Aetna Medicare Assure Plan (HMO D-SNP)
Aetna Medicare Assure Plan (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H3312-070.
$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: H3312-070.
New York Counties Served
Cattaraugus
Fairfield
Genesee
Livingston
Monroe
Broome
Cayuga
Chautauqua
Chemung
Chenango
Clinton
Columbia
Cortland
Delaware
Dutchess
Erie
Franklin
Fulton
Greene
Hamilton
Herkimer
Jefferson
Lewis
Madison
Montgomery
Niagara
Oneida
Onondaga
Ontario
Orange
Orleans
Oswego
Otsego
Passaic
Putnam
Rensselaer
Saint Lawrence
Saratoga
Schenectady
Schoharie
Schuyler
Seneca
Steuben
Sullivan
Tioga
Tompkins
Ulster
Warren
Washington
Wayne
Wyoming
Yates
Basic Costs and Coverage
Coverage | Cost |
---|---|
Monthly Deductible | $0 |
Out of Pocket Max |
In-Network: $8300 Out-of-Network: N/A |
Initial Coverage Limit | $4660 |
Catastrophic Coverage Limit | $7,400 |
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 |
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 | $300 quarterly OTC allowance, for more information see Evidence of Coverage |
Podiatry Services | In-Network: Copayment for Medicare-Covered Podiatry Services $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 | $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 | $250 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 |