Aetna Medicare Freedom (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you have a $275 copay for days 1-8, and no copay for days 9-90. For Inpatient Hospital Psychiatric, there is a $355 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute is covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for Outpatient Hospital Services with a copay between $0 and $275, Observation Services with a $275 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $30 copay for both individual and group sessions, and Outpatient Blood Services with no copay. Prior authorization is required for many of these services.

Partial Hospitalization See details

Partial Hospitalization is covered by the Aetna Medicare Freedom (PPO) plan, but requires prior authorization. You will have an $80 copay for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered under the Aetna Medicare Freedom (PPO) plan. Ground Ambulance Services have a $270 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 by the Aetna Medicare Freedom (PPO) plan. Emergency Services have a $110 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Services have varying copays depending on the service: Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $110 copay, and Worldwide Emergency Transportation has a $270 copay.

Primary Care See details

The Aetna Medicare Freedom (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, and Physician Specialist Services with a copay between $0 and $30. Mental Health Specialty Services, Psychiatric Services, and Opioid Treatment Program Services have a $30 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a $30 copay, and Additional Telehealth benefits have a copay between $0 and $30, with 20% coinsurance. Podiatry Services are not covered.

Preventive Services See details

Preventive Services include coverage for annual physical exams with no copay, and other services such as Health Education, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies, all with no copay. Kidney Disease Education Services has a 20% coinsurance. Other services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, 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 under the Aetna Medicare Freedom (PPO) plan with a $30 copay, and routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered, with a maximum benefit of $500 per ear every year, and there is no copay for prescription hearing aids (all types). Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.

Vision Services See details

The Aetna Medicare Freedom (PPO) plan covers vision services, including eye exams with a copay of $0-$30 and eyewear with a copay of $0 and a combined maximum of $340 per year. Routine eye exams have no copay, and other eye exam services are covered with no copay.

Dental Services See details

The Aetna Medicare Freedom (PPO) plan covers a variety of dental services. Medicare Dental Services have a $30 copay, 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. There is a maximum plan benefit coverage of $2,700 per year for both in-network and out-of-network services.

Home Infusion bundled Services See details

Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered under the Aetna Medicare Freedom (PPO) plan. Medicare Part B Insulin Drugs have a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.

Dialysis Services See details

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

Medical Equipment See details

Medical Equipment benefits are covered by the Aetna Medicare Freedom (PPO) plan. Durable Medical Equipment (DME) is covered with a 20% coinsurance, and Prosthetics/Medical Supplies - Non-Medicare benefit are covered with a coinsurance. Diabetic Equipment is covered, with coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts, and a copay for Medicare-covered Diabetes Supplies.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services include coverage for all diagnostic services, with a copay between $0 and $95 for diagnostic procedures and tests, and no copay for lab services. Radiological services include a copay for diagnostic and therapeutic radiological services, and a coinsurance of at least 20% for therapeutic radiological services; outpatient X-ray services have no copay.

Home Health Services See details

Home Health Services are covered by the Aetna Medicare Freedom (PPO) 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 Freedom (PPO) plan. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) benefits are covered by the Aetna Medicare Freedom (PPO) plan, but require prior authorization. For days 1-25, there is no copay, and for days 26-100, the copay is $125.

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

Other Services See details

The Aetna Medicare Freedom (PPO) plan covers Over-the-Counter (OTC) items with no copay, a maximum benefit of $90 every three months, and covers Nicotine Replacement Therapy and Naloxone. The plan does not cover acupuncture. The plan also covers a meal benefit with no copay, and other services including annual wellness exams, screening mammography, gFOBT, and FIT tests with no copay.