Aetna Medicare Eagle (HMO-POS)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $370 copay for days 1-5, and no copay for days 6-90.

Outpatient Services See details

Outpatient Services are covered, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a copay between $0 and $325, observation services have a $325 copay, ambulatory surgical center services have no copay, individual and group outpatient substance abuse sessions have a $40 copay, and outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the Aetna Medicare Eagle (HMO-POS) plan, with a $55 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Aetna Medicare Eagle (HMO-POS) plan. Ground Ambulance Services have a copay of $245, and Air Ambulance Services have 20% coinsurance. Transportation Services to plan-approved or any health-related locations are not covered.

Emergency Services See details

Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Aetna Medicare Eagle (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage and Urgent Coverage have a $125 copay, while Worldwide Emergency Transportation has a $245 copay.

Primary Care See details

The Aetna Medicare Eagle (HMO-POS) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, while occupational therapy services have a $35 copay.

Physician specialist services have a $35 copay, and physical therapy and speech-language pathology services have a $20 copay. Mental health and psychiatric services, as well as opioid treatment program services, have a $40 copay for individual or group sessions. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $50.

Preventive Services See details

Preventive Services include an annual physical exam with no copay, and additional preventive services with a copay; other services such as in-home safety assessments, personal emergency response systems, and others are not covered. Kidney Disease Education Services have a 20% coinsurance, and other preventive services have no copay for glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit.

Hearing Services See details

Hearing services include hearing exams, routine hearing exams, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a maximum plan benefit of $1250 per ear per year.

Vision Services See details

The Aetna Medicare Eagle (HMO-POS) plan covers vision services, including eye exams and eyewear. Eye exams have no copay, and routine eye exams are covered once per year. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, also have no copay, with a combined maximum benefit of $200 per year.

Dental Services See details

Dental Services include coverage for 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 with no copay; however, there is a $35 copay for Medicare Dental Services, and maxillofacial prosthetics, implant services, and orthodontics are not covered. This benefit has a maximum plan benefit of $1,500 every year.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.

Dialysis Services See details

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

Medical Equipment See details

Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetics/Medical Supplies with a coinsurance for Medicare-covered items, and Diabetic Equipment with a coinsurance of 0-20% for Diabetic Supplies and 20% for Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $20, and Lab Services with no copay. Diagnostic Radiological Services have a copay up to $150, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.

Home Health Services See details

Home Health Services are covered under the Aetna Medicare Eagle (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered by the Aetna Medicare Eagle (HMO-POS) plan. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Eagle (HMO-POS) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100.

Other Services See details

Other services include coverage for Over-the-Counter (OTC) items and meal benefits with no copay, and annual wellness exams, screening mammography, and gFOBT/FIT 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.