- Aetna Copay For Specialist Services
- Aetna Copay For Specialist Physicians
- Aetna Copay For Specialist Clinic
- Does Aetna Require A Referral To See A Specialist
- Aetna Copay For Specialist Group
- What Is The Copay For Aetna
- How To Pay Aetna Copay
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Luckily, his health plan has some fixed costs and only requires $30 copays for visits to his regular doctor and $50 copays to see specialists like an orthopedist. (He also once paid a $150 copay the night he landed in the emergency room when his knee was so swollen he couldn’t bend it.). Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD). PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists. Why choose the Aetna Open Access plan? Large nationwide Aetna Network.
Aetna Medicare Value Plan (HMO) H3146-004 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in North Carolina. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Value Plan (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out of pocket. This can be a extremely nice safety net.
Aetna Medicare Value Plan (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 Value Plan (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.
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2021 Aetna Medicare Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H3146-004 |
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| Provider: | Aetna Medicare |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $5,500 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $0 |
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| Tiers with No Deductible: | 0 |
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| Gap Coverage: | Yes |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H3146-005 |
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Aetna Medicare Value Plan (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.
H3146-004 Part-D Deductible and Premium
Aetna Medicare Value Plan (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.
H3146-004 Formulary or Drug Coverage
Aetna Medicare Value Plan (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Star wars knights of the old republic emulator. 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 Plan (HMO) Summary of Benefits
Additional Benefits
Comprehensive Dental
| Diagnostic services | $0 copay |
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| Endodontics | $0 copay |
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| Extractions | $0 copay |
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| Non-routine services | $0 copay |
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| Periodontics | $0 copay |
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| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
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| Restorative services | $0 copay |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-100 copay |
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| Diagnostic tests and procedures | $0-75 copay |
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| Lab services | $0 copay |
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| Outpatient x-rays | $14 copay |
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Doctor Visits
| Primary | $0 copay |
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| Specialist | $25 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $0-25 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $25 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
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| Hearing aids | $0 copay |
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| Hearing exam | $25 copay |
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Inpatient Hospital Coverage
$325 per day for days 1 through 5
$0 per day for days 6 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $325 per day for days 1 through 5
$0 per day for days 6 through 90 |
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| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
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| Outpatient individual therapy visit | $40 copay |
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| Outpatient individual therapy visit with a psychiatrist | $40 copay |
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MOOP
Option
| Yes, contact plan for further details |
|---|
Optional supplemental benefits
Outpatient Hospital Coverage
Preventive Care
Aetna Copay For Specialist Services
Preventive Dental
| Cleaning | $0 copay |
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| Dental x-ray(s) | $0 copay |
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| Fluoride treatment | $0 copay |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $25 copay |
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| Physical therapy and speech and language therapy visit | $25 copay |
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Skilled Nursing Facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Eyeglass frames | $0 copay |
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| Eyeglass lenses | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Other | $25 copay |
|---|
| Routine eye exam | $0 copay |
|---|
| Upgrades | $0 copay |
|---|
Aetna Copay For Specialist Physicians
Wellness Programs (e.g. fitness nursing hotline)
Aetna Copay For Specialist Clinic
Ready to Enroll?
Or Call
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Sun 9am-6pm EST
Coverage Area for Aetna Medicare Value Plan (HMO)
Does Aetna Require A Referral To See A Specialist
(Click county to compare all available Advantage plans)
Aetna Copay For Specialist Group
| State: | North Carolina
|
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| County: | Durham,Johnston,Orange,Person,Wake,
|
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What Is The Copay For Aetna
How To Pay Aetna Copay
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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.