Aetna Medicare Dual Preferred (HMO D-SNP)

Inpatient Hospital See details

Inpatient hospital stays, including acute and psychiatric care, are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. The plan has a copay of $1875 per admission or stay for Medicare-covered stays in the hospital, and there is no cost sharing on the day of discharge. Additional days for inpatient hospital-acute are covered with no copay per day, but non-Medicare covered stays and upgrades are not covered.

Outpatient Services See details

Outpatient Services, including hospital services, observation services, and substance abuse services, are covered. Outpatient hospital services and observation services have a 20% coinsurance, and outpatient blood services have a 20% coinsurance with a waived three-pint deductible. Individual and group sessions for outpatient substance abuse have a minimum 20% coinsurance and a maximum 20% coinsurance.

Partial Hospitalization See details

Partial Hospitalization is covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan with prior authorization required. You will pay a 20% coinsurance for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered, including both ground and air ambulance services with a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered with no copay, but are limited to 36 one-way trips per year using rideshare services, bus/subway, or medical transport.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $110 copay, while Urgently Needed Services have a $45 copay, and there is no coinsurance for either. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have no copay.

Primary Care See details

Primary Care Physician Services are covered with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, and Routine Chiropractic Care has no copay.

Occupational Therapy Services, Physician Specialist Services, and Physical Therapy and Speech-Language Pathology Services are covered with a 20% coinsurance, and no copay.

Mental Health Specialty Services and Psychiatric Services are covered with a 20% coinsurance, and Opioid Treatment Program Services have a 20% coinsurance.

Podiatry Services are covered, with Routine Foot Care covered with a 20% coinsurance and no copay for Medicare-covered Podiatry Services.

Other Health Care Professional services are covered with a coinsurance between 0-20%.

Additional Telehealth Benefits are covered with no copay.

Preventive Services See details

The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers preventive services, including annual physical exams with no copay. Additional preventive services, such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, and Wigs for Hair Loss Related to Chemotherapy, are covered with varying copays and maximum plan benefit coverage amounts. Other preventive services like Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have a 20% coinsurance.

Hearing Services See details

Hearing Services include hearing exams and prescription hearing aids. Hearing exams have a coinsurance of at most 20% for routine hearing exams, and a $0 copay for Medicare-covered benefits and hearing aid fittings/evaluations. Prescription hearing aids are covered with a maximum benefit of $1250.00 per year, and a $0 copay for all types except inner ear, outer ear, and over the ear, which are not covered.

Vision Services See details

Vision Services includes coverage for eye exams with a 20% coinsurance for routine eye exams, and no copay for Medicare-covered benefits. Eyewear is covered with a 20% coinsurance for contact lenses, and no copay for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum plan benefit of $530 per year.

Dental Services See details

Dental services with Aetna Medicare Dual Preferred (HMO D-SNP) include a 20% coinsurance for Medicare Dental Services, with other services covered up to a $3,500 maximum per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with no copay, but with visit limits. Maxillofacial prosthetics, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan, including Medicare Part B Insulin Drugs with a $35 copay. Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs are also covered, with a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered with a coinsurance between 20% and 20%, and prior authorization is required.

Medical Equipment See details

Medical Equipment is covered by the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Durable Medical Equipment (DME) has a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance with no copay, and Medical Supplies have a 20% coinsurance with no copay. Diabetic Supplies have no coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered under the Aetna Medicare Dual Preferred (HMO D-SNP) plan. Diagnostic Procedures/Tests, Lab Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%, while Diagnostic Radiological Services has a coinsurance of at most 20% but can be as low as 0%. There is no copay for any of these services.

Home Health Services See details

Home Health Services are covered by the Aetna Medicare Dual Preferred (HMO D-SNP) 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 Dual Preferred (HMO D-SNP) plan. The plan does not cover any of the sub-services including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered, with prior authorization required. The plan does not cover additional days beyond Medicare-covered for SNF, and does not cover non-Medicare-covered stays for SNF.

Other Services See details

The Aetna Medicare Dual Preferred (HMO D-SNP) plan covers over-the-counter items with no copay, up to a maximum of $225 per month, and also covers meal benefits and other services with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, and other services are not covered.