2020 Aetna Medicare Advantra Gold (PPO) H1608-027-000 in WV from Aetna | HealthPocket

Aetna Medicare Advantra Gold (PPO)

$58/mo

Benefits & Coverage

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderAetna
Plan IDH1608-027-000
Plan Year2020
CMS Rating
Plan TypePPO
Annual Deductible$0.00
Out-of-Pocket Maximum5900

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 a copay of $0 for Tier 1 preferred generic drugs (30 day supply, preferred retail pharmacies)
  • was the 5th best selling plan in Kanawha in 2021

Overview

Premium
Total monthly premium$58.00
Health plan premium$43.70
Drug plan premium$14.30
Standard Part B premium$135.50
Part B premium reductionNo
Deductible
Health plan deductible$500 annual deductible
Drug plan deductible$0.00
Estimated yearly costs
Estimated total yearly costs for care$4,602.00
Out-of-pocket max
Out-of-pocket max$10,000 In and Out-of-network
$5,900 In-network

Benefits & costs

Doctor services
Primary doctor visitIn-network: $10 per visit
Out-of-network: 20% per visit
Specialist visitIn-network: $35 per visit
Out-of-network: 20% per visit
Tests, labs, & imaging
Diagnostic tests & proceduresIn-network: $5
Out-of-network: 20%
Lab servicesIn-network: $10
Out-of-network: 20%
Diagnostic radiology services (like MRI)In-network: $10-275
Out-of-network: 20%
Outpatient x-raysIn-network: $20
Out-of-network: 20%
Emergency care$90 per visit (always covered)
Urgent care$50 per visit (always covered)
Hospital services
Inpatient hospital coverageIn-network: $400 per stay
Out-of-network: 40% per stay
Outpatient hospital coverageIn-network: $225 per visit
Out-of-network: 20% per visit
Skilled nursing facility
Skilled nursing facilityIn-network: $0 per day for days 1 through 20
$178 per day for days 21 through 100
Out-of-network: 40% per stay
Preventive services
Preventive servicesIn-network: $0 copay
Out-of-network: 0-20%
Ambulance
Ground ambulanceIn-network: $255
Out-of-network: $255
Therapy services
Occupational therapy visitIn-network: $25
Out-of-network: 20%
Physical therapy & speech & language therapy visitIn-network: $25
Out-of-network: 20%
Mental health services
Outpatient group therapy with a psychiatristIn-network: $40
Out-of-network: 45%
Outpatient individual therapy with a psychiatristIn-network: $40
Out-of-network: 45%
Outpatient group therapy visitIn-network: $40
Out-of-network: 45%
Outpatient individual therapy visitIn-network: $40
Out-of-network: 45%
Opioid treatment services
Opioid treatment servicesCovered
Other services
Durable medical equipment (like wheelchairs & oxygen)In-network: 20% per item
Out-of-network: 30% per item
Prosthetics (like braces, artificial limbs)In-network: 20% per item
Out-of-network: 30% per item
Diabetes suppliesIn-network: 0-20% per item
Out-of-network: 0-20% per item

Extra benefits & costs

Hearing
Hearing examIn-network: $35
Out-of-network: $0 copay
Fitting/evaluationIn-network: $0 copay
Out-of-network: $0 copay
Hearing aids - All typesIn-network: $0 copay
Out-of-network: $0 copay
Preventive dental
Oral examIn-network: $0 copay
Out-of-network: 30%
CleaningIn-network: $0 copay
Out-of-network: 30%
Fluoride treatmentNot covered
Dental x-raysIn-network: $0 copay
Out-of-network: 30%
Comprehensive dental
Non-routine servicesIn-network: 50%
Out-of-network: 70%
Diagnostic servicesNot covered
Restorative servicesIn-network: 50%
Out-of-network: 70%
EndodonticsIn-network: 50%
Out-of-network: 70%
PeriodonticsIn-network: 50%
Out-of-network: 70%
ExtractionsIn-network: 50%
Out-of-network: 70%
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Vision
Routine eye examIn-network: $0 copay
Out-of-network: 20%
Contact lensesIn-network: $0 copay
Out-of-network: $0 copay
Eyeglasses (frames & lenses)In-network: $0 copay
Out-of-network: $0 copay
Eyeglass frames (only)In-network: $0 copay
Out-of-network: $0 copay
Eyeglass lenses (only)In-network: $0 copay
Out-of-network: $0 copay
UpgradesIn-network: $0 copay
Out-of-network: $0 copay
More benefits
Fitness benefitLimited coverage
Over the counter drug benefitsLimited coverage
In-home support servicesNot covered
Home and bathroom safety devicesNot covered
Meals for short durationLimited coverage
Annual physical examsLimited coverage
TelehealthNot covered
Special benefits
Reduced cost sharing for certain people with MedicareLimited coverage

Drug coverage & costs

Part B drugs
Chemotherapy drugsIn-network: 20%
Out-of-network: 20%
Other Part B drugsIn-network: 20%
Out-of-network: 20%

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$0 copay$15 copay$0 copay$15 copay
Tier 2: Generic$5 copay$20 copay$5 copay$20 copay
Tier 3: Preferred Brand$47 copay$47 copay$47 copay$47 copay
Tier 4: Non-Preferred Drug$100 copay$100 copay$100 copay$100 copay
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance33% coinsurance

60 Day SupplyPreferred Retail Pharmacies Drug CostStandard Retail Pharmacies Drug CostPreferred Mail-Order Drug CostStandard Mail-Order Drug Cost
Tier 1: Preferred Generic$0 copay$30 copay$0 copay$30 copay
Tier 2: Generic$10 copay$40 copay$10 copay$40 copay
Tier 3: Preferred Brand$94 copay$94 copay$94 copay$94 copay
Tier 4: Non-Preferred Drug$200 copay$200 copay$200 copay$200 copay
Tier 5: Specialty Tier
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$45 copay
Tier 2: Generic$10 copay$60 copay$10 copay$60 copay
Tier 3: Preferred Brand$141 copay$141 copay$141 copay$141 copay
Tier 4: Non-Preferred Drug$300 copay$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 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
Statin Use in Persons with DiabetesNot Rated

Physicians that accept Aetna Medicare Advantra Gold (PPO) for West Virginia

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Deborah, Albert
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Scott, Naegele
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David, Felton
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Ronald, Jones
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Johanna, Cook
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Pratikkumar, Patel
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Neil, Copeland
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Susan, Ayoubi
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Anjlee, Patel
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Marcus, Shaffer
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Ashley, Mitchell
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Jane, Nicholas
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Sachin, Bendre
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Jennifer, Divita
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Youmna, Mousattat
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Carrie, Bush
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Aaron, Parry
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Zeina, Haidar
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Ramanathapura, Narasimhamurthy Haricharan
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Michaela, Kessler
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Prasadarao, Mukkamala
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Rose, Ayoob
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Deborah Albert, M.D.
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  • Phone Number
    (304) 388-1770
  • Office Locations
    830 Pennsylvania Ave Ste 202
    Charleston, WV 25302
830 Pennsylvania Ave Ste 202 Charleston WV, 25302

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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.