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Aetna Medicare Assure Value (HMO D-SNP)

Aetna Inc.
Aetna Medicare Assure Value (HMO D-SNP) H1610-003 Plan Details
3.5 out of 5 stars

Aetna Medicare Assure Value (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1610-003.

$0.00
Monthly Premium

Aetna Medicare Assure Value (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1610-003.

Aetna Inc.
Aetna Medicare Assure Value (HMO D-SNP) H1610-003 Plan Details
3.5 out of 5 stars

Aetna Medicare Assure Value (HMO D-SNP) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1610-003.

$0.00
Monthly Premium

Virginia Counties Served

Accomack Albemarle Alleghany Amelia Amherst Arlington Bland Botetourt Buchanan Chesterfield Covington City Hampton City Isle Of Wight Alexandria City Appomattox Augusta Bath Bedford Bristol City Brunswick Buckingham Buena Vista City Campbell Caroline Carroll Charles City Charlottesville City Chesapeake City Clarke Colonial Heights City Craig Culpeper Cumberland Danville City Dickenson Dinwiddie Emporia City Essex Fairfax Fairfax City Falls Church City Fauquier Floyd Fluvanna Franklin Franklin City Frederick Fredericksburg City Galax City Giles Gloucester Goochland Grayson Greene Greensville Halifax Hanover Harrisonburg City Henrico Henry Highland Hopewell City James City Jefferson King And Queen King George King William Lancaster Lee Lexington City Loudoun Louisa Lunenburg Lynchburg City Madison Manassas City Manassas Park City Martinsville City Mathews Mecklenburg Middlesex Montgomery Nelson New Kent Newport News City Norfolk City Northampton Northumberland Norton City Nottoway Orange Page Patrick Petersburg City Pittsylvania Poquoson City Portsmouth City Powhatan Prince Edward Prince George Prince William Pulaski Radford Rappahannock Richmond Richmond City Roanoke Roanoke City Rockbridge Rockingham Russell Salem Scott Shenandoah Smyth Southampton Spotsylvania Stafford Staunton City Suffolk City Surry Sussex Tazewell Virginia Beach City Warren Washington Waynesboro City Westmoreland Williamsburg City Winchester City Wise Wythe York

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 $50,000
Emergency Room Visit
$0
Ambulance Transportation
$0

Health Care Services and Medical Supplies

Aetna Medicare Assure Value (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
Included in Extra Benefits Card, 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 3 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
$2,000 every year for preventive and comprehensive services, for more information see the Evidence of Coverage

Vision Benefits

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

Coverage Cost
Vision Benefits
$300 every year, see the Evidence of Coverage

Hearing Benefits

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

Coverage Cost
Hearing Benefits
$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
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