2020 Medicare Advantage Plan Details
Medicare Plan Name: Aetna Medicare Basics Plan (PPO)
Location: Autauga, Alabama
Plan ID: H5521 – 229 – 0
Member Services:
— Enrollment Options —
Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
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Email a copy of the Aetna Medicare Basics Plan (PPO) benefit details
— Medicare Plan Features —
Monthly Premium: $0.00
Annual Deductible: no drug coverage
Health Plan Type: Local PPO *
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): $6,400
Plan Offers Mail Order? n/a
Number of Members enrolled in this plan in Autauga, Alabama: less than 10 members
Number of Members enrolled in this plan in Alabama: less than 10 members
Number of Members enrolled in this plan in (H5521 – 229): 100 members
Plan’s Summary Star Rating: 4.5 out of 5 Stars.
Customer Service Rating: 5 out of 5 Stars.
Member Experience Rating: 4 out of 5 Stars.
Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Health Benefits —
** Base Plan **
Premium Total monthly premium: $0.00
Health plan premium: $0.00
Standard Part B premium: $135.50
Part B premium reduction: No
Deductible Health plan deductible: $150 annual deductible
Estimated yearly costs Estimated total yearly costs for care: $6,390.00
Out-of-pocket max Out-of-pocket max: $10,000 In and Out-of-network $6,400 In-network
Doctor services Primary doctor visit: In-network: $5 per visit Out-of-network: $30 per visit
Specialist visit: In-network: $20 per visit Out-of-network: $50 per visit
Tests, labs, & imaging Diagnostic tests & procedures: In-network: $5-95 Out-of-network: 35%
Lab services: In-network: $5-20 Out-of-network: 35%
Diagnostic radiology services (like MRI): In-network: $5-200 Out-of-network: 35%
Outpatient x-rays: In-network: $5-25 Out-of-network: 35%
Emergency care: $90 per visit (always covered)
Urgent care: $5-20 per visit (always covered)
Hospital services Inpatient hospital coverage: In-network: $225 per day for days 1 through 5 $0 per day for days 6 through 90 Out-of-network: 35% per stay
Outpatient hospital coverage: In-network: $20-150 per visit Out-of-network: 35% per visit
Skilled nursing facility Skilled nursing facility: In-network: $0 per day for days 1 through 20 $178 per day for days 21 through 100 Out-of-network: 35% per stay
Preventive services Preventive services: In-network: $0 copay Out-of-network: $0 copay
Ambulance Ground ambulance: In-network: $275 Out-of-network: $275
Therapy services Occupational therapy visit: In-network: $20 Out-of-network: $50
Physical therapy & speech & language therapy visit: In-network: $20 Out-of-network: $50
Mental health services Outpatient group therapy with a psychiatrist: In-network: $20 Out-of-network: $50
Outpatient individual therapy with a psychiatrist: In-network: $20 Out-of-network: $50
Outpatient group therapy visit: In-network: $20 Out-of-network: $50
Outpatient individual therapy visit: In-network: $20 Out-of-network: $50
Opioid treatment services Opioid treatment services: Covered
Other services Durable medical equipment (like wheelchairs & oxygen): In-network: 20% per item Out-of-network: 35% per item
Prosthetics (like braces, artificial limbs): In-network: 20% per item Out-of-network: 35% per item
Diabetes supplies: In-network: 0-20% per item Out-of-network: 0-20% per item
Hearing Hearing exam: In-network: $20 Out-of-network: $50
Fitting/evaluation: In-network: $20 Out-of-network: $50
Hearing aids – Inner ear: Not covered
Hearing aids – Outer ear: Not covered
Hearing aids – Over the ear: Not covered
Preventive dental Oral exam: In-network: $0 copay Out-of-network: $0 copay
Cleaning: In-network: $0 copay Out-of-network: $0 copay
Fluoride treatment: In-network: $0 copay Out-of-network: $0 copay
Dental x-rays: In-network: $0 copay Out-of-network: $0 copay
Comprehensive dental Non-routine services: In-network: $0 copay Out-of-network: $0 copay
Diagnostic services: In-network: $0 copay Out-of-network: $0 copay
Restorative services: In-network: $0 copay Out-of-network: $0 copay
Endodontics: In-network: $0 copay Out-of-network: $0 copay
Periodontics: In-network: $0 copay Out-of-network: $0 copay
Extractions: In-network: $0 copay Out-of-network: $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services: In-network: $0 copay Out-of-network: $0 copay
Vision Routine eye exam: In-network: $0 copay Out-of-network: $0 copay
Contact lenses: In-network: $0 copay Out-of-network: $0 copay
Eyeglasses (frames & lenses): In-network: $0 copay Out-of-network: $0 copay
Eyeglass frames (only): In-network: $0 copay Out-of-network: $0 copay
Eyeglass lenses (only): In-network: $0 copay Out-of-network: $0 copay
Upgrades: In-network: $0 copay Out-of-network: $0 copay
More benefits Fitness benefit: Limited coverage
Over the counter drug benefits: Limited coverage
In-home support services: Not covered
Home and bathroom safety devices: Not covered
Meals for short duration: Limited coverage
Annual physical exams: Limited coverage
Telehealth: Not covered
Part B drugs Chemotherapy drugs: In-network: 20% Out-of-network: 35%
Other Part B drugs: In-network: 20% Out-of-network: 35%