Aetna Medicare Longevity (PPO I-SNP)
Aetna Medicare Longevity (PPO I-SNP) H5521-461 Plan Details
Aetna Medicare Longevity (PPO I-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-461
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$72.30
Monthly Premium
Aetna Medicare Longevity (PPO I-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-461
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
Aetna Medicare Longevity (PPO I-SNP) H5521-461 Plan Details
Aetna Medicare Longevity (PPO I-SNP) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-461
HelpAdvisor Editorial Team analysis of data from the 2025 MA Landscape Source Files and carrier-provided plan data supplied by SunFire, Inc., a private company that creates software solutions for agents and brokers to compare Medicare plans. For more information, visit www.sunfireinc.com.
$72.30
Monthly Premium
New York Counties Served
Westchester
Putnam
Rockland
Fairfield
Albany
Sullivan
Rensselaer
Dutchess
Greene
Columbia
Delaware
Orange
Saratoga
Montgomery
Schenectady
Schoharie
Fulton
Washington
Chenango
Otsego
Warren
Hamilton
Ulster
Clinton
Lewis
Erie
Wyoming
Passaic
Essex
Franklin
Saint Lawrence
Onondaga
Cayuga
Yates
Oswego
Oneida
Madison
Cortland
Seneca
Wayne
Tioga
Ontario
Schuyler
Herkimer
Monroe
Jefferson
Broome
Niagara
Genesee
Cattaraugus
Bergen
Allegany
Orleans
Steuben
Chautauqua
Livingston
Chemung
Suffolk
Richmond
New York
Bronx
Nassau
Queens
Kings
Tompkins
Basic Costs and Coverage
| Coverage | Cost |
|---|---|
| Monthly Deductible | $590 |
| Out of Pocket Max |
In-Network: $9350 Out-of-Network: N/A |
| Initial Coverage Limit | $2000 |
| Catastrophic Coverage Limit | $2,000 |
| Primary Care Doctor Visit | $0 in-network|30% out-of-network |
| Specialty Doctor Visit | In-Network|0% for services provided in a nursing home|20% for services provided outside a nursing home||Out-of-Network|30% |
| Inpatient Hospital Care | $1,632 deductible plus $0 per day, days 1-60; $408 per day, days 61-90 per benefit period |
| Urgent Care | Copayment for Urgent Care $45 |
| Emergency Room Visit | $110 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance Transportation | 20% in-network|20% out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Longevity (PPO I-SNP) 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: Coinsurance for Medicare-covered Chiropractic Services 20% Prior Authorization Required for Chiropractic Services Prior authorization required Out-of-Network: Medicare Covered Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 30% |
| Diabetes Supplies, Training, Nutrition Therapy and Monitoring | In-Network|20%||Out-of-Network|20% |
| Durable Medical Eqipment (DME) | In-Network|20%||Out-of-Network|30% |
| Diagnostic Tests, Lab and Radiology Services, and X-Rays | Lab Services: In-Network|$0 ||Out-of-Network|30% Diagnostic Procedures: In-Network|0% for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)||20% for other diagnostic procedures and tests||Out-of-Network|30% Imaging: Xray: 20% in-network|CT Scans: 20% in-network|Diagnostic Radiology other than CT Scans: 20% in-network|Diagnostic Radiology Mammogram: 0% in-network|30% out-of-network |
| Home Health Care | $0 in-network|30% out-of-network |
| Mental Health Inpatient Care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 Prior Authorization Required for Psychiatric Hospital Services Prior authorization required Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 30% |
| Mental Health Outpatient Care | In-Network|20% for Mental Health: Group Sessions|20% for Mental Health: Individual Sessions|20% for Psychiatric Services: Group Sessions|20% for Psychiatric Services: Individual Sessions||Out-of-Network|30% for Mental Health Services- Group Sessions|30% for Mental Health Services - Individual Sessions|30% for Psychiatric Services: Group Sessions|30% for Psychiatric Services: Individual Sessions |
| Outpatient Services / Surgery | Ambulatory Surgical Center: In-Network|0% for preventive and diagnostic colonoscopy|20% all other ambulatory surgical center services||Out-of-Network|30% |
| Outpatient Substance Abuse Care | In-Network: Coinsurance for Medicare-covered Individual Sessions 20% Coinsurance for Medicare-covered Group Sessions 20% Prior Authorization Required for Outpatient Substance Abuse Services Prior authorization required Out-of-Network: Medicare Covered Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 30% Coinsurance for Medicare Covered Group Sessions 30% |
| Over-the-counter (OTC) Items | $380 quarterly benefit amount (allowance) to purchase approved over-the-counter (OTC) health and wellness products. Approved items can be purchased online, in store, or by phone. Unused benefit amounts do not rollover. |
| Podiatry Services | In-Network: Coinsurance for Medicare-Covered Podiatry Services 20% Copayment for Routine Foot Care $0
Prior authorization required Out-of-Network: Medicare Covered Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 30% Non-Medicare Covered Podiatry Services: Coinsurance for Non-Medicare Covered Podiatry Services 30% |
| Skilled Nursing Facility Care | $0 per stay in-network|30% per stay out-of-network |
Dental Benefits
The following dental services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Dental Care | In-Network||Preventive dental services:|$0 for oral exams|$0 for cleanings|$0 for x-rays||Out-of-Network||Preventive dental services:|50% for oral exams|50% for cleanings|50% for x-rays||Frequencies vary by covered dental service. |
Vision Benefits
The following vision services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Vision Benefits | In-Network||Eye Exams:|$0 for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||Out-of-Network||Eye Exams:|0%-30% based on level of Medicaid eligibility for Medicare-covered eye exams|30% for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year in or out-of-network)||Eyewear:|0%-30% based on level of Medicaid eligibility for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Eyeglass Lenses and Frames|$0 for Upgrades||$250 benefit amount (allowance) every year for non-Medicare covered prescription eyewear. |
Hearing Benefits
The following hearing services are covered from in-network providers.
| Coverage | Cost |
|---|---|
| Hearing Benefits | In-Network||Hearing Exams:|20% for Medicare-covered hearing exams|$0 for non-Medicare covered hearing exams|(Maximum one non-Medicare covered hearing exam every year in or out-of-network)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$750 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year)||Out-of-Network:||Hearing Exams:|30% for Medicare-covered hearing exams|30% for non-Medicare covered hearing exam every year in or out-of-network||Hearing Aids: You must purchase hearing aids through NationsHearing |
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 | In-Network|$0 copay for all preventive services covered under Original Medicare||Out-of-Network|0% for the pneumonia, influenza, Hepatitis B, and Covid-19 vaccines|30% for all other preventive services covered under Original Medicare |
