard mail order $24.00
  • Preferred cost-share retail $0.00
Annual Drug Deductible $615 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $6.00
  • Standard mail order $6.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $36.00
  • Standard mail order $36.00
  • Preferred cost-share retail $0.00
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