Aetna Medicare Premier (HMO-POS)

Inpatient Hospital See details

The Aetna Medicare Premier (HMO-POS) plan covers inpatient hospital stays, including psychiatric and acute care. For inpatient hospital acute and psychiatric care, you pay a $280 copay for days 1-8, and no copay for days 9-90. Additional days for inpatient hospital-acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.

Outpatient Services See details

Outpatient Services include coverage for all outpatient hospital services with a copay between $0 and $375, observation services with a $280 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a copay of $40 for both individual and group sessions, and outpatient blood services with no copay.

Partial Hospitalization See details

Partial Hospitalization is covered under the Aetna Medicare Premier (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Aetna Medicare Premier (HMO-POS) plan. Ground and air ambulance services have a $295 copay, and transportation services to a plan-approved health-related location have no copay.

Emergency Services See details

Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. For Emergency Services and Worldwide Emergency Coverage, the copay is $125, for Urgently Needed Services the copay is $45, and for Worldwide Emergency Transportation the copay is $295; all services have no coinsurance.

Primary Care See details

Primary Care Physician Services are covered with no copay. Chiropractic Services and Routine Chiropractic Care each have a $20 copay.

Occupational Therapy Services have a $40 copay.

Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services each have a $40 copay.

Mental Health Specialty Services, Individual Sessions for Mental Health Specialty Services, Group Sessions for Mental Health Specialty Services, Podiatry Services, Other Health Care Professional, Psychiatric Services, Individual Sessions for Psychiatric Services, Group Sessions for Psychiatric Services, and Opioid Treatment Program Services all have a minimum copay of $40.

Additional Telehealth Benefits have a 20% coinsurance and a copay between $0 and $45.

Preventive Services See details

The Aetna Medicare Premier (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. The plan also covers health education, wigs for hair loss related to chemotherapy, nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, all with no copay. Kidney Disease Education Services are covered with 20% coinsurance. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.

Hearing Services See details

Hearing exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered with no copay. Prescription hearing aids (all types) are covered with no copay, up to a maximum of $1500 per year, and prescription hearing aids - inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.

Vision Services See details

The Aetna Medicare Premier (HMO-POS) plan covers vision services, including eye exams with a copay of $0-$40. Eyewear is covered with a $0 copay, and a combined maximum of $180 per year.

Dental Services See details

The Aetna Medicare Premier (HMO-POS) plan covers Medicare Dental Services with no copay, and other dental services including oral exams, dental x-rays, prophylaxis (cleaning), restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery, with varying coinsurance costs. However, fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a coinsurance for some services, and Diabetic Equipment. Diabetic Supplies have a coinsurance of 0% to 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered under the Aetna Medicare Premier (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $200, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $200, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $10 copay.

Home Health Services See details

Home Health Services are covered by the Aetna Medicare Premier (HMO-POS) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Aetna Medicare Premier (HMO-POS) plan. While the plan covers Cardiac Rehabilitation Services, it does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the Aetna Medicare Premier (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.

Other Services See details

The Aetna Medicare Premier (HMO-POS) plan covers Over-the-Counter (OTC) Items and Meal Benefits with no copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. Other services such as annual wellness exams, screening mammography, gFOBT, and FIT are covered with no copay.