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2016 Medicare Advantage Plan Benefit Details for the Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan) - H7172-001-0
This is archive material for research purposes. Please see PDPFinder.com or MAFinder.com for current plans.

2016 Medicare Advantage Plan Details
Medicare Plan Name:Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan)
Location:Madison, Ohio     Click to see other locations
Plan ID:H7172 - 001 - 0     Click to see other plans
Member Services:1-855-364-0974 TTY users 711
— This plan information is for research purposes only. —
Click here to see plans for the current plan year
Medicare Contact Information:Please go to Medicare.gov or call 1-800-MEDICARE (1-800-633-4227) to get information on all of your options.
TTY users 1-877-486-2048
or contact your local SHIP for assistance
Email a copy of the Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:$0
Health Plan Type:MMP
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$0
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:3,358 drugsBrowse the Aetna Better Health of Ohio, MyCare Ohio (Medicare-Medicaid Plan) Formulary
This plan has 3 drug tiers. See cost-sharing for all pharmacies and tiers. 
Formulary Drug Details:Tier 1Tier 2Tier 3Tier 4Tier 5
• Preferred Pharmacy
  Cost-Sharing during
  initial coverage phase:		$0.00$0.00$0.00  
• Number of Drugs per
  Tier:		23301028
Plan's Pharmacy Search:http://www.aetnabetterhealth.com/ohio/members/premier/partd
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Madison, Ohio:99 members
Number of Members enrolled in this plan in (H7172 - 001):13,417 members
Plan’s Summary Star Rating: New plan - No summary rating as of yet.
• Customer Service Rating: New plan - not yet rated.
• Member Experience Rating: New plan - not yet rated.
• Drug Cost Accuracy Rating: New plan - not yet rated.
— Plan Premium Details —
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
— Plan Health Benefits —
** Cost **
Monthly premium, deductible, and limits on how much you pay for covered services
Some services may require a monthly payment amount.
You pay nothing
In this plan you will pay nothing for services from any provider.
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
** Doctor and Hospital Choice **
Acupuncture
Not covered
** Extra Benefits **
Inpatient mental health care
For inpatient mental health care see the "Mental Health Care" section.
Outpatient prescription drugs
For Part B drugs such as chemotherapy drugs1:  You pay nothing
Other Part B drugs1:  You pay nothing
You may get your drugs at network retail pharmacies and mail order pharmacies.
You pay nothing
If you reside in a long-term care facility you pay the same as at a retail pharmacy.
You may get drugs from an out-of-network pharmacy and pay the same as an in-network pharmacy but you will get less of the drug.
You pay nothing
** Important Information **
Monthly premium, deductible, and limits on how much you pay for covered services
Some services may require a monthly payment amount.
You pay nothing
In this plan you will pay nothing for services from any provider.
Please note that you will still need to pay your cost-sharing for your Part D prescription drugs.
Our plan has a coverage limit every year for certain in-network benefits. Contact us for the services that apply.
** Outpatient Care and Services **
Acupuncture
Not covered
Additional home care services
Home and community based services:   You pay nothing
Private duty nursing services (for up to 16 hours every day):   You pay nothing
Additional services
Mental Health and Addiction Services from a Certified Provider:   You pay nothing
Medically Necessary Wheelchair Van:   You pay nothing
Adult Day Health Services:   You pay nothing
Alternative Meals Services:   You pay nothing
Assisted Living Services:   You pay nothing
Choices Home Care Assistant:   You pay nothing
Chore Services:   You pay nothing
Community Transition:   You pay nothing
Emergency Response Services:   You pay nothing
Enhanced Community Living Services:   You pay nothing
Home Care Attendant:   You pay nothing
Home Delivered Meals:   You pay nothing
Home Medical Equipment and Supplemental Adaptive and Assistive Services:   You pay nothing (there is a limit to how much our plan will pay)
Home Modification Maintenance and Repair:   You pay nothing (there is a limit to how much our plan will pay)
Homemaker Services:   You pay nothing
Independent Living Assistance:   You pay nothing
Nutritional Consultation:   You pay nothing
Out of Home Respite Services:   You pay nothing
Personal Care Services:   You pay nothing
Pest Control:   You pay nothing
Social Work Counseling:   You pay nothing
Waiver Nursing Services:   You pay nothing
Waiver Transportation:   You pay nothing
Ambulance
You pay nothing
Chiropractic care
Manipulation of the spine to correct a subluxation (when 1 or more of the bones of your spine move out of position):  You pay nothing
Dental services
Limited dental services (this does not include services in connection with care treatment filling removal or replacement of teeth):  You pay nothing
Preventive dental services:
  • Cleaning (for up to 1 every six months):  You pay nothing
  • Dental x-ray(s) (for up to 1 every six months):  You pay nothing
  • Fluoride treatment (for up to 1 every six months):  You pay nothing
  • Oral exam (for up to 1 every six months):  You pay nothing
    • Diabetes supplies and services
    Diabetes monitoring supplies:  You pay nothing
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  You pay nothing
    Diagnostic tests, lab and radiology services, and x-rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs CT scans):  You pay nothing
    Diagnostic tests and procedures:  You pay nothing
    Lab services:  You pay nothing
    Outpatient x-rays:  You pay nothing
    Therapeutic radiology services (such as radiation treatment for cancer):  You pay nothing
    Doctor's office visits
    Primary care physician visit:  You pay nothing
    Specialist visit:  You pay nothing
    Durable medical equipment (wheelchairs, oxygen, etc.)
