PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Aetna
CMS Rating
Plan Type
HMO
Annual Deductible
$175.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$3,400 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$0.00
Monthly Health Plan Premium
$0.00

Benefits

Service
Cost
Ambulance Services
$300 copay
Doctors Office Visits
Primary care physician visit: You pay nothing
Specialist visit: $15 copay
Emergency Care
$75 copay
If you are immediately admitted to the hospital, you do not have to pay
your share of the cost for emergency care. See the "Inpatient Hospital
Care" section of this booklet for other costs.
Home Health Care
You pay nothing
Mental Health Care
Inpatient visit:
Our plan covers up to 190 days in a lifetime for inpatient mental health
care in a psychiatric hospital. The inpatient hospital care limit does not
apply to inpatient mental services provided in a general hospital.
Our plan covers 90 days for an inpatient hospital stay.
Our plan also covers 60 "lifetime reserve days." These are "extra" days
that we cover. If your hospital stay is longer than 90 days, you can use
these extra days. But once you have used up these extra 60 days, your
inpatient hospital coverage will be limited to 90 days.
  • $1,953 copay per stay

  • Outpatient group therapy visit: $40 copay
    Outpatient individual therapy visit: $40 copay
    This benefit will begin on day one each time you are admitted to a specific
    facility type. A transfer within or to a facility, including Inpatient
    Rehabilitation, Long Term Acute Care, Inpatient Acute or Psychiatric facility
    is considered a new admission. You pay your cost share per admission.
    Outpatient hospital
    $15-289 per visit
    Renal dialysis
    $30 per visit
    Inpatient Hospital Care
    Our plan covers an unlimited number of days for an inpatient hospital
    stay.
  • $289 copay per day for days 1 through 6

  • You pay nothing per day for days 7 through 90

  • You pay nothing per day for days 91 and beyond

  • This benefit will begin on day one each time you are admitted to a specific
    facility type. A transfer within or to a facility, including Inpatient
    Rehabilitation, Long Term Acute Care, Inpatient Acute or Psychiatric facility
    is considered a new admission. You pay your cost share per admission.
    Diabetes Supplies and Services
    Diabetes monitoring supplies: 0-20% of the cost, depending on the supply
    Diabetes self-management training: You pay nothing
    Therapeutic shoes or inserts: You pay nothing
    You pay a $0 copayment for glucose monitors and diabetic test strips from
    our preferred vendor, OneTouch/LifeScan. You will pay 20% of the cost
    of glucose monitors and diabetic test strips from non-preferred vendors.
    Acupuncture
    Not covered
    Preventive Care
    You pay nothing
    Our plan covers many preventive services, including:
  • Abdominal aortic aneurysm screening

  • Alcohol misuse counseling

  • Bone mass measurement

  • Breast cancer screening (mammogram)

  • Cardiovascular disease (behavioral therapy)

  • Cardiovascular screenings

  • Cervical and vaginal cancer screening

  • Colorectal cancer screenings (Colonoscopy, Fecal occult blood test,

  • Flexible sigmoidoscopy)
  • Depression screening

  • Diabetes screenings

  • HIV screening

  • 1 Medical nutrition therapy services
  • Obesity screening and counseling

  • Prostate cancer screenings (PSA)

  • Sexually transmitted infections screening and counseling

  • Tobacco use cessation counseling (counseling for people with no sign

  • of tobacco-related disease)
  • Vaccines, including Flu shots, Hepatitis B shots, Pneumococcal shots

  • "Welcome to Medicare" preventive visit (one-time)

