2020 Medicare Advantage Plan Details
Medicare Plan Name: Aetna Medicare Freedom Plan (PPO)
Location: Autauga, Alabama
Plan ID: H5521 – 224 – 0
Member Services: 1-800-282-5366 TTY users 711
— Enrollment Options —
Medicare Contact Information: 1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
Advertisement
Speak to a licensed sales agent to learn more and enroll.
Call Medicare Solutions at 855-373-9484 / TTY 711

Monday ‐ Friday 8:30am — 10pm EST
MULTIPLAN_GHHJTEXEN_ACCEPTED
— Medicare Plan Features —
Monthly Premium: $0.00 (see Plan Premium Details below)
Annual Deductible: $200 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit (ICL): $4,020
Health Plan Type: Local PPO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP): $5,700
Additional Gap Coverage? Yes, some additional gap coverage.
Total Number of Formulary Drugs: 3,774 drugs

This plan has 5 drug tiers.

 

Formulary Drug Details: Tier 1 Tier 2 Tier 3 Tier 4 Tier 5
Preferred Pharmacy
Cost-Sharing during
initial coverage phase:
$0.00 $10.00 $47.00 $100.00 29%
Number of Drugs per
Tier:
330 573 918 1313 640
Plan’s Pharmacy Search:
Plan Offers Mail Order? Yes
Number of Members enrolled in this plan in Autauga, Alabama: 47 members
Number of Members enrolled in this plan in Alabama: 393 members
Number of Members enrolled in this plan in (H5521 – 224): 420 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 Premium Details —
The Monthly Premium is Split as Follows: Total
Premium
Part C
Premium
Part D Base
Premium
Part D Supplemental
Premium
$0.00 $0.00 $0.00 $0.00
Monthly Premium with Extra Help Low-Income Subsidy (LIS): 100%
Subsidy
75%
Subsidy
50%
Subsidy
25%
Subsidy
Monthly Part D Premium with LIS: $0.00 $0.00 $0.00 $0.00
Total Monthly Premium with LIS (Parts C & D): $0.00 $0.00 $0.00 $0.00