In the Deductible co-pay stage, you are responsible for the full cost of your prescriptions. Your Medicare deductible cannot exceed $360 in 2016. Co-Pay Range FREE – $164. If your Medicare co-pay is higher than $155.00, you can save money by using a GoodRx coupon instead. Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care. After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay.

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Aetna Medicare Select (HMO) H1609-016 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Select (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,000 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Select (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Select (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:	H1609-016
Provider:	Aetna Medicare
Year:	2021
Type:	Local HMO
Monthly Premium C+D:	$0
Part C Premium:	$0
MOOP:	$3,000
Part D (Drug) Premium:	$0
Part D Supplemental Premium	$0
Total Part D Premium:	$0
Drug Deductible:	$0
Tiers with No Deductible:	0
Gap Coverage:	Yes
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H1609-018

Aetna Medicare Select (HMO) Part-C Premium

Aetna Medicare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H1609-016 Part-D Deductible and Premium

Aetna Medicare Select (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Aetna Medicare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.

H1609-016 Formulary or Drug Coverage

Aetna Medicare Select (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Aetna Medicare Select (HMO) Summary of Benefits

Additional Benefits

No

Comprehensive Dental

Diagnostic services	$0 copay
Endodontics	$0 copay
Extractions	$0 copay
Non-routine services	$0 copay
Periodontics	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	$0 copay

Deductible

$0

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0 copay
Diagnostic tests and procedures	$0 copay
Lab services	$0 copay
Outpatient x-rays	$0 copay

Doctor Visits

Primary	$0 copay
Specialist	$0 copay

Emergency care/Urgent Care

Emergency	$50 copay per visit (always covered)
Urgent care	$0 copay

Foot Care (podiatry services)

Foot exams and treatment	$0 copay
Routine foot care	$0 copay

Ground Ambulance

$0 copay

Hearing

Fitting/evaluation	$0 copay
Hearing aids	$0 copay
Hearing exam	$0 copay

Inpatient Hospital Coverage

$0 copay per stay

Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	$0 copay
Prosthetics (e.g., braces, artificial limbs)	$0 copay

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

Mental Health Services

Inpatient hospital - psychiatric	$0 copay per stay
Outpatient group therapy visit	$0 copay
Outpatient group therapy visit with a psychiatrist	$0 copay
Outpatient individual therapy visit	$0 copay
Outpatient individual therapy visit with a psychiatrist	$0 copay

MOOP

$3,000 In-network

Option

No

Optional supplemental benefits

No

Outpatient Hospital Coverage

$0 copay

Preventive Care

$0 copay

Preventive Dental

Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Fluoride treatment	$0 copay
Oral exam	$0 copay

Rehabilitation Services

Occupational therapy visit	$0 copay
Physical therapy and speech and language therapy visit	$0 copay

Skilled Nursing Facility

$0 copay per stay

Transportation

$0 copay

Vision

Contact lenses	$0 copay
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	$0 copay
Other	$0 copay
Routine eye exam	$0 copay
Upgrades	Not covered

Aetna Medicare Copay Reduction Form

Wellness Programs (e.g. fitness nursing hotline)

Covered

Reviews for Aetna Medicare Select (HMO) H1609

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Aetna Medicare Select (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Aetna Medicare Select (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Aetna Medicare Select (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST

Coverage Area for Aetna Medicare Select (HMO)

(Click county to compare all available Advantage plans)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Jump to:

Aetna Medicare Value (PPO) H5521-231 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Indiana. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Value (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,950 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,950 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Value (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Value (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:	H5521-231
Provider:	Aetna Medicare
Year:	2021
Type:	Local PPO
Monthly Premium C+D:	$0
Part C Premium:	$0
MOOP:	$5,950
Part D (Drug) Premium:	$0
Part D Supplemental Premium	$0
Total Part D Premium:	$0
Drug Deductible:	$0
Tiers with No Deductible:	0
Gap Coverage:	Yes
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H5521-232

Aetna Medicare Value (PPO) Part-C Premium

Aetna Medicare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H5521-231 Part-D Deductible and Premium

Aetna Medicare Value (PPO) has a monthly drug premium of $0 and a $0 drug deductible. This Aetna Medicare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.

