Aetna Medicare Platinum Plan (HMO)

Aetna Medicare
Medicare Advantage Plan (with drug coverage)
Plan ID: H3931-115-0 | Carson City County, NV | 2021
3.5/5 stars
Medicare Plan Overall Rating
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Aetna Medicare Platinum Plan Drug Coverage and Costs in Carson City County, NV

Aetna Medicare Platinum Plan
Drug Coverage Drug Coverage included in plan
Plan Type HMO
Total Monthly Premium $0.00
Health Plan Premium $0.00
Drug Plan Premium $0.00
Standard Part B Premium $148.50
Max You Pay for Health Services (in-network) $7,550.00
Part D Deductible $100.00
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Doctors, Specialists, Tests, Labs, Imaging

Aetna Medicare Platinum Plan
Primary Doctor Visit $0 copay
Specialist Visit $45 copay per visit
Diagnostic Tests & Procedures $0-20 copay
Lab Services $0 copay
Diagnostic Radiology Services (like MRI) $0-250 copay
Outpatient X-rays $20 copay

Hospitals, Skilled Nursing, Urgent Care

Aetna Medicare Platinum Plan
Emergency Care $90 copay per visit (always covered)
Urgent Care $45 copay per visit (always covered)
Ambulance (Ground) $270 copay
Inpatient Hospital Coverage $325 per day for days 1 through 6
$0 per day for days 7 through 90
Outpatient Hospital Coverage $0-400 copay per visit
Skilled Nursing Facility Stays $0 per day for days 1 through 20
$184 per day for days 21 through 100
Preventive Services $0 copay

Hearing and Vision

Aetna Medicare Platinum Plan
Hearing Exam $0 copay
Hearing Fitting / Evaluation Not covered
Hearing Aides - All Types
Routine Eye Exam $0 copay
Contact Lenses $0 copay
Eyeglasses (Frames & Lenses) $0 copay
Eyeglass Frames (only) $0 copay
Eyeglass Lenses (only) $0 copay
Upgrades (vision) $0 copay

Physical, Occupational, Speech Therapy and Mental Health

Aetna Medicare Platinum Plan
Occupational Therapy Visit $40 copay
Physical Therapy Visit $40 copay
Speech Pathology Visit $40 copay
Outpatient Group Therapy with a Psychiatrist $40 copay
Outpatient Individual Therapy with a Psychiatrist $40 copay
Outpatient Group Therapy Visit $40 copay
Outpatient Individual Therapy Visit $40 copay

Dental Coverage

Aetna Medicare Platinum Plan
Oral Exam $0 copay
Oral Cleaning $0 copay
Flouride Treatment $0 copay
Dental X-rays $0 copay
Non-routine Services $0 copay
Diagnostic Services $0 copay
Restorative Services $0 copay
Endodontics $0 copay
Periodontics $0 copay
Extractions $0 copay
Prosthodontics, Other Oral / Maxillofacial Surgery, Other Services $0 copay

Medical Equipment, Dialysis, Diabetes

Aetna Medicare Platinum Plan
Durable medical equipment (like wheelchairs & oxygen) 20% coinsurance per item
Prosthetics (like braces, artificial limbs) 20% coinsurance per item
Diabetes Supplies 0-20% coinsurance per item

Drug Coverage and Costs (Initial Coverage Phase)

Aetna Medicare Platinum Plan
Preferred Retail Pharmacy (1 month supply)
Preferred Generic $0.00 copay
Generic $10.00 copay
Preferred Brand $47.00 copay
Non-Preferred Brand $100.00 copay
Specialty Tier 31%
Standard Retail Pharmacy (1 month supply)
Preferred Generic $15.00 copay
Generic $20.00 copay
Preferred Brand $47.00 copay
Non-Preferred Brand $100.00 copay
Specialty Tier 31%
Preferred Mail Order Pharmacy (3 month supply)
Preferred Generic $0.00 copay
Generic $25.00 copay
Preferred Brand $141.00 copay
Non-Preferred Brand $300.00 copay
Standard Mail Order Pharmacy (3 month supply)
Preferred Generic $45.00 copay
Generic $60.00 copay
Preferred Brand $141.00 copay
Non-Preferred Brand $300.00 copay

Important Plan Information

Plan limits may apply for the above services - There may be limits on how much the plan will provide.

Advanced Plan Approval May be Required for the above services - A process through which the physician or other health care provider is required to obtain advance approval from the plan that payment will be made for a service or item furnished to an enrollee. Unless specified otherwise with respect to a particular item or service, the enrollee is not responsible for obtaining (prior) authorization.

