Aetna Medicare Elite (PPO)

Aetna Medicare Elite (PPO) H1608-037 Plan Details

3.5 out of 5 stars

Aetna Medicare Elite (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1608-037.

^$0.00

Monthly Premium

Aetna Medicare Elite (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1608-037.

Aetna Medicare Elite (PPO) H1608-037 Plan Details

3.5 out of 5 stars

Aetna Medicare Elite (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H1608-037.

^$0.00

Monthly Premium

Iowa Counties Served

Adair Adams Allamakee Appanoose Audubon Benton Black Hawk Boone Bremer Buchanan Burt Butler Calhoun Carroll Cass Cedar Cerro Gordo Cherokee Chickasaw Clarke Clay Clayton Clinton Crawford Dallas Davis Decatur Delaware Des Moines Dickinson Fayette Floyd Franklin Fremont Greene Grundy Guthrie Hamilton Hancock Hardin Harrison Henry Howard Humboldt Ida Jackson Jasper Jefferson Johnson Jones Keokuk Kossuth Lee Linn Louisa Lucas Lyon Madison Mahaska Marion Marshall Mills Mitchell Monona Monroe Montgomery Muscatine Obrien Osceola Page Palo Alto Plymouth Pocahontas Polk Pottawattamie Poweshiek Ringgold Sac Scott Shelby Sioux Story Tama Taylor Union Van Buren Wapello Warren Washington Wayne Webster Winneshiek Woodbury Wright

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$0
Out of Pocket Max	In-Network: $4900 Out-of-Network: N/A
Initial Coverage Limit	$4660
Catastrophic Coverage Limit	$7,400
Primary Care Doctor Visit	$0 in-network / 45% out-of-network
Specialty Doctor Visit	$35 in-network / 45% out-of-network
Inpatient Hospital Care	$390 per day, days 1-5; $0 per day, days 6-90 in-network / 45% per stay out-of-network
Urgent Care	Copayment for Urgent Care $50.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $110.00
Emergency Room Visit	$110 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	$350 in-network / $350 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Elite (PPO) 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 $20.00 Prior Authorization Required for Chiropractic Services Prior authorization required Out-of-Network: Coinsurance for Medicare Covered Chiropractic Services 45%
Diabetes Supplies, Training, Nutrition Therapy and Monitoring	0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable Medical Eqipment (DME)	0% - 20% for each Medicare-covered durable medical equipment item / 0% for continuous glucose meters / 20% for all other Medicare-covered DME items / 45% out-of-network
Diagnostic Tests, Lab and Radiology Services, and X-Rays	Lab Services: Lab Services: $0 in-network/ 45% out-of-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $35 in-network/ 45% out-of-network, for more information see Evidence of Coverage Imaging: Xray: $10 in-network / CT Scans: $250 in-network / Diagnostic Radiology other than CT Scans: $250 in-network / Diagnostic Radiology Mammogram: $0 in-network / 45% out-of-network, for more information see Evidence of Coverage
Home Health Care	$0 in-network / 45% out-of-network
Mental Health Inpatient Care	In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $1871.00 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required Out-of-Network: Coinsurance for Psychiatric Hospital Services per Stay 45%
Mental Health Outpatient Care	Mental Health: Group Sessions: $40 in-network/ Individual Sessions: $40 in-network/ 45% out-of-network, for more information see Evidence of Coverage Psychiatric Services: Group Sessions: $40 in-network/ Individual Sessions: $40 in-network/ 45% out-of-network, for more information see Evidence of Coverage
Outpatient Services / Surgery	Ambulatory Surgical Center: $300 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network / 45% out-of-network, 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 Out-of-Network: Coinsurance for Medicare Covered Individual or Group Sessions 45%
Over-the-counter (OTC) Items	$45 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry Services	In-Network: Copayment for Medicare-Covered Podiatry Services $35.00 Out-of-Network: Coinsurance for Medicare Covered Podiatry Services 45%
Skilled Nursing Facility Care	$0 per day, days 1-20 $184 per day, days 21-100 In-Network: 45% per day, days 1-100 Out-of-Network: for more information see Evidence of Coverage

Dental Benefits

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

Coverage	Cost
Dental Care	$1,000 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	$370 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	$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

Back to Plans in Iowa

Aetna Medicare Elite (PPO)

Iowa Counties Served

Basic Costs and Coverage

Health Care Services and Medical Supplies

Dental Benefits

Vision Benefits

Hearing Benefits

Preventive Services and Health/Wellness Education Programs

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