2019 Aetna Medicare Freedom Plan (PPO) H5521-218-000 in MS from Aetna | HealthPocket

Aetna Medicare Freedom Plan (PPO)

$0/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAetna
Plan IDH5521-218-000
Plan Year2019
CMS Rating
Plan TypePPO
Annual Deductible$195.00
Out-of-Pocket Maximum6700

What To Know About This Plan
  • This plan has health and drug coverage
  • This plan is available for 2021. see plan

Why We Like This Plan
  • has both Health and Drug Coverage
  • has no additional premium costs outside of your Medicare Part B premium

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)$10,000 In and Out-of-network
$6,700 In-network
Optional Supplemental BenefitsNo

Benefits

SERVICECOST
Inpatient hospital coverageIn-Network:$275 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:35% per stay
Outpatient hospital coverageIn-Network:$30-225 per visit
Out-of-Network:35% per visit
Doctor visitsPrimary:
In-Network:$5 per visit
Out-of-Network:$20 per visit
Specialist:
In-Network:$30 per visit
Out-of-Network:$40 per visit
Preventive careIn-Network:$0 copay
Out-of-Network:$0 copay
Emergency care/Urgent careEmergency:$90 per visit (always covered)
Urgent care:$5-30 per visit (always covered)
Diagnostic procedures/lab services/imagingDiagnostic tests and procedures:
In-Network:$5-95
Out-of-Network:35%
Lab services:
In-Network:$5-15
Out-of-Network:35%
Diagnostic radiology services (e.g., MRI):
In-Network:$5-225
Out-of-Network:35%
Outpatient x-rays:
In-Network:$5-25
Out-of-Network:35%
Mental health servicesInpatient hospital - psychiatric:
In-Network:$295 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-Network:35% per stay
Outpatient group therapy visit with a psychiatrist:
In-Network:$35
Out-of-Network:$40
Outpatient individual therapy visit with a psychiatrist:
In-Network:$35
Out-of-Network:$40
Outpatient group therapy visit:
In-Network:$35
Out-of-Network:$40
Outpatient individual therapy visit:
In-Network:$35
Out-of-Network:$40
Skilled Nursing FacilityIn-Network:$0 per day for days 1 through 20
$160 per day for days 21 through 100
Out-of-Network:35% per stay
Rehabilitation servicesOccupational therapy visit:
In-Network:$20
Out-of-Network:$40
Physical therapy and speech and language therapy visit:
In-Network:$20
Out-of-Network:$40
Ground ambulanceIn-Network:$275
Out-of-Network:$275
TransportationNot covered
Foot care (podiatry services)Foot exams and treatment:
In-Network:$30
Out-of-Network:$40
Routine foot care:Not covered
Medical equipment/suppliesDurable medical equipment (e.g., wheelchairs, oxygen):
In-Network:15% per item
Out-of-Network:25% per item
Prosthetics (e.g., braces, artificial limbs):
In-Network:15% per item
Out-of-Network:25% 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 drugsChemotherapy:
In-Network:20%
Out-of-Network:35%
Other Part B drugs:
In-Network:20%
Out-of-Network:35%

Benefits Services

Hearing
Hearing examIn-Network: $30
Out-of-Network: $40
Fitting/evaluationIn-Network: $30
Out-of-Network: $40
There may be limits on how much the plan will provide.
Hearing aids - inner earNot covered
Hearing aids - outer earNot covered
Hearing aids - over the earNot covered
Preventive Dental
Oral examIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
CleaningIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Fluoride treatmentIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Dental x-ray(s)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Comprehensive Dental
Non-routine servicesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Diagnostic servicesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Restorative servicesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
EndodonticsIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
PeriodonticsIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
ExtractionsIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Prosthodontics, other oral/maxillofacial surgery, other servicesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Vision
Routine eye examIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
OtherNot covered
Contact lensesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglasses (frames and lenses)In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass framesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
Eyeglass lensesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.
UpgradesIn-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan will provide.

Coverage Area for Aetna Medicare Freedom (PPO)

StateMississippi
CountyHarrison

All cost-sharing assumes in-network healthcare providers.
Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit


30 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$2 copay$15 copay$2 copay
Tier 2: Non-Preferred Generic$5 copay$20 copay$5 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
Tier 6: Select Care Drugs

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$4 copay$30 copay$4 copay
Tier 2: Non-Preferred Generic$10 copay$40 copay$10 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
Tier 6: Select Care Drugs
90 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$45 copay$0 copay
Tier 2: Non-Preferred Generic$15 copay$60 copay$10 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
Tier 6: Select Care Drugs

Physicians that accept Aetna Medicare Freedom (PPO) for Mississippi

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Timothy, Jackson
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Edward, Cohen
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Eric, Lawson
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Robert, Johansen
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Jason, Crowder
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Brenda, Safley
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Marie, Maples
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Allison, Whiting
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Jordan, Bennett
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Jennifer, Hornberger
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Joseph, Cox
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Richard, Hays
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Ira, Gaddy
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Lauren, Ferguson
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Heather, Williams
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Millicent, Holliman
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Leena, Pande
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Stephanie, Tapp
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Tamela, Ladner
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Dominic, Miceli
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Raun, Wetzel
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Timothy Jackson, M.D.
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  • Phone Number
    (228) 832-9933
  • Office Locations
    12080 New Orleans Ave N
    Gulfport, MS 39503
12080 New Orleans Ave N Gulfport MS, 39503
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Medicare Plans Found

 

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HealthPocket is a free information source designed to help consumers find medical coverage. Whether you are looking for Medicare, or an individual and family 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 part of the Benefytt Technologies, Inc. family of companies.