Aetna Medicare Select (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital services, including acute and psychiatric care, are covered with prior authorization. For inpatient hospital-acute, you will pay a copay of $374 for days 1-8, and no copay for days 9-90, while inpatient hospital psychiatric care has a copay of $286 for days 1-8, and no copay for days 9-90. Additional days and upgrades for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient services include outpatient hospital services with a copay between $0 and $374, observation services with a $374 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $40 copay for both individual and group sessions, and outpatient blood services are covered with no copay.

Partial Hospitalization See details

Partial hospitalization is covered by the Aetna Medicare Select (HMO-POS) plan, but requires prior authorization. You will have a $105 copay for this service.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by Aetna Medicare Select (HMO-POS), with prior authorization required for all ambulance services. Ground ambulance services have a $275 copay, while air ambulance services have a 20% coinsurance. Transportation Services to any health-related location are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Aetna Medicare Select (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Transportation has a $275 copay.

Primary Care See details

The Aetna Medicare Select (HMO-POS) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy with a $30 copay, and physician specialist services with a $40 copay. Mental health and psychiatric services for individual or group sessions have a $40 copay, while physical therapy and speech-language pathology services have a $30 copay. Additionally, the plan offers additional telehealth benefits with a 20% coinsurance and a copay between $0 and $40, and opioid treatment program services with a $40 copay.

Preventive Services See details

The Aetna Medicare Select (HMO-POS) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services include Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, and Fitness Benefit, with no copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services include Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.

Hearing Services See details

The Aetna Medicare Select (HMO-POS) plan covers hearing exams with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $1000 per year, and prescription hearing aids (all types) are covered with no copay, but prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.

Vision Services See details

The Aetna Medicare Select (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $40, and routine eye exams and other eye exam services with no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are covered with no copay, up to a combined maximum of $215 per year.

Dental Services See details

Dental Services are covered, with a $1,650 annual maximum. Medicare Dental Services have a $40 copay and require prior authorization, while 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 have no copay. Maxillofacial prosthetics, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.

Dialysis Services See details

Dialysis Services are covered under the Aetna Medicare Select (HMO-POS) plan, but prior authorization is required. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has a coinsurance between 0% and 20% and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and Medical Supplies have a coinsurance between 0% and 20%. Diabetic Supplies have a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts have no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered by the Aetna Medicare Select (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services have no copay. Diagnostic Radiological Services have a copay of up to $300, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have no copay.

Home Health Services See details

Home Health Services are covered with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. Prior authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the Aetna Medicare Select (HMO-POS) plan. Despite the general coverage, specific services such as Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, the copay is $10, and for days 21-100, the copay is $214.

Additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.

Other Services See details

The Aetna Medicare Select (HMO-POS) plan covers Over-the-Counter (OTC) Items with no copay, and a maximum benefit coverage amount of $45.00 every three months; it also covers a meal benefit with no copay, and annual wellness exams, screening mammography, and gFOBT/FIT with no copay. Acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing, and other services are not covered.