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Aetna Medicare Premier (PPO)

Medicare Advantage Plan for Michigan

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Monthly Cost

$20.20

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAetna
Plan IDH5521-149-0
CMS Rating1
Plan TypePPO
Annual Deductible$115.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage

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)
$10,000 In and Out-of-network $4,900 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$20.20
Monthly Health Plan Premium
$71.80

Benefits

Service
Cost
Inpatient hospital coverage
In-Network:
$360 for days 1 through 5
$0 for days 6 through 90
Out-of-Network:
50% per stay
Outpatient hospital coverage
In-Network:
$45-200 per visit
Out-of-Network:
50% per visit
Doctor visits
Primary:
In-Network:
$0 copay
Out-of-Network:
50% per visit
Specialist:
In-Network:
$45 per visit
Out-of-Network:
50% per visit
Preventive care
In-Network:
$0 copay
Out-of-Network:
0-50%
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$0-45 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
In-Network:
$75
Out-of-Network:
50%
Lab services:
In-Network:
$5
Out-of-Network:
50%
Diagnostic radiology services (e.g., MRI):
In-Network:
$250
Out-of-Network:
50%
Outpatient x-rays:
In-Network:
$5
Out-of-Network:
50%
Mental health services
In-Network:
$1,562 per stay
Out-of-Network:
50% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
50%
Outpatient individual therapy visit with a psychiatrist:
In-Network:
$40
Out-of-Network:
50%
Outpatient group therapy visit:
In-Network:
$40
Out-of-Network:
50%
Outpatient individual therapy visit:
In-Network:
$40
Out-of-Network:
50%
Skilled Nursing Facility
In-Network:
$0 for days 1 through 20
$160 for days 21 through 100
Out-of-Network:
50% per stay
Rehabilitation services
Occupational therapy visit:
In-Network:
$40
Out-of-Network:
50%
Physical therapy and speech and language therapy visit:
In-Network:
$40
Out-of-Network:
50%
Ambulance
In-Network:
$300
Out-of-Network:
$300
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
In-Network:
$45
Out-of-Network:
50%
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
In-Network:
20% per item
Out-of-Network:
50% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:
20% per item
Out-of-Network:
50% per item
Diabetes supplies:
In-Network:
0-20% per item
Out-of-Network:
0-20% per item
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
In-Network:
20%
Out-of-Network:
50%
Other Part B drugs:
In-Network:
20%
Out-of-Network:
50%

Coverage Area for Aetna Medicare Premier (PPO)

StateMichigan
CountyWayne

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$2 copay$10 copay$2 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 Tier30% coinsurance30% coinsurance30% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$6 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
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 Premier (PPO) for Michigan

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AMOUZEGAR, SYED
16810 W WARREN AVE
DETROIT, MI 48228
See Details
EUBANKS, PRINCE
20526 PLYMOUTH RD
DETROIT, MI 48228
See Details
OBEID, ERFAN
15841 W WARREN AVE
DETROIT, MI 48228
See Details
GHAITH, SALEH
16921 W WARREN AVE STE B
DETROIT, MI 48228
See Details
SAAD, GEORGE
20526 PLYMOUTH RD STE C
DETROIT, MI 48228
See Details
PRECHEL, WILLIAM
16551 W WARREN AVE
DETROIT, MI 48228
See Details
ZOUABI, FIRAS
18311 W WARREN AVE
DETROIT, MI 48228
See Details
OBEID, ZAFER
16921 W WARREN AVE
DETROIT, MI 48228
See Details
KHANZODE, SATISH
20720 PLYMOUTH RD
DETROIT, MI 48228
See Details
RUKMANGATHAN, SHALINI
15841 W WARREN AVE
DETROIT, MI 48228
See Details
SIGNORI, ENRIQUE
4900 MERCURY DR
DEARBORN, MI 48126
See Details
BANISTER, SUHAIL
4700 SCHAEFER RD
DEARBORN, MI 48126
See Details
BERRI, ZIAD
14515 FORD RD
DEARBORN, MI 48126
See Details
SELITSKY, BENSON
5050 SCHAEFER RD
DEARBORN, MI 48126
See Details
STEFAN, NATALIE
5500 AUTO CLUB DR
DEARBORN, MI 48126
See Details
MOHAMED, TAHIR
6050 GREENFIELD RD
DEARBORN, MI 48126
See Details
WOLFFING, BYRON
HENRY FORD HEALTH SYSTEM
DEARBORN, MI 48126
See Details
ELMENINI, MOHAMMAD
10645 W WARREN AVE
DEARBORN, MI 48126
See Details
LOTENERO, CARRIE
19401 HUBBARD DR
DEARBORN, MI 48126
See Details
Details
SYED AMOUZEGAR, M.D.
Phone Number
(313) 582-9520
Office Locations
16810 W WARREN AVE
DETROIT, MI 48228
16810 W WARREN AVE DETROIT MI, 48228

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