  • Yearly "Wellness" visit

  • Any additional preventive services approved by Medicare during the
    contract year will be covered.
    Outpatient Substance Abuse
    Group therapy visit: $40 copay
    Individual therapy visit: $40 copay
    Outpatient Rehabilitation
    Cardiac (heart) rehab services (for a maximum of 2 one-hour sessions per
    day for up to 36 sessions up to 36 weeks): $15 copay
    Occupational therapy visit: $15 copay
    Physical therapy and speech and language therapy visit: $15 copay
    Hospice
    You pay nothing for hospice care from a Medicare-certified hospice. You
    may have to pay part of the cost for drugs and respite care. Hospice is
    covered outside of our plan. Please contact us for more details.
    Transportation
    Not covered
    Over-the-Counter Items
    Not Covered
    Dental Services
    Limited dental services (this does not include services in connection with
    care, treatment, filling, removal, or replacement of teeth): $15 copay
    Vision Services
    Exam to diagnose and treat diseases and conditions of the eye (including
    yearly glaucoma screening): $0-15 copay, depending on the service
    Routine eye exam (for up to 1 every year): You pay nothing
    Eyeglasses or contact lenses after cataract surgery: You pay nothing
    $0 copay for Medicare-covered glaucoma screening.
    Hearing Services
    Exam to diagnose and treat hearing and balance issues: $15 copay
    Routine hearing exam (for up to 1 every year): $0 copay
    Hearing aid fitting/evaluation: $15 copay
    Hearing aid: $0 copay
    Our plan pays up to $300 every three years for hearing aids.
    Any licensed hearing provider may provide services. You pay the provider
    and then submit an itemized billing statement and paid receipt.
    Reimbursement is paid to you. You are responsible for any amount over
    the coverage limit. The maximum plan benefit amount is for both ears
    combined.
    Prosthetic Devices (braces artificial limbs etc.)
    Prosthetic devices: 20% of the cost
    Related medical supplies: $15 copay
    Renal Dialysis
    $30 copay
    Outpatient Surgery
    Ambulatory surgical center: $289 copay
    Outpatient hospital: $15-289 copay, depending on the service
    The minimum copay will apply to Medicare-covered outpatient hospital
    services other than outpatient hospital surgery. The maximum copay will
    apply to Medicare-covered outpatient hospital surgery.
    Chiropractic Care
    Manipulation of the spine to correct a subluxation (when 1 or more of the
    bones of your spine move out of position): $20 copay
    Diagnostic Tests Lab and Radiology Services and X-Rays (Costs for these services may be different if received in an outpatient surgery setting)
    Diagnostic radiology services (such as MRIs, CT scans): 20% of the cost
    Diagnostic tests and procedures: $15 copay
    Lab services: You pay nothing
    Outpatient x-rays: $15 copay
    Therapeutic radiology services (such as radiation treatment for cancer):
    20% of the cost
    Foot Care
    Foot exams and treatment if you have diabetes-related nerve damage
    and/or meet certain conditions: $15 copay
    Urgent Care
    $0-55 copay, depending on the service
    The minimum copay would apply for urgently needed care received by a
    Primary Care Physician. The maximum copay would apply for urgently
    needed care received at an Urgent Care facility.
    Skilled Nursing Facility
    Our plan covers up to 100 days in a SNF.
  • $25 copay per day for days 1 through 20

  • $150 copay per day for days 21 through 100
  • Durable Medical Equipment (wheelchairs oxygen etc.)
    20% of the cost

    Cost Sharing Information

    Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

    30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$5 copay$15 copay$15 copay
    Tier 2: Non-Preferred Generic$10 copay$20 copay$20 copay
    Tier 3: Preferred Brand Name$47 copay$47 copay$47 copay
    Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
    Tier 5: Specialty Tier29% coinsurance29% coinsurance29% coinsurance
    90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
    Tier 1: Preferred Generic$15 copay$45 copay$45 copay
    Tier 2: Non-Preferred Generic$30 copay$60 copay$60 copay
    Tier 3: Preferred Brand Name$141 copay$141 copay$141 copay
    Tier 4: Non-Preferred Brand Name$300 copay$300 copay$300 copay
    Tier 5: Specialty Tier

    CMS Ratings

    Staying healthy - screenings, tests and vaccines

    Breast cancer screening
    Colorectal cancer screening
    Annual flu vaccine
    Improving or maintaining physical health
    Improving or maintaining mental health
    Monitoring physical ability
    Adult BMI assessment

    Managing Chronic Conditions

    Special needs plan care management
    Not Rated
    Care for older adults – medication review
    Not Rated
    Care for older adults – functional status assessment
    Not Rated
    Care for older adults – Pain screening
    Not Rated
    Osteoporosis management in women who had a fracture
    Diabetes care – eye exam
    Diabetes care – kidney disease monitoring
    Diabetes care – blood sugar controlled
    Controlling blood pressure
    Rheumatoid arthritis management
    Reducing the risk of falling
    Plan all-cause readmissions

