Aetna Medicare Assure Plus (HMO D-SNP)

Aetna Inc.
Aetna Medicare Assure Plus (HMO D-SNP) H1609-043 Plan Details
3.5 out of 5 stars

Aetna Medicare Assure Plus (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1609-043

Have Medicare questions?

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

$32.50
Monthly Premium

Aetna Medicare Assure Plus (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1609-043

Have Medicare questions?

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

Aetna Inc.
Aetna Medicare Assure Plus (HMO D-SNP) H1609-043 Plan Details
3.5 out of 5 stars

Aetna Medicare Assure Plus (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1609-043

Have Medicare questions?

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

$32.50
Monthly Premium

Florida Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $3850
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 per stay
Urgent Care
Copayment for Urgent Care $0.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0.00
Emergency Room Visit
$0 - $75 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. For more information see Evidence of Coverage.
Ambulance Transportation
$0

Health Care Services and Medical Supplies

Aetna Medicare Assure Plus (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
Copayment for Routine Care $0.00
  • Maximum 18 Routine Care every year
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 Sessions, $0 for Mental Health:
Individual Sessions based on level of Medicaid eligibility. For more information see Evidence of Coverage |$0 for Psychiatric Services:
Group Sessions, $0 for Psychiatric Services:
Individual Sessions based on level of Medicaid eligibility. 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 24 visits every year
Referral Required for Podiatry Services
Skilled Nursing Facility Care
$0 per stay, 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|Preventive dental services: |Oral exams: $0 copay (see Evidence of Coverage)|Cleanings: $0 copay (one visit every six months)|Bitewing x-rays: $0 copay (see Evidence of Coverage)|Fluoride treatment: $0 copay (one visit every six months)|Comprehensive dental services:|Non-routine services: $0 copay (see Evidence of Coverage)|Diagnostic services: $0 copay (see Evidence of Coverage)|Restorative services: $0 copay (see Evidence of Coverage)|Endodontics: $0 copay (see Evidence of Coverage)|Periodontal services: $0 copay (see Evidence of Coverage)|Extractions: $0 copay (eight visits every year)|Prosthodontics and maxillofacial services: $0 copay (see Evidence of Coverage)|Preventive and comprehensive dental services are not covered out-of-network.

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|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|(Maximum three pairs every year)|Copayment for Upgrades $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $400 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 $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 Plus (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