Physician Referral May be Required - A process through which the enrolleeā€™s primary care physician or other network physician (depending on the plan policy) permits or instructs the enrollee to obtain an item or service from another physician or other provider type.

FOR INFORMATIONAL PURPOSES ONLY

The plans listed on this page are for informational purposes only. CareListings has no plan affiliations and does not endorse any plans displayed. The information provided is based on publicly available data from the Centers for Medicare & Medicaid Services (CMS). Current data is accessible on medicare.gov. Not connected with or endorsed by the U.S. Government or the federal Medicare program. Actual plan costs and coverage can vary. Always consult a licensed insurance agent before purchasing insurance products.

Medicare Star Rating Performance

AETNA HEALTH INC. (PA)
Aetna Medicare
3.5/5 stars
Summary Rating of Health Plan Quality 3.5/5 stars
Staying Healthy: Screenings, Tests, & Vaccines 3/5 stars
Breast cancer screening 3/5 stars
Colorectal cancer screening 3/5 stars
Yearly flu vaccine 3/5 stars
Improving or maintaining physical health 5/5 stars
Improving or maintaining mental health 3/5 stars
Monitoring physical activity 3/5 stars
Checking to see if members are at a healthy weight 4/5 stars
Managing Chronic (Long-term) Conditions 4/5 stars
Members whose plan did an assessment of their health needs and risks Not Available
Yearly review of all medications and supplements being taken Not Available
Yearly assessment of how well plan members are able to do activities of daily living Not Available
Yearly pain screening or pain management plan Not Available
Osteoporosis management 4/5 stars
Eye exam to check for damage from diabetes 4/5 stars
Kidney function testing for members with diabetes 5/5 stars
Plan members with diabetes whose blood sugar is under control 5/5 stars
Rheumatoid arthritis management 3/5 stars
Reducing the risk of falling 2/5 stars
Improving bladder control 4/5 stars
The plan makes sure member medication records are up-to-date after hospital discharge 4/5 stars
The plan makes sure members with heart disease get the most effective drugs to treat high cholesterol 3/5 stars
Member Experience with Health Plan 3/5 stars
Ease of getting needed care and seeing specialists 3/5 stars
Getting appointments and care quickly 2/5 stars
Health plan provides information or help when members need it 2/5 stars
Member's rating of health care quality 3/5 stars
Member's rating of health plan 3/5 stars
Coordination of members' health care services 4/5 stars
Member Complaints & Changes in the Health Plan's Performance 3/5 stars
Complaints about the health plan (more stars are better because it means fewer complaints) 5/5 stars
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) 2/5 stars
Improvement (if any) in the health plan's performance 2/5 stars
Health Plan Customer Service 5/5 stars
Health plan makes timely decisions about appeals 4/5 stars
Fairness of the health plan's appeal decisions, based on an independent reviewer 5/5 stars
Availability of TTY services and foreign language interpretation when prospective members call the health plan 5/5 stars
Drug Plan (Part D) Star Rating 3.5/5 stars
Drug Plan Customer Service 5/5 stars
Availability of TTY services and foreign language interpretation when prospective members call the drug plan 5/5 stars
Drug plan fails to make timely decisions about appeals (more stars are better because it means fewer delays) 4/5 stars
Fairness of drug plan's appeal decisions, based on an independent reviewer 5/5 stars
Member Complaints & Changes in the Drug Plan's Performance 4/5 stars
Complaints about the drug plan (more stars are better because it means fewer complaints) 5/5 stars
Members choosing to leave the plan (more stars are better because it means fewer members choose to leave the plan) 2/5 stars
Improvement (if any) in the drug plan's performance 4/5 stars
Member Experience with the Drug Plan 3/5 stars
Members' rating of drug plan 2/5 stars
Ease of getting prescriptions filled when using the plan 4/5 stars
Drug Safety & Accuracy of Drug Pricing 3/5 stars
Plan provides accurate drug pricing information for Medicare's website 5/5 stars
Taking diabetes medication as directed 4/5 stars
Taking blood pressure medication as directed 3/5 stars
Taking cholesterol medication as directed 3/5 stars
Members who had a pharmacist (or other health professional) help them understand and manage their medications 2/5 stars
The plan makes sure members with diabetes take the most effective drugs to treat high cholesterol 3/5 stars
Last Updated: November 15, 2020

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