    Member Experience with Health Plan

    Getting needed care
    Getting appointments and care quickly
    Customer service
    Overall rating of health care quality
    Overall rating of plan
    Care Coordination

    Member Complaints, and Changes in Health Plan's Performance

    Complaints about the health plan
    Members choosing to leave the health plan
    Beneficiary access and performance problems
    Health plan quality improvement

    Health Plan Customer Service

    Plan makes timely decision about appeals
    Reviewing appeals decisions
    Call center – foreign language interpreter and TTY/TDD availability - Medical

    Drug Plan Customer Service

    Call center – foreign language interpreter and TTY/TDD availability - Drugs
    Appeals auto-forward
    Appeals upheld
    Not Rated

    Member Complaints, and Changes in Drug Plan's Performance

    Complaints about the drug plan
    Members choosing to leave the drug plan
    Beneficiary access and performance problems
    Drug plan quality improvement

    Member Experience with Drug Plan

    Rating of drug plan
    Getting needed prescription drugs

    Drug Pricing and Patient Safety

    MPF Price Accuracy
    High risk medication
    Part D medication adherence for diabetes
    Part D medication adherence for hypertension
    Part D medication adherence for cholesterol
    Medication Therapy Management program completion rate

    Physician Finder

    Physicians that accept Aetna Medicare Select (HMO) for California

    /
    YESAYAN, EDUARD
    4364 S CENTRAL AVE
    LOS ANGELES, CA 90011
    BROWN, BASSETT
    2707 S CENTRAL AVE
    LOS ANGELES, CA 90011
    CANCIO, JUAN POCHOLO
    2050 S. CENTRAL AVE.
    LOS ANGELES, CA 90011
    GHAFUR, NAEEMAH
    2707 S CENTRAL AVE
    LOS ANGELES, CA 90011
    HERRERA, GASTON
    1061 E. VERNON AVE SUITE# F
    LOS ANGELES, CA 90011
    BAHARI-NEJAD, PEJMAN
    4425 S CENTRAL AVE
    LOS ANGELES, CA 90011
    NOYA, DAVID
    4425 S CENTRAL AVE
    LOS ANGELES, CA 90011
    LAWRENCE, PATRICK
    1061 E VERNON AVE
    LOS ANGELES, CA 90011
    CADRY, MEHRANGIZ
    2707 S CENTRAL AVE
    LOS ANGELES, CA 90011
    NGUYEN, LISA
    2511 S CENTRAL AVE STE A
    LOS ANGELES, CA 90011
    JEFFERSON, RONALD
    4211 AVALON BLVD
    LOS ANGELES, CA 90011
    LARA, AGUSTIN
    1005 E WASHINGTON BLVD
    LOS ANGELES, CA 90021
    CHAVEZ, EDGAR
    1005 E WASHINGTON BLVD STE A
    LOS ANGELES, CA 90021
    KWON, OSUN
    1200 N STATE STREET IRD 806
    LOS ANGELES, CA 90089
    RICE, CHANTELLE
    2250 ALCAZAR ST.
    LOS ANGELES, CA 90089
    BOYD, STUART
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    GINSBERG, DAVID
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    SCHECHTER, NAOMI
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    LIN, YVONNE
    1441 EASTLAKE AVE # 7419
    LOS ANGELES, CA 90089
    DANESHMAND, SIAMAK
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    AULT, GLENN
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    MILLER, DAVID
    2020 ZONAL AVE
    LOS ANGELES, CA 90089
    PHAM, HUYEN
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    EISENBERG, BURTON
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    MERCHANT, AKIL
    1441 EASTLAKE AVE
    LOS ANGELES, CA 90089
    Details
    EDUARD YESAYAN, DDS
    Phone Number
    (323) 232-5267
    Office Locations
    4364 S CENTRAL AVE
    LOS ANGELES, CA 90011
    4364 S CENTRAL AVE LOS ANGELES CA, 90011

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