Aetna Medicare Premier (HMO-POS)

Aetna Medicare Premier (HMO-POS) H7149-001 Plan Details

4 out of 5 stars

Aetna Medicare Premier (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H7149-001.

^$0.00

Monthly Premium

Aetna Medicare Premier (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H7149-001.

Aetna Medicare Premier (HMO-POS) H7149-001 Plan Details

4 out of 5 stars

Aetna Medicare Premier (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc..
Plan ID: H7149-001.

^$0.00

Monthly Premium

Nebraska Counties Served

Adams Burt Cass Antelope Boone Boyd Buffalo Butler Cedar Clay Colfax Custer Dakota Decatur Dixon Douglas Fillmore Franklin Frontier Furnas Gage Garfield Gosper Greeley Gregory Hall Hamilton Harlan Howard Jefferson Jewell Johnson Kearney Knox Lancaster Madison Nance Nemaha Nuckolls Otoe Pawnee Phelps Pierce Platte Polk Rawlins Richardson Rock Saline Saunders Sedgwick Seward Sherman Stanton Thayer Thurston Todd Valley Washington Wayne Webster Wheeler York

Basic Costs and Coverage

Coverage	Cost
Monthly Deductible	$0
Out of Pocket Max	In-Network: $4100 Out-of-Network: N/A
Initial Coverage Limit	$4660
Catastrophic Coverage Limit	$7,400
Primary Care Doctor Visit	$0
Specialty Doctor Visit	$30
Inpatient Hospital Care	$350 per day, days 1-5; $0 per day, days 6-90
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 you do not have to pay your cost share may be waived, for more information see the Evidence of Coverage
Ambulance Transportation	$335

Health Care Services and Medical Supplies

Aetna Medicare Premier (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 $20.00 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)	0% - 20% for each Medicare-covered durable medical equipment item / 0% for continuous glucose meters / 20% for all other Medicare-covered DME items
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: $40 in-network, for more information see Evidence of Coverage Imaging: Xray: $15 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: $370.00 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: $300 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-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
Over-the-counter (OTC) Items	$105 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry Services	In-Network: Copayment for Medicare-Covered Podiatry Services $30.00
Skilled Nursing Facility Care	$0 per day, days 1-20 $184 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	$2,000 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	$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	$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 Nebraska

Aetna Medicare Premier (HMO-POS)

Nebraska 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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