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Aetna Medicare Value (HMO-POS)

Aetna Inc.
Aetna Medicare Value (HMO-POS) H3931-162 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: H3931-162

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: H3931-162

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) H3931-162 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: H3931-162

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

Virginia Counties Served

Henry Botetourt Carroll Montgomery Franklin Radford Pittsylvania Norton City Pulaski Grayson Wythe Bland Martinsville City Salem Lee Washington Prince William Scott Dickenson Tazewell Wise Buchanan Galax City Staunton City Bath Buena Vista City Alleghany Highland Rockbridge Covington City Lexington City Danville City Smyth Loudoun Clarke Manassas City Fauquier Manassas Park City Rappahannock Fairfax Winchester City Greene Fairfax City Falls Church City Spotsylvania Arlington Stafford Alexandria City Fredericksburg City Hanover Shenandoah New Kent Caroline Orange Nelson King George Warren Albemarle King William Frederick Page Madison Fluvanna Augusta Louisa Richmond City Charlottesville City Nottoway Waynesboro City Amelia Buckingham Charles City Lunenburg Goochland Henrico Cumberland Powhatan Chesterfield Floyd Brunswick Dinwiddie Petersburg City Emporia City Halifax Prince George Greensville Craig Colonial Heights City Jefferson Charlotte Hopewell City Patrick Mecklenburg Giles Russell Roanoke Roanoke City

Basic Costs and Coverage

Coverage Cost
Monthly Deductible $250
Out of Pocket Max In-Network: $4150
Out-of-Network: N/A
Initial Coverage Limit $2000
Catastrophic Coverage Limit $2,000
Primary Care Doctor Visit
$0
Specialty Doctor Visit
In-Network|$20
Inpatient Hospital Care
$415 per day, days 1-8; $0 per day, days 9-90
Urgent Care
Copayment for Urgent Care $30

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $140
Maximum Plan Benefit of $250,000
Emergency Room Visit
$140 If you are admitted to the hospital within 0 hours your cost share may be waived
Ambulance Transportation
$275

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 $20
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)||$0 for services provided by your primary care physician in their office|$100 for services performed by a provider other than your primary care physician
Imaging: Xray: $0 for services provided by your primary care physician in their office in-network; $50 for services performed by a provider other than your primary care physician in-network|CT Scans: $0 for services provided by your primary care physician in their office in-network; $200 for services performed by a provider other than your primary care physician in-network|Diagnostic Radiology other than CT Scans: $0 for services provided by your primary care physician in their office in-network; $200 for services performed by a provider other than your primary care physician in-network|Diagnostic Radiology Mammogram: $0 in-network
Home Health Care
$0
Mental Health Inpatient Care
In-Network:

Psychiatric Hospital Services:
$318 per day for days 1 to 8
$0 per day for days 9 to 90
Prior Authorization Required for Psychiatric Hospital Services
Prior authorization required
Mental Health Outpatient Care
In-Network|$40 for Mental Health:
Group Sessions|$40 for Mental Health:
Individual Sessions|$40 for Psychiatric Services:
Group Sessions|$40 for Psychiatric Services:
Individual Sessions
Outpatient Services / Surgery
Ambulatory Surgical Center: In-Network|$0 for preventive and diagnostic colonoscopy|$315 all other ambulatory surgical center services
Outpatient Substance Abuse Care
In-Network:
Copayment for Medicare-covered Individual Sessions $40
Copayment for Medicare-covered Group Sessions $40
Prior Authorization Required for Outpatient Substance Abuse Services
Prior authorization required
Over-the-counter (OTC) Items
$45 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:
Copayment for Medicare-Covered Podiatry Services $20
Skilled Nursing Facility Care
$20 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||$2,000 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services.||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|$20 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||$200 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)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$2,000 benefit amount (allowance) per ear, every year 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 $250 (excludes Tiers 1 and 2) per year.

Coverage
Cost
Coverage & Cost
Annual Drug Deductible $250 (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 $10.00
  • Standard retail $12.00
  • Standard mail order $12.00
  • Preferred cost-share retail $10.00
Annual Drug Deductible $250 (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 $20.00
  • Standard retail $24.00
  • Standard mail order $24.00
  • Preferred cost-share retail $20.00
Annual Drug Deductible $250 (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 $20.00
  • Standard retail $36.00
  • Standard mail order $36.00
  • Preferred cost-share retail $30.00
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