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

ZIP Code
County

Insurance Type	Medicare Advantage Plan (Part C w/ RX)
Insurance Provider	Aetna
Plan ID	H1608-027-000
Plan Year	2020
CMS Rating
Plan Type	PPO
Annual Deductible	$0.00
Out-of-Pocket Maximum	5900

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 reduction	No
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 visit	In-network: $10 per visit Out-of-network: 20% per visit
Specialist visit	In-network: $35 per visit Out-of-network: 20% per visit
Tests, labs, & imaging
Diagnostic tests & procedures	In-network: $5 Out-of-network: 20%
Lab services	In-network: $10 Out-of-network: 20%
Diagnostic radiology services (like MRI)	In-network: $10-275 Out-of-network: 20%
Outpatient x-rays	In-network: $20 Out-of-network: 20%
Emergency care	$90 per visit (always covered)
Urgent care	$50 per visit (always covered)
Hospital services
Inpatient hospital coverage	In-network: $400 per stay Out-of-network: 40% per stay
Outpatient hospital coverage	In-network: $225 per visit Out-of-network: 20% per visit
Skilled nursing facility
Skilled nursing facility	In-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 services	In-network: $0 copay Out-of-network: 0-20%
Ambulance
Ground ambulance	In-network: $255 Out-of-network: $255
Therapy services
Occupational therapy visit	In-network: $25 Out-of-network: 20%
Physical therapy & speech & language therapy visit	In-network: $25 Out-of-network: 20%
Mental health services
Outpatient group therapy with a psychiatrist	In-network: $40 Out-of-network: 45%
Outpatient individual therapy with a psychiatrist	In-network: $40 Out-of-network: 45%
Outpatient group therapy visit	In-network: $40 Out-of-network: 45%
Outpatient individual therapy visit	In-network: $40 Out-of-network: 45%
Opioid treatment services
Opioid treatment services	Covered
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 supplies	In-network: 0-20% per item Out-of-network: 0-20% per item

Extra benefits & costs

Hearing
Hearing exam	In-network: $35 Out-of-network: $0 copay
Fitting/evaluation	In-network: $0 copay Out-of-network: $0 copay
Hearing aids - All types	In-network: $0 copay Out-of-network: $0 copay
Preventive dental
Oral exam	In-network: $0 copay Out-of-network: 30%
Cleaning	In-network: $0 copay Out-of-network: 30%
Fluoride treatment	Not covered
Dental x-rays	In-network: $0 copay Out-of-network: 30%
Comprehensive dental
Non-routine services	In-network: 50% Out-of-network: 70%
Diagnostic services	Not covered
Restorative services	In-network: 50% Out-of-network: 70%
Endodontics	In-network: 50% Out-of-network: 70%
Periodontics	In-network: 50% Out-of-network: 70%
Extractions	In-network: 50% Out-of-network: 70%
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Vision
Routine eye exam	In-network: $0 copay Out-of-network: 20%
Contact lenses	In-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
Upgrades	In-network: $0 copay Out-of-network: $0 copay
More benefits
Fitness benefit	Limited coverage
Over the counter drug benefits	Limited coverage
In-home support services	Not covered
Home and bathroom safety devices	Not covered
Meals for short duration	Limited coverage
Annual physical exams	Limited coverage
Telehealth	Not covered
Special benefits
Reduced cost sharing for certain people with Medicare	Limited coverage

Drug coverage & costs

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

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

30 Day Supply	Preferred Retail Pharmacies Drug Cost	Standard Retail Pharmacies Drug Cost	Preferred Mail-Order Drug Cost	Standard 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 Tier	33% coinsurance	33% coinsurance	33% coinsurance	33% coinsurance

60 Day Supply	Preferred Retail Pharmacies Drug Cost	Standard Retail Pharmacies Drug Cost	Preferred Mail-Order Drug Cost	Standard 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 Supply	Preferred Retail Pharmacies Drug Cost	Standard Retail Pharmacies Drug Cost	Preferred Mail-Order Drug Cost	Standard 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 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
Statin Use in Persons with Diabetes	Not Rated

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

Last Name

Location/Distance

Please select the correct zip

Deborah, Albert

Scott, Naegele

David, Felton

Ronald, Jones

Johanna, Cook

Pratikkumar, Patel

Neil, Copeland

Susan, Ayoubi

Anjlee, Patel

Marcus, Shaffer

Ashley, Mitchell

Jane, Nicholas

Sachin, Bendre

Jennifer, Divita

Youmna, Mousattat

Carrie, Bush

Aaron, Parry

Zeina, Haidar

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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Aetna Medicare Advantra Gold (PPO)

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Aetna Medicare Advantra Gold (PPO)

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Plan Details

Overview

Benefits & costs

Extra benefits & costs

Drug coverage & costs

Cost Sharing Information

CMS Ratings

Staying healthy - screenings, tests and vaccines

Managing Chronic Conditions

Member Experience with Health Plan

Member Complaints, and Changes in Health Plan's Performance

Health Plan Customer Service

Drug Plan Customer Service

Member Complaints, and Changes in Drug Plan's Performance

Member Experience with Drug Plan

Drug Pricing and Patient Safety

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