H5521-231 Formulary or Drug Coverage

Aetna Medicare Value (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Aetna Medicare Value (PPO) Summary of Benefits

Additional Benefits

No

Comprehensive Dental

Diagnostic services	Not covered
Endodontics	50% coinsurance (Out-of-Network)
Endodontics	20% coinsurance
Extractions	50% coinsurance (Out-of-Network)
Extractions	20% coinsurance
Non-routine services	20% coinsurance
Non-routine services	50% coinsurance (Out-of-Network)
Periodontics	20% coinsurance
Periodontics	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	50% coinsurance (Out-of-Network)
Restorative services	20% coinsurance

Deductible

$0

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	50% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$0-275 copay
Diagnostic tests and procedures	$0-75 copay
Diagnostic tests and procedures	50% coinsurance (Out-of-Network)
Lab services	$0-15 copay
Lab services	$25 copay (Out-of-Network)
Outpatient x-rays	50% coinsurance (Out-of-Network)
Outpatient x-rays	$20 copay

Doctor Visits

Primary	$0 copay
Primary	$30 copay per visit (Out-of-Network)
Specialist	$45 copay per visit
Specialist	$65 copay per visit (Out-of-Network)

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$65 copay per visit (always covered)

Foot Care (podiatry services)

Foot exams and treatment	$45 copay
Foot exams and treatment	$65 copay (Out-of-Network)
Routine foot care	Not covered

Ground Ambulance

$295 copay (Out-of-Network)
$295 copay

Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$65 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing exam	$65 copay (Out-of-Network)
Hearing exam	$45 copay

Inpatient Hospital Coverage

$290 per day for days 1 through 7 $0 per day for days 8 through 90
50% per stay (Out-of-Network)

Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item (Out-of-Network)
Diabetes supplies	0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	50% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	50% coinsurance per item (Out-of-Network)

Medicare Part B Drugs

Chemotherapy	50% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	50% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

Mental Health Services

Inpatient hospital - psychiatric	$1,871 per stay
Inpatient hospital - psychiatric	50% per stay (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	50% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	50% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

MOOP

$9,500 In and Out-of-network $5,950 In-network

Option

No

Optional supplemental benefits

No

Outpatient Hospital Coverage

$0-325 copay per visit
50% coinsurance per visit (Out-of-Network)

Preventive Care

Aetna Medicare Coinsurance

0-50% coinsurance (Out-of-Network)
$0 copay

Preventive Dental

Cleaning	$0 copay
Cleaning	30% coinsurance (Out-of-Network)
Dental x-ray(s)	30% coinsurance (Out-of-Network)
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	30% coinsurance (Out-of-Network)

Rehabilitation Services

Occupational therapy visit	50% coinsurance (Out-of-Network)
Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	50% coinsurance (Out-of-Network)

Skilled Nursing Facility

50% per stay (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

Aetna Medicare Copay Waiver

Transportation

Not covered

Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	$65 copay (Out-of-Network)
Other	$45 copay
Routine eye exam	$0 copay
Routine eye exam	$65 copay (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

Wellness Programs (e.g. fitness nursing hotline)

Covered

Reviews for Aetna Medicare Value (PPO) H5521

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Aetna Medicare Value (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Aetna Medicare Value (PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Aetna Medicare Value (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST

Coverage Area for Aetna Medicare Value (PPO)

(Click county to compare all available Advantage plans)

State:	Indiana
County:	Boone,Brown,Clay,Clinton,Delaware, Fountain,Hamilton,Hancock,Hendricks, Howard,Jackson,Jennings,Johnson, Lawrence,Madison,Marion,Montgomery, Morgan,Parke,Putnam,Shelby, Tippecanoe,Tipton,Vermillion,Vigo, Warren,Wayne,

Go to top

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.