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2020 Medicare Advantage Plan Benefit Details for the Aetna Medicare Choice (HMO-POS)


2020 Medicare Advantage Plan Details
Medicare Plan Name:Aetna Medicare Choice (HMO-POS)
Location:Miami-Dade, Florida
Plan ID:H1609 - 028 - 0     Click to see other plans
Member Services:1-833-570-6670 TTY users 711
— Enrollment Options —
Medicare Contact Information:1-800-MEDICARE (1-800-633-4227)
TTY users 1-877-486-2048
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Call Medicare Solutions at 855-373-9484 / TTY 711

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Email a copy of the Aetna Medicare Choice (HMO-POS) benefit details
— Medicare Plan Features —
Monthly Premium:$0.00 (see Plan Premium Details below)
Annual Deductible:$195 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit (ICL):$4,020
Health Plan Type:Local HMO
Maximum Out-of-Pocket Limit for Parts A & B (MOOP):$6,700
Additional Gap Coverage?Yes, some additional gap coverage.
Total Number of Formulary Drugs:3,774 drugsBrowse the Aetna Medicare Choice (HMO-POS) Formulary
This plan has 5 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$47.00$100.0029%
Number of Drugs per
  Tier:
3305739181313640
Plan's Pharmacy Search:http://www.aetnamedicare.com/findpharmacy
Plan Offers Mail Order?Yes
Number of Members enrolled in this plan in Miami-Dade, Florida:65 members
Number of Members enrolled in this plan in (H1609 - 028):2,486 members
Plan’s Summary Star Rating: 4.5 out of 5 Stars.
Customer Service Rating: 5 out of 5 Stars.
Member Experience Rating: 4 out of 5 Stars.
Drug Cost Accuracy Rating: 4 out of 5 Stars.
— Plan Premium Details —
The Monthly Premium is Split as Follows:
Total
Premium
Part C
Premium
Part D Base
Premium
Part D Supplemental
Premium
$0.00$0.00$0.00$0.00
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
Total Monthly Premium with LIS (Parts C & D):$0.00$0.00$0.00$0.00
— Plan Health Benefits —
** Base Plan **
Premium Total monthly premium: $0.00
  Health plan premium: $0.00
  Drug plan premium: $0.00
  Standard Part B premium: $135.50
  Part B premium reduction: No
Deductible Health plan deductible: $500 Out-of-network
  Drug plan deductible: $195.00
Estimated yearly costs Estimated total yearly costs for care: $3,930.00
Out-of-pocket max Out-of-pocket max: $10,000 In and Out-of-network $6,700 In-network
Doctor services Primary doctor visit: In-network: $0 copay Out-of-network: No Data
  Specialist visit: In-network: $40 per visit Out-of-network: $50 per visit
Tests, labs, & imaging Diagnostic tests & procedures: In-network: $0-200 Out-of-network: 50%
  Lab services: In-network: $0-125 Out-of-network: 50%
  Diagnostic radiology services (like MRI): In-network: $0-200 Out-of-network: 50%
  Outpatient x-rays: In-network: $10 Out-of-network: 50%
  Emergency care: $90 per visit (always covered)
  Urgent care: $0-50 per visit (always covered)
Hospital services Inpatient hospital coverage: In-network: $350 per day for days 1 through 4 $0 per day for days 5 through 90 Out-of-network: 50% per stay
  Outpatient hospital coverage: In-network: $250 per visit Out-of-network: 50% per visit
Skilled nursing facility Skilled nursing facility: In-network: $0 per day for days 1 through 20 $178 per day for days 21 through 100 Out-of-network: 50% per stay
Preventive services Preventive services: In-network: $0 copay Out-of-network: $0 copay
Ambulance Ground ambulance: In-network: $255 Out-of-network: $255
Therapy services Occupational therapy visit: In-network: $35 Out-of-network: No Data
  Physical therapy & speech & language therapy visit: In-network: $35 Out-of-network: No Data
Mental health services Outpatient group therapy with a psychiatrist: In-network: $35 Out-of-network: No Data
  Outpatient individual therapy with a psychiatrist: In-network: $40 Out-of-network: No Data
  Outpatient group therapy visit: In-network: $35 Out-of-network: No Data
  Outpatient individual therapy visit: In-network: $40 Out-of-network: No Data
Opioid treatment services Opioid treatment services: Covered
Other services Durable medical equipment (like wheelchairs & oxygen): In-network: 20% per item Out-of-network: No Data
  Prosthetics (like braces, artificial limbs): In-network: 20% per item Out-of-network: No Data
  Diabetes supplies: In-network: 0-20% per item Out-of-network: No Data
Hearing Hearing exam: In-network: $40 Out-of-network: No Data
  Fitting/evaluation: In-network: $0 copay Out-of-network: No Data
  Hearing aids - All types: In-network: $0 copay Out-of-network: No Data
Preventive dental Oral exam: In-network: $0 copay Out-of-network: No Data
  Cleaning: In-network: $0 copay Out-of-network: No Data
  Fluoride treatment: In-network: $0 copay Out-of-network: No Data
  Dental x-rays: In-network: $0 copay Out-of-network: No Data
Comprehensive dental Non-routine services: In-network: $0 copay Out-of-network: No Data
  Diagnostic services: In-network: $0 copay Out-of-network: No Data
  Restorative services: In-network: $0 copay Out-of-network: No Data
  Endodontics: Not covered
  Periodontics: In-network: $0 copay Out-of-network: No Data
  Extractions: In-network: $0 copay Out-of-network: No Data
  Prosthodontics, other oral/maxillofacial surgery, other services: Not covered
Vision Routine eye exam: In-network: $0 copay Out-of-network: No Data
  Contact lenses: In-network: $0 copay Out-of-network: No Data
  Eyeglasses (frames & lenses): In-network: $0 copay Out-of-network: No Data
  Eyeglass frames (only): Not covered
  Eyeglass lenses (only): Not covered
  Upgrades: Not covered
More benefits Fitness benefit: Limited coverage
  Over the counter drug benefits: Limited coverage
  In-home support services: Not covered
  Home and bathroom safety devices: Not covered
  Meals for short duration: Not covered
  Annual physical exams: Limited coverage
  Telehealth: Not covered
Part B drugs Chemotherapy drugs: In-network: 20% Out-of-network: No Data
  Other Part B drugs: In-network: 20% Out-of-network: No Data




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