Aetna Medicare Assure Plan (HMO-POS D-SNP)
Aetna Medicare Assure Plan (HMO-POS D-SNP) H3597-012 Plan Details
Aetna Medicare Assure Plan (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3597-012
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$0.00
Monthly Premium
Aetna Medicare Assure Plan (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3597-012
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
Aetna Medicare Assure Plan (HMO-POS D-SNP) H3597-012 Plan Details
Aetna Medicare Assure Plan (HMO-POS D-SNP) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3597-012
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
$0.00
Monthly Premium
Maine Counties Served
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $0 |
| Out of Pocket Max |
In-Network: $8850 Out-of-Network: N/A |
| Initial Coverage Limit | $0 |
| Catastrophic Coverage Limit | $8,000 |
| Primary Care Doctor Visit | 20%, For more information see Evidence of Coverage |
| Specialty Doctor Visit | 20%, For more information see Evidence of Coverage |
| Inpatient Hospital Care | $2080 per stay, For more information see Evidence of Coverage |
| 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 | $100, For more information see Evidence of Coverage |
| Ambulance Transportation | 20%, For more information see Evidence of Coverage |
Health Care Services and Medical Supplies
Aetna Medicare Assure Plan (HMO-POS 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) | 19%, For more information see Evidence of Coverage |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: Lab Services: 20%, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: 20%, For more information see Evidence of Coverage Imaging: Xray: 20% | CT Scans: 20% | Diagnostic Radiology other than CT Scans: 20% | Diagnostic Radiology Mammogram: 0%, For more information see Evidence of Coverage |
| 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 | Mental Health: Group Sessions: 20%| Individual Sessions: 20%|Psychiatric Services: Group Sessions: 20%| Individual Sessions: 20%, For more information see Evidence of Coverage |
| Outpatient Services / Surgery | Ambulatory Surgical Center: 20%, For more information see Evidence of Coverage |
| 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
|
| Skilled Nursing Facility Care | $0 per day, days 1-20 $200 per day, days 21-100, 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 |Out Of Network Dental Coverage|Preventive dental services:| $0 copay |Comprehensive dental services:| $0 copay |$2,200 maximum benefit for preventive and comprehensive dental services combined - see 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 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)|$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 |
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