Aetna Medicare Elite 2 NJ South (PPO)

Inpatient Hospital See details

Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute with a copay of $385 for days 1-6, and no copay for days 7-90, as well as Inpatient Hospital Psychiatric with a copay of $339 for days 1-6, and no copay for days 7-90. Additional Days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for all outpatient hospital services with a copay ranging from $0 to $395, observation services with a $385 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $40 copay for both individual and group sessions, and Outpatient Blood Services with no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by Aetna Medicare Elite 2 NJ South (PPO) with an $80 copay. Prior authorization is required.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the Aetna Medicare Elite 2 NJ South (PPO) plan. Ground and Air Ambulance Services have a $300 copay, with no 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 Elite 2 NJ South (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Urgently Needed Services has a $45 copay, and Worldwide Emergency Transportation has a $300 copay; all services have no coinsurance.

Primary Care See details

The Aetna Medicare Elite 2 NJ South (PPO) plan covers primary care physician services with a $10 copay, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $45 copay, mental health specialty services with a $40 copay for individual and group sessions, other health care professional services with a copay between $0 and $45, psychiatric services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, and opioid treatment program services with a $40 copay; however, routine chiropractic care and podiatry services are not covered. Additional telehealth benefits are covered with a 20% coinsurance and a copay between $0 and $45.

Preventive Services See details

Preventive services include coverage for annual physical exams with no copay, and additional services such as Health Education, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, and Remote Access Technologies with a $0 copay. Kidney Disease Education Services have a 20% coinsurance. Other preventive services, including glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, have a $0 copay.

Hearing Services See details

Hearing services include coverage for hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a maximum copay of $1700, while prescription hearing aids for the 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 Elite 2 NJ South (PPO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with no copay, up to a combined maximum of $150 every year. Routine eye exams, other eye exam services, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are all covered with no copay.

Dental Services See details

Dental Services include coverage for Medicare Dental Services with a $45 copay, oral exams, dental x-rays, and prophylaxis (cleaning) with no copay. However, fluoride treatment, orthodontic services, and several other dental services are not covered.

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 by the Aetna Medicare Elite 2 NJ South (PPO) plan, with a coinsurance of 20%. Prior authorization is required.

Medical Equipment See details

Medical Equipment benefits are covered by the Aetna Medicare Elite 2 NJ South (PPO) plan, including Durable Medical Equipment (DME) with 0%-20% coinsurance and no copay. Prosthetics/Medical Supplies have no copay, and coinsurance applies. Diabetic Equipment, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are covered with coinsurance, and Diabetic Supplies have 0%-20% coinsurance. Durable Medical Equipment for use outside the home is not covered.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered by Aetna Medicare Elite 2 NJ South (PPO). Diagnostic Procedures/Tests have a copay between $0 and $45, and Lab Services have no copay.

Diagnostic Radiological Services have a maximum copay of $325 and Therapeutic Radiological Services have a coinsurance of 20%.

Outpatient X-Ray Services have a copay of $45.

Home Health Services See details

Home Health Services are covered by the Aetna Medicare Elite 2 NJ South (PPO) plan 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 Elite 2 NJ South (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

The Aetna Medicare Elite 2 NJ South (PPO) plan covers Skilled Nursing Facility (SNF) services, but requires prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $195.

Other Services See details

The Aetna Medicare Elite 2 NJ South (PPO) plan does not cover acupuncture, over-the-counter items, 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. The plan covers a meal benefit with no copay. Other services such as annual wellness exams and screening mammography, as well as gFOBT and FIT, are covered with no copay.