Aetna Medicare Select (HMO)

Monthly premium

$0.00
CMS Plan Rating
Contract ID
โ˜…โ˜…โ˜…โ˜…โ˜…
H1609-059-000
Medical deductible
$0
Rx deductible
$200
Medicare Part B Giveback
N/A

Monthly premium

$0.00
Aetna Medicare Select (HMO)
Contract ID
CMS Plan Rating
H1609-059-000
โ˜…โ˜…โ˜…โ˜…โ˜…
Medical deductible
$0
Rx deductible
$200
Medicare Part B Giveback
N/A

Medicare Advantage, also known as Medicare Part C, is a health plan option that provides Medicare Part A and Part B coverage. Medicare Advantage plans areย offered by private insurance companies that are approved by Medicare. These plans provide benefits similar to Original Medicare Part A and Part B, but often include additional benefits such as dental, hearing and vision.

Medical benefits

In-network

What you pay

Primary doctor
$0 copay
Specialist
$20 copay
Outpatient diagnostic tests/Lab and X-Rays
$0 - $200 copay
Urgent care
$30 copay
Maximum Out-of-Pocket (Annually)
$3,900
Ambulance services
$240 copay
Emergency room (waived if admitted to hospital within 24 hours)
$150 copay
Inpatient hospital care
$200 per day, days 1-7; $0 per day, days 8-90
Skilled nursing facility
$0 per day (Days 1โ€‘20)

For full plan details, see the Evidence of Coverage or Summary of Benefitsย in the Plan Documents.ย 

Rx benefits

Tier 1 - Preferred generic
$0 copay
Tier 2 - Generic
$0 copay
Tier 3 - Preferred brand
25%
Tier 4 - Non-preferred brand
30%
Tier 5 - Specialty
30%

Additional Benefits

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