Aetna Medicare Elite Plan (HMO-POS)

Aetna Inc.
Aetna Medicare Elite Plan (HMO-POS) H3748-007 Plan Details
3.5 out of 5 stars

Aetna Medicare Elite Plan (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3748-007

Have Medicare questions?

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

$0.00
Monthly Premium

Aetna Medicare Elite Plan (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3748-007

Have Medicare questions?

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

Aetna Inc.
Aetna Medicare Elite Plan (HMO-POS) H3748-007 Plan Details
3.5 out of 5 stars

Aetna Medicare Elite Plan (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3748-007

Have Medicare questions?

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

$0.00
Monthly Premium

Washington Counties Served

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $0
Out of Pocket Max In-Network: $5200
Out-of-Network: N/A
Initial Coverage Limit $5030
Catastrophic Coverage Limit $8,000
Primary Care Doctor Visit
$0
Specialty Doctor Visit
$40
Inpatient Hospital Care
$395 per day, days 1-5; $0 per day, days 6-90
Urgent Care
Copayment for Urgent Care $40.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $120.00
Emergency Room Visit
$120 If you are admitted to the hospital within 0 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance Transportation
$275

Health Care Services and Medical Supplies

Aetna Medicare Elite Plan (HMO-POS) 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 $10.00
Prior Authorization Required for Chiropractic Services
Prior authorization required
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable Medical Eqipment (DME)
20%
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: Lab Services: $0 in-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $0 in-network, for more information see Evidence of Coverage
Imaging: Xray: $0 in-network | CT Scans: $275 in-network | Diagnostic Radiology other than CT Scans: $275 in-network | Diagnostic Radiology Mammogram: $0 in-network, for more information see Evidence of Coverage
Home Health Care
$0
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$395.00 per day for days 1 to 5
$0.00 per day for days 6 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
Mental Health:
Group Sessions: $40 in-network|
Individual Sessions: $40 in-network, for more information see Evidence of Coverage |Psychiatric Services:
Group Sessions: $40 in-network|
Individual Sessions: $40 in-network, for more information see Evidence of Coverage
Outpatient Services / Surgery
Ambulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $255 All other in network ASC services , for more information see Evidence of Coverage
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $40.00
Copayment for Medicare-covered Group Sessions $40.00
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $40.00
Skilled Nursing Facility Care
$0 per day, days 1-20
$196 per day, days 21-100 in-network, 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:| 20% coinsurance |Comprehensive dental services:| 20% coinsurance |$1,700 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
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|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $320 reimbursement every year. For more information, 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)|$2,000 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