Aetna Medicare Value (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $300 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you'll pay a $350 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services, including all outpatient hospital services and outpatient blood services, are covered by the Aetna Medicare Value (PPO) plan. Outpatient hospital services have a copay between $0 and $300, while observation services have a $300 copay, and outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered, with no copay. Prior authorization is required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Aetna Medicare Value (PPO) plan. Ground ambulance services have a $265 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 Value (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation have copays of $125, $125, and $265, respectively.

Primary Care See details

The Aetna Medicare Value (PPO) plan covers primary care physician services for a $5 copay, chiropractic services for a $20 copay, and occupational therapy services for a $35 copay. The plan also covers physician specialist services with a copay between $0 and $50, and physical therapy and speech-language pathology services for a $35 copay. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $50.

Preventive Services See details

The Aetna Medicare Value (PPO) plan covers preventive services, including an annual physical exam with no copay. Additional preventive services are covered with a copay, and kidney disease education services have a 20% coinsurance. Other preventive services, like glaucoma screening and diabetes self-management training, are covered with no copay.

Hearing Services See details

Hearing services include hearing exams with a $50 copay, routine hearing exams with no copay for 1 visit per year, and fitting/evaluation for hearing aids with no copay for 1 visit per year. Prescription hearing aids have a maximum benefit of $500 per year, with no copay for all types of prescription hearing aids for 2 visits per year, 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

Vision services, including routine eye exams, other eye exam services, and eyewear, are covered. Routine eye exams have no copay, and other eye exam services have no copay; eyewear has a combined maximum plan benefit of $215 per year, with no copay.

Dental Services See details

The Aetna Medicare Value (PPO) plan covers Medicare Dental Services with a $50 copay, and other dental services including 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. This plan has a maximum benefit of $1,000 per year for both in-network and out-of-network services. Maxillofacial prosthetics, implant services, and orthodontics are not covered.

Home Infusion bundled Services See details

Home Infusion bundled Services are covered, with a prior authorization requirement. 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 Value (PPO) plan, but require prior authorization. You will pay 20% coinsurance for these services.

Medical Equipment See details

Medical Equipment is covered by Aetna Medicare Value (PPO). Durable Medical Equipment (DME) has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered.

Prosthetics/Medical Supplies - Non-Medicare benefit, Medicare-covered Prosthetic Devices, and Medicare-covered Medical Supplies are covered with a coinsurance.

Diabetic Equipment is covered, including Diabetic Supplies with a coinsurance between 0% and 20%, and Diabetic Therapeutic Shoes/Inserts with no coinsurance.

Diagnostic and Radiological Services See details

The Aetna Medicare Value (PPO) plan covers diagnostic and radiological services, including all diagnostic services, diagnostic procedures/tests with a copay between $0 and $20, and lab services with no copay. The plan also covers radiological services, with a copay of up to $295 for diagnostic radiological services and a coinsurance of at least 20% for therapeutic radiological services, and a $30 copay for outpatient X-ray services.

Home Health Services See details

Home Health Services are covered by the Aetna Medicare Value (PPO) plan with no copay and no coinsurance; however, additional hours of care and personal care services are not covered. This benefit requires authorization.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered, but the plan does not cover any of the sub-services. There is a copay for the covered services, but the amount is not specified.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered under the Aetna Medicare Value (PPO) plan, with prior authorization required. For days 1-20, the copay is $10, and for days 21-100, the copay is $214; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.

Other Services See details

The Aetna Medicare Value (PPO) plan's Other Services benefit covers over-the-counter items with no copay, a maximum benefit of $75 every three months, and offers nicotine replacement therapy and Naloxone coverage. Acupuncture, 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, 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.