Aetna Medicare Assure Premier (HMO D-SNP)

Aetna Inc.
Aetna Medicare Assure Premier (HMO D-SNP) H5593-001 Plan Details
4 out of 5 stars

Aetna Medicare Assure Premier (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H5593-001.

$0.00
Monthly Premium

Aetna Medicare Assure Premier (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H5593-001.

Aetna Inc.
Aetna Medicare Assure Premier (HMO D-SNP) H5593-001 Plan Details
4 out of 5 stars

Aetna Medicare Assure Premier (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H5593-001.

$0.00
Monthly Premium

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
Maximum Plan Benefit of $150000.00
Emergency Room Visit
$0
Ambulance Transportation
$0

Health Care Services and Medical Supplies

Aetna Medicare Assure Premier (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
Medium Over-the-Counter (OTC) kit of preselected OTC items mailed once a year and $255 quarterly OTC allowance, 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
$3,250 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
$500 every year, see the Evidence of Coverage

Hearing Benefits

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

Coverage Cost
Hearing Benefits
$2,000 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