Aetna Medicare Value (HMO-POS)

Aetna Inc.
Aetna Medicare Value (HMO-POS) H3312-048 Plan Details
3.5 out of 5 stars

Aetna Medicare Value (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3312-048

HelpAdvisor Editorial Team analysis of data from the 2024 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.

$0.00
Monthly Premium

Aetna Medicare Value (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3312-048

HelpAdvisor Editorial Team analysis of data from the 2024 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 Inc.
Aetna Medicare Value (HMO-POS) H3312-048 Plan Details
3.5 out of 5 stars

Aetna Medicare Value (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3312-048

HelpAdvisor Editorial Team analysis of data from the 2024 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.

$0.00
Monthly Premium

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $450
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
Specialty Doctor Visit
In-Network|$0 for services provided in a nursing home|$35 for services provided outside a nursing home
Inpatient Hospital Care
$300 per day, days 1-6; $0 per day, days 7-90
Urgent Care
Copayment for Urgent Care $45

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $110
Emergency Room Visit
$110 If you are admitted to the hospital within 0 hours your cost share may be waived
Ambulance Transportation
$300

Health Care Services and Medical Supplies

Aetna Medicare Value (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 $15
Diabetes Supplies, Training, Nutrition Therapy and Monitoring
In-Network|0% for OneTouch/LifeScan diabetic supplies|20% for other covered diabetic supplies
Durable Medical Eqipment (DME)
In-Network|0% for continuous glucose monitors|20% for all other Medicare-covered DME items
Diagnostic Tests, Lab and Radiology Services, and X-Rays
Lab Services: In-Network|$0
Diagnostic Procedures: In-Network|$0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)||$25 for other diagnostic procedures and tests
Imaging: Xray: $25 in-network|CT Scans: $200 for CT/CAT scans in-network; $250 for all other complex imaging in-network|Diagnostic Radiology other than CT Scans: $200 for CT/CAT scans in-network; $250 for all other complex imaging in-network|Diagnostic Radiology Mammogram: $0 in-network
Home Health Care
$0
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$300 per day for days 1 to 6
$0 per day for days 7 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network|$25 for Mental Health:
Group Sessions|$25 for Mental Health:
Individual Sessions|$25 for Psychiatric Services:
Group Sessions|$25 for Psychiatric Services:
Individual Sessions
Outpatient Services / Surgery
Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$200 all other ambulatory surgical center services
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $25
Copayment for Medicare-covered Group Sessions $25
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Podiatry Services
In-Network:
Copayment for Medicare-Covered Podiatry Services $25
Skilled Nursing Facility Care
$0 per day, days 1-20
$214 per day, days 21-100 in-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 fluoride treatment|$0 for x-rays|$0 for other diagnostic dental services|$0 for other preventive dental services||Comprehensive dental services:|$0 for restorative services|$0 for endodontic services|$0 for periodontic services|$0 for removeable prosthodontics|$0 for fixed prosthodontics|$0 for oral and maxillofacial surgery|$0 for adjunctive services||Out-of-Network||Preventive dental services:|50% for oral exams|50% for cleanings|50% for fluoride treatments|50% for x-rays|50% for other diagnostic dental services|50% for other preventive dental services||Comprehensive dental services:|50% for restorative services|50% for endodontic services|50% for periodontic services|50% for removeable prosthodontics|50% for fixed prosthodontics|50% for oral and maxillofacial surgery|50% for adjunctive services||$1,250 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services. Medical necessity requirements vary by covered dental service.||ADA recognized dental services are covered up to the benefit amount excluding implants and related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions.

Vision Benefits

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

Coverage Cost
Vision Benefits
In-Network||Eye Exams:|$0 for Diabetic eye exams|$25 for all other Medicare-covered eye exams|$0 for non-Medicare covered eye exams|(Maximum one non-Medicare covered eye exam every year)||Eyewear:|$0 for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||$180 benefit amount (allowance) reimbursement 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:|$25 for Medicare-covered hearing exams|$0 for non-Medicare covered hearing exams|(Maximum one non-Medicare covered hearing exam every year)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0-$1,700 for hearing aids|(Maximum two hearing aids every year)

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

Prescription Drug Costs and Coverage

The Aetna Medicare Value (HMO-POS) plan offers the following prescription drug coverage, with an annual drug deductible of $450 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $450 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $2.00
  • Standard mail order $2.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $12.00
  • Standard mail order $12.00
  • Preferred cost-share retail $0.00
Annual Drug Deductible $450 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $4.00
  • Standard mail order $4.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $24.00
  • Standard mail order $24.00
  • Preferred cost-share retail $0.00
Annual Drug Deductible $450 (excludes Tiers 1 and 2)
Preferred Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $6.00
  • Standard mail order $6.00
  • Preferred cost-share retail $0.00
Generic
  • Preferred cost-share mail order $0.00
  • Standard retail $36.00
  • Standard mail order $36.00
  • Preferred cost-share retail $0.00