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Aetna Medicare Advantra Credit Value (PPO)

4.5 out of 5 stars* for plan year 2024
$0.00 Monthly Premium

Aetna Medicare Advantra Credit Value (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H5522-017-000

$0.00 Monthly Premium

Pennsylvania Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Pennsylvania Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$7,550.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$8,000.00
Primary care doctor visit$10 in-network | 40% out-of-network
Specialty doctor visit$50 in-network | 40% out-of-network
Inpatient hospital care$360 per day, days 1-5; $0 per day, days 6-90 in-network | 45% per stay out-of-network
Urgent care
Urgent Care:
Copayment for Urgent Care $50.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $100.00
Emergency room visit$100 If you are admitted to the hospital within 24 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance transportation$275 in-network | $275 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Advantra Credit Value (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Advantra Credit Value (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic services
Out-of-Network:

Chiropractic Services:
Coinsurance for Medicare Covered Chiropractic Services 40%
Diabetes supplies, training, nutrition therapy and monitoring0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable medical equipment (DME)0% - 20% for each Medicare-covered durable medical equipment item | 0% for continuous glucose meters | 20% for all other Medicare-covered DME items | 20% out-of-network
Diagnostic tests, lab and radiology services, and X-raysLab Services: Lab Services: $5 in-network| 40% out-of-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $20 in-network| 40% out-of-network, for more information see Evidence of Coverage
Imaging: Xray: $50 in-network | CT Scans: $10 for services provided by your primary care physician in their office in-network; $350 for services performed by a provider other than your primary care physician in-network | Diagnostic Radiology other than CT Scans: $10 for services provided by your primary care physician in their office in-network; $350 for services performed by a provider other than your primary care physician in-network | Diagnostic Radiology Mammogram: $0 in-network | 40% out-of-network, for more information see Evidence of Coverage
Home health care$0 in-network | $0 out-of-network
Mental health inpatient care
Out-of-Network:
Coinsurance for Psychiatric Hospital Services per Stay 45%
Mental health outpatient careMental Health - Group Sessions: $40 in-network| Mental Health - Individual Sessions: $40 in-network| 40% out-of-network, for more information see Evidence of Coverage |Psychiatric Services - Group Sessions: $40 in-network| Psychiatric Services - Individual Sessions: $40 in-network| 40% out-of-network, for more information see Evidence of Coverage
Outpatient services/surgeryAmbulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $250 All other in network ASC services | 40% out-of-network, for more information see Evidence of Coverage
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $45.00
Copayment for Medicare-covered Group Sessions $45.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter itemsIn Network: |Over-the-counter (OTC) items:|$45 quarterly amount (allowance) to purchase approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers and more. Approved items can be purchased online, in store, or by phone. |Be sure to use the full benefit amount quarterly, because any unused amount will not rollover.|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit, for more information see Evidence of Coverage
Podiatry services
Out-of-Network:

Podiatry Services:
Coinsurance for Medicare Covered Podiatry Services 40%
Podiatry Services:
Coinsurance for Non-Medicare Covered Podiatry Services 40%
Skilled Nursing Facility (SNF) care$0 per day, days 1-20; $203 per day, days 21-100 in-network| 40% per stay out-of-network, for more information see Evidence of Coverage

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental careIn Network Dental Coverage|For covered services: ADA recognized dental services are covered excluding only cosmetic services, those considered medical in nature, and administrative changes.|Preventive dental services: |Oral exams: $0 copay |Cleanings: $0 copay |Fluoride treatment: $0 copay |Bitewing x-rays: $0 copay |Comprehensive dental services:|Non-routine services: $0 copay |Diagnostic services: $0 copay |Restorative services: $0 copay |Endodontics: $0 copay |Periodontics: $0 copay |Extractions: $0 copay |Prosthodontics and maxillofacial services: $0 copay |Out Of Network Dental Coverage|Preventive dental services:| 50% coinsurance |Comprehensive dental services:| 50% coinsurance |$1,000 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefitsIn-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0-$50|Copayment for Routine Eye Exams $0 |(Maximum one exam every year)|Eyewear:|Copayment for Medicare Covered Benefits $0|Copayment for Contacts $0|Copayment for Eyeglasses $0|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Out-of-Network:|Eye Exams:|Coinsurance for Medicare-Covered Benefits 40%|Coinsurance for Routine Eye Exams 40%|Eyewear:|Coinsurance for Medicare-Covered Benefits 40%|Copayment for Non-Medicare covered Benefits $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $210 every year. See the Evidence of Coverage

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefitsIn-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $50|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Copayment for Fitting/Evaluation for Hearing Aid $0|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year) |Out-of-Network:|Coinsurance for Medicare Covered Hearing Exams 40%|Coinsurance for Non-Medicare Covered Hearing Exams 40% |Member must purchase hearing aids through NationsHearing|$500 per ear every year, for more information see the Evidence of Coverage

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programs$0 copay for all preventive services covered under Original Medicare at zero cost sharing

When reviewing Pennsylvania Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Pennsylvania that offer similar benefits at similar or lower prices than the plan above. Call 1-877-890-1409 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Pennsylvania Counties Served

Enrolling in H5522-017-000 Medicare Advantage Plans in Pennsylvania

Medicare beneficiaries from Pennsylvania may have access to Medicare Advantage plans from Aetna and other insurance companies.

Get help comparing your local plan options by calling to speak with a licensed insurance agent who can help you find out if your doctor and prescription drugs are covered by a Medicare Advantage plan in your area.

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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