Aetna Medicare Select (HMO)

Medicare Advantage Plan for California

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAetna
Plan IDH0523-22-0
CMS Rating1
Plan TypeHMO
Annual Deductible$0.00

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
  • has a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$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
Inpatient hospital coverage
$50 for days 1 through 4
$0 for days 5 through 90
Outpatient hospital coverage
$0-50 per visit
Doctor visits
Primary:$0 copay
Specialist:$0 copay
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:$75 per visit (always covered)
Urgent care:$0-30 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:$0 copay
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):$125
Outpatient x-rays:$0 copay
Mental health services
$1,562 per stay
Outpatient group therapy visit with a psychiatrist:$40
Outpatient individual therapy visit with a psychiatrist:$40
Outpatient group therapy visit:$40
Outpatient individual therapy visit:$40
Skilled Nursing Facility
$0 for days 1 through 20
$160 for days 21 through 100
Rehabilitation services
Occupational therapy visit:$0 copay
Physical therapy and speech and language therapy visit:$0 copay
Ambulance
$225
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:$0 copay
Routine foot care:Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):20% per item
Prosthetics (e.g., braces, artificial limbs):20% per item
Diabetes supplies:0-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:20%
Other Part B drugs:20%

Coverage Area for Aetna Medicare Select (HMO)

StateCalifornia
CountyLos Angeles

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$10 copay$0 copay
Tier 2: Non-Preferred Generic$5 copay$15 copay$5 copay
Tier 3: Preferred Brand Name$42 copay$47 copay$42 copay
Tier 4: Non-Preferred Brand Name$100 copay$100 copay$100 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$45 copay$10 copay
Tier 3: Preferred Brand Name$126 copay$141 copay$121 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

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Not Rated
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

/
GHAFUR, NAEEMAH
2707 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
NOYA, DAVID
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
HERRERA, GASTON
1061 E. VERNON AVE SUITE# F
LOS ANGELES, CA 90011
SINHA, RAKHI
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
BROWN, BASSETT
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
JEFFERSON, RONALD
4211 AVALON BLVD
LOS ANGELES, CA 90011
OHEARN, THOMAS
1670 E 120TH ST.
LOS ANGELES, CA 90011
CHAVEZ, EDGAR
1005 E WASHINGTON BLVD STE A
LOS ANGELES, CA 90021
LARA, AGUSTIN
1005 E WASHINGTON BLVD
LOS ANGELES, CA 90021
KAO, VINCENT
2020 ZONAL AVE
LOS ANGELES, CA 90089
LAU, RONALD
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
GARCIA, AGUSTIN
52579 HIGHWAY 51 S
INDEPENDENCE, LA 70443
HUSAIN, HATIM
2020 ZONAL AVE # 631
LOS ANGELES, CA 90089
DORFF, TANYA
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
LIN, YVONNE
1441 EASTLAKE AVE # 7419
LOS ANGELES, CA 90089
AULT, GLENN
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
TULPULE, ANIL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
MILLER, DAVID
2020 ZONAL AVE
LOS ANGELES, CA 90089
HU, JAMES
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
EL-MASRY, MARY
USC DEPT OF INTERNAL MEDICINE 2020 ZONAL AVE STE 620
LOS ANGELES, CA 90089
Details
NAEEMAH GHAFUR, M.D.
Phone Number
(323) 234-5000
Office Locations
2707 S CENTRAL AVE
LOS ANGELES, CA 90011
2707 S CENTRAL AVE LOS ANGELES CA, 90011

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