    You pay nothing
    Incontinence Garments:  You pay nothing
    Emergency care
    You pay nothing
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam:  You pay nothing
    Hearing aid fitting/evaluation:  You pay nothing
    Hearing aid:  You pay nothing
    Home health care
    You pay nothing
    Additional hours of care:  You pay nothing
    Mental health care
    Inpatient visit:
    Our plan covers an unlimited number of days for an inpatient hospital stay.
    You pay nothing
    Outpatient group therapy visit:  You pay nothing
    Outpatient individual therapy visit:  You pay nothing
    Outpatient rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per day for up to 36 sessions up to 36 weeks):  You pay nothing
    Occupational therapy visit:  You pay nothing
    Physical therapy and speech and language therapy visit:  You pay nothing
    Outpatient substance abuse
    Group therapy visit:  You pay nothing
    Individual therapy visit:  You pay nothing
    Outpatient surgery
    Ambulatory surgical center:  You pay nothing
    Outpatient hospital:  You pay nothing
    Freestanding birth center services:  You pay nothing
    Over-the-counter items
    Please visit our website to see our list of covered over-the-counter items.
    Prosthetic devices (braces, artificial limbs, etc.)
    Prosthetic devices:  You pay nothing
    Related medical supplies:  You pay nothing
    Renal dialysis
    You pay nothing
    Transportation
      You pay nothing
    Urgently needed services
    You pay nothing
    Vision services
    Exam to diagnose and treat diseases and conditions of the eye (including yearly glaucoma screening):  You pay nothing
    Routine eye exam (for up to 1 every two years):  You pay nothing
    Eyeglasses (frames and lenses) (for up to 1 every two years):  You pay nothing
    Eyeglass frames (for up to 1 every two years):  You pay nothing
    Eyeglass lenses (for up to 1 every two years):  You pay nothing
    Eyeglasses or contact lenses after cataract surgery:  You pay nothing
    ** Hospice **
    Hospice
    You pay nothing for hospice care from a Medicare-certified hospice. You may have to pay part of the cost for drugs and respite care.
    ** Preventive Care **
    Preventive care
    You pay nothing
    Our plan covers many preventive services including:
    • Abdominal aortic aneurysm screening
    • Alcohol misuse counseling
    • Bone mass measurement
    • Breast cancer screening (mammogram)
    • Cardiovascular disease (behavioral therapy)
    • Cardiovascular screenings
    • Cervical and vaginal cancer screening
    • Colorectal cancer screenings (Colonoscopy Fecal occult blood test Flexible sigmoidoscopy)
    • Depression screening
    • Diabetes screenings
    • HIV screening
    • Medical nutrition therapy services
    • Obesity screening and counseling
    • Prostate cancer screenings (PSA)
    • Sexually transmitted infections screening and counseling
    • Tobacco use cessation counseling (counseling for people with no sign of tobacco-related disease)
    • Vaccines including Flu shots Hepatitis B shots Pneumococcal shots
    • "Welcome to Medicare" preventive visit (one-time)
    • Yearly "Wellness" visit
    Any additional preventive services approved by Medicare during the contract year will be covered.
    Early and periodic screening diagnostic and treatment (EPSDT) services:  You pay nothing
    Family planning services:  You pay nothing
    Tobacco cessation counseling for pregnant women:  You pay nothing
    ** Inpatient Care **
    Inpatient hospital care
    Our plan covers an unlimited number of days for an inpatient hospital stay.
    You pay nothing
    Inpatient mental health care
    For inpatient mental health care see the "Mental Health Care" section.
    Skilled Nursing Facility (SNF)
    Our plan covers an unlimited number of days in a SNF.
    You pay nothing
    Outpatient prescription drugs
    For Part B drugs such as chemotherapy drugs1:  You pay nothing
    Other Part B drugs1:  You pay nothing
    You may get your drugs at network retail pharmacies and mail order pharmacies.
    You pay nothing
    If you reside in a long-term care facility you pay the same as at a retail pharmacy.
    You may get drugs from an out-of-network pharmacy and pay the same as an in-network pharmacy but you will get less of the drug.
    You pay nothing
    Additional home care services
    Home and community based services:   You pay nothing
    Private duty nursing services (for up to 16 hours every day):   You pay nothing
    ** Outpatient Care **
    Diabetes supplies and services
    Diabetes monitoring supplies:  You pay nothing
    Diabetes self-management training:  You pay nothing
    Therapeutic shoes or inserts:  You pay nothing
    Foot care (podiatry services)
    Foot exams and treatment if you have diabetes-related nerve damage and/or meet certain conditions:  You pay nothing
    Hearing services
    Exam to diagnose and treat hearing and balance issues:  You pay nothing
    Routine hearing exam:  You pay nothing
    Hearing aid fitting/evaluation:  You pay nothing
    Hearing aid:  You pay nothing
    ** Outpatient Medical Services and Supplies **
    Outpatient substance abuse
    Group therapy visit:  You pay nothing
    Individual therapy visit:  You pay nothing
    Prosthetic devices (braces, artificial limbs, etc.)
    Prosthetic devices:  You pay nothing
    Related medical supplies:  You pay nothing
    ** Additional Benefits **
    Inpatient mental health care
    For inpatient mental health care see the "Mental Health Care" section.




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