Aetna Therapy Copay

Radiation therapy: $0 copay. Aetna Better Health of Kentucky is not responsible or liable for content, accuracy or privacy practices of linked sites or for products or services described on these sites. If you did not intend to leave our site, click or tap the 'x' in the upper right-hand corner. Applicable plans: Applies to all Aetna plans; self-insured plan sponsors can opt out. Description: Until at least June 4th, 2020, Aetna will waive member cost sharing for any covered telemedicine visits — regardless of diagnosis. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits.

  1. Aetna Medicare Freedom Plan (PPO) H5521-178 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Louisiana. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Freedom Plan (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP).
  2. His copays extend to physical therapy visits, where he’ll pay $20 for each session. Leon’s determined to get everything back on track so he and Leah can return to doing the things they love: spending time together outdoors. By learning how premiums, deductibles, coinsurance and copays work, you can better understand your health care costs.

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Aetna Medicare Freedom Plan (PPO) H5521-216 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Alabama. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Freedom Plan (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $6,900 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $6,900 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Freedom Plan (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Freedom Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.



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2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:
H5521-216
Provider:Aetna Medicare
Year:2021
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $6,900
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $0
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H5521-217

Aetna Medicare Freedom Plan (PPO) Part-C Premium

Aetna Medicare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.


H5521-216 Part-D Deductible and Premium

Aetna Medicare Freedom Plan (PPO) has a monthly drug premium of $0 and a $0 drug deductible. This Aetna Medicare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.


Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.


H5521-216 Formulary or Drug Coverage

Aetna Medicare Freedom Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.



2021 Aetna Medicare Freedom Plan (PPO) Summary of Benefits



Additional Benefits


No


Comprehensive Dental


Diagnostic services$0 copay
Diagnostic services$0 copay (Out-of-Network)
Endodontics$0 copay
Endodontics$0 copay (Out-of-Network)
Extractions$0 copay
Extractions$0 copay (Out-of-Network)
Non-routine services$0 copay
Non-routine services$0 copay (Out-of-Network)
Periodontics$0 copay
Periodontics$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services$0 copay (Out-of-Network)
Restorative services$0 copay
Restorative services$0 copay (Out-of-Network)


Deductible


$0


Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-200 copay
Diagnostic radiology services (e.g., MRI)35% coinsurance (Out-of-Network)
Diagnostic tests and procedures$0-95 copay
Diagnostic tests and procedures35% coinsurance (Out-of-Network)
Lab services$0-20 copay
Lab services35% coinsurance (Out-of-Network)
Outpatient x-rays$5-35 copay
Outpatient x-rays35% coinsurance (Out-of-Network)


Doctor Visits


Primary$30 copay per visit (Out-of-Network)
Primary$5 copay per visit
Specialist$35 copay per visit
Specialist$50 copay per visit (Out-of-Network)


Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$50 copay per visit (always covered)


Foot Care (podiatry services)


Foot exams and treatment$35 copay
Foot exams and treatment$50 copay (Out-of-Network)
Routine foot careNot covered


Counseling

Ground Ambulance


$295 copay
$295 copay (Out-of-Network)


Hearing


Fitting/evaluation$0 copay
Fitting/evaluation$50 copay (Out-of-Network)
Hearing aids$0 copay
Hearing aids$0 copay (Out-of-Network)
Hearing exam$35 copay
Hearing exam$50 copay (Out-of-Network)


Inpatient Hospital Coverage


$250 per day for days 1 through 7
$0 per day for days 8 through 90
35% per stay (Out-of-Network)


Medical Equipment/Supplies


Diabetes supplies0-20% coinsurance per item
Diabetes supplies0-20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)35% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)35% coinsurance per item (Out-of-Network)


Medicare Part B Drugs


Chemotherapy20% coinsurance
Chemotherapy35% coinsurance (Out-of-Network)
Other Part B drugs20% coinsurance
Other Part B drugs35% coinsurance (Out-of-Network)


Mental Health Services


Inpatient hospital - psychiatric$295 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital - psychiatric35% per stay (Out-of-Network)
Outpatient group therapy visit$30 copay
Outpatient group therapy visit$50 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist$30 copay
Outpatient group therapy visit with a psychiatrist$50 copay (Out-of-Network)
Outpatient individual therapy visit$30 copay
Outpatient individual therapy visit$50 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist$30 copay
Outpatient individual therapy visit with a psychiatrist$50 copay (Out-of-Network)


MOOP


$11,300 In and Out-of-network
$6,900 In-network


Option


No

Aetna Therapy Copay Program


Optional supplemental benefits


No


Outpatient Hospital Coverage


$0-195 copay per visit
35% coinsurance per visit (Out-of-Network)


Preventive Care


$0 copay
$0 copay (Out-of-Network)


Preventive Dental


Cleaning$0 copay
Cleaning$0 copay (Out-of-Network)
Dental x-ray(s)$0 copay
Dental x-ray(s)$0 copay (Out-of-Network)
Fluoride treatment$0 copay
Fluoride treatment$0 copay (Out-of-Network)
Oral exam$0 copay
Oral exam$0 copay (Out-of-Network)


Rehabilitation Services


Occupational therapy visit$20 copay
Occupational therapy visit$50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit$20 copay
Physical therapy and speech and language therapy visit$50 copay (Out-of-Network)


Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100
35% per stay (Out-of-Network)


Transportation


Not covered


Vision


Contact lenses$0 copay
Contact lenses$0 copay (Out-of-Network)
Eyeglass frames$0 copay
Eyeglass frames$0 copay (Out-of-Network)
Eyeglass lenses$0 copay
Eyeglass lenses$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)$0 copay
Eyeglasses (frames and lenses)$0 copay (Out-of-Network)
Other$35 copay
Other$50 copay (Out-of-Network)
Routine eye exam$0 copay
Routine eye exam$50 copay (Out-of-Network)
Upgrades$0 copay
Upgrades$0 copay (Out-of-Network)


Wellness Programs (e.g. fitness nursing hotline)


Covered

Reviews for Aetna Medicare Freedom Plan (PPO) H5521


2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Aetna Medicare Freedom Plan (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Aetna

Health Plan Customer Service Rating for Aetna Medicare Freedom Plan (PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Aetna Medicare Freedom Plan (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes


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Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
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Aetna Copay Plans



Coverage Area for Aetna Medicare Freedom Plan (PPO)

Copay For Aetna Insurance

(Click county to compare all available Advantage plans)

State: Alabama
County:Fayette,Lamar,Pickens,Tuscaloosa,

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Aetna Therapy Copay Card


Aetna Therapy Copay Assistance

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.