Aetna Medicare Assure Plan (HMO D-SNP)

Aetna Inc.
Aetna Medicare Assure Plan (HMO D-SNP) H3146-002 Plan Details
4 out of 5 stars

Aetna Medicare Assure Plan (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3146-002

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

Aetna Medicare Assure Plan (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3146-002

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

Aetna Inc.
Aetna Medicare Assure Plan (HMO D-SNP) H3146-002 Plan Details
4 out of 5 stars

Aetna Medicare Assure Plan (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3146-002

Have Medicare questions?

Talk to a licensed agent today to find a plan that fits your needs.

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $8850
Out-of-Network: N/A
Initial Coverage Limit $5030
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 $250000.00
Emergency Room Visit
$0
Ambulance Transportation
$0

Health Care Services and Medical Supplies

Aetna Medicare Assure Plan (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
Prior Authorization Required for Chiropractic Services
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, 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
  • Maximum 12 visits every year
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 |$3,000 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 $300 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)|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)|$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

Prescription Drug Costs and Coverage

The Aetna Medicare Assure Plan (HMO D-SNP) plan offers the following prescription drug coverage, with an annual drug deductible of $0 per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $0
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Preferred Brand
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Non-Preferred Drug
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Specialty Tier
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Annual Drug Deductible $0
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Preferred Brand
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Non-Preferred Drug
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Specialty Tier
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A
Annual Drug Deductible $0
Preferred Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Generic
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Preferred Brand
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Non-Preferred Drug
  • Preferred cost-share retail $0.00
  • Standard retail $0.00
  • Preferred cost-share mail order $0.00
  • Standard mail order $0.00
Specialty Tier
  • Preferred cost-share retail N/A
  • Standard retail N/A
  • Preferred cost-share mail order N/A
  • Standard mail order N/A