2019 Aetna Medicare Value Plan (HMO) H3597-1-0 in ME from Aetna | HealthPocket

Aetna Medicare Value Plan (HMO)

$0/mo

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Zip Code04401
Applicant9/20/1984 Male
Coverage Start9/21/2019
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Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAetna
Plan IDH3597-1-0
Plan Year2019
CMS Rating
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)
  • was the 3rd best selling plan in Penobscot in 2019

Costs and Other Important Information

Plan Year2019
Monthly Health Plan Premium$0.00
Monthly Drug Plan Premium$0.00
Health Plan Deductible$0
Other health plan deductibles?No
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)$5,900 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverage$275 per day for days 1 through 5
$0 per day for days 6 through 90
Outpatient hospital coverage$35-195 per visit
Doctor visitsPrimary:$0 copay
Specialist:$35 per visit
Preventive care$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$0-35 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:$35
Lab services:$0 copay
Diagnostic radiology services (e.g., MRI):5%
Outpatient x-rays:$0-20
Mental health servicesInpatient hospital - psychiatric:$1,660 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 per day for days 1 through 20
$172 per day for days 21 through 100
Rehabilitation servicesOccupational therapy visit:$35
Physical therapy and speech and language therapy visit:$35
Ground ambulance$200
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:$35
Routine foot care:Not covered
Medical equipment/suppliesDurable 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 drugsChemotherapy:20%
Other Part B drugs:20%

Benefits Services

Hearing
Hearing exam$35
Fitting/evaluation$35There may be limits on how much the plan will provide.
Hearing aids$0 copay. There may be limits on how much the plan will provide.
Preventive Dental
Oral exam50%There may be limits on how much the plan will provide.
Cleaning50%There may be limits on how much the plan will provide.
Fluoride treatment50%There may be limits on how much the plan will provide.
Dental x-ray(s)50%There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine services50%There may be limits on how much the plan will provide.
Diagnostic services50%There may be limits on how much the plan will provide.
Restorative services50%There may be limits on how much the plan will provide.
Endodontics50%There may be limits on how much the plan will provide.
Periodontics50%There may be limits on how much the plan will provide.
Extractions50%There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other services50%There may be limits on how much the plan will provide.
Vision
Routine eye exam$0 copay. There may be limits on how much the plan will provide.
OtherNot covered
Contact lenses$0 copay. There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)$0 copay. There may be limits on how much the plan will provide.
Eyeglass frames$0 copay. There may be limits on how much the plan will provide.
Eyeglass lenses$0 copay. There may be limits on how much the plan will provide.
Upgrades$0 copay. There may be limits on how much the plan will provide.

Coverage Area for Aetna Medicare Value (HMO)

StateMaine
CountyPenobscot

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$15 copay$0 copay
Tier 2: Non-Preferred Generic$0 copay$20 copay$0 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 Tier33% coinsurance33% coinsurance33% coinsurance

60 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$30 copay$0 copay
Tier 2: Non-Preferred Generic$0 copay$40 copay$0 copay
Tier 3: Preferred Brand Name$94 copay$94 copay$94 copay
Tier 4: Non-Preferred Brand Name$200 copay$200 copay$200 copay
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$0 copay$45 copay$0 copay
Tier 2: Non-Preferred Generic$0 copay$60 copay$0 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$136 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$300 copay
Tier 5: Specialty Tier

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 managementNot Rated
Care for older adults – medication reviewNot Rated
Care for older adults – functional status assessmentNot Rated
Care for older adults – Pain screeningNot 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 planNot 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
Statin Use in Persons with Diabetes

Physicians that accept Aetna Medicare Value (HMO) for Maine

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Edwin, Bruno
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D, Mcguire
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Bernard, Castonguay
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Peggy, Clark
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Lewis, Phillips
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Guillermo, Olivos
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Melissa, Berky
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Thomas, Beebe
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David, Newman
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Martina, Bosse
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Kara, Martin
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Sapna, Malik
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Noelle, Lincoln
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Karie, Davis
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Edwin Bruno, D.P.M.
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  • Phone Number
    (207) 942-3988
  • Office Locations
    277 State St
    Bangor, ME 04401
277 State St Bangor ME, 04401

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)

Medicare Plans Found

 

HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, Medicaid or an individual health insurance plan, we will help you find the right healthcare option and save on your out of pocket healthcare costs. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. If you select a plan presented on our site, you will be directed (via a click or a call) to one of our partners who can help you with your application. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. HealthPocket, Inc. is a wholly owned subsidiary of Health Plan Intermediaries Holdings LLC (NASDAQ: HIIQ)