Aetna Medicare Advantra Silver Plus (PPO)

4.5 out of 5 stars* for plan year 2023
$18.00 Monthly Premium

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

Plan ID: H5522-013-000

$18.00 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$18.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$7,000.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit$5 in-network / 40% out-of-network
Specialty doctor visit$35 in-network / 40% out-of-network
Inpatient hospital care$395 per stay in-network / 40% per stay out-of-network
Urgent care
Urgent Care:
Copayment for Urgent Care $50.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $95.00
Emergency room visit$95 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$250 in-network / $250 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Advantra Silver Plus (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Advantra Silver Plus (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 50%
Chiropractic Services:
Coinsurance for Non-Medicare Covered Chiropractic Services 50%
Diabetes supplies, training, nutrition therapy and monitoring0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable medical equipment (DME)20% in-network / 20% out-of-network
Diagnostic tests, lab and radiology services, and X-raysLab Services: Lab Services: $0 in-network/ 40% out-of-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $0 in-network/ 40% out-of-network, for more information see Evidence of Coverage
Imaging: Xray: $25 in-network / CT Scans: $5 for services provided by your primary care physician in their office in-network; $285 for services performed by a provider other than your primary care physician in-network / Diagnostic Radiology other than CT Scans: $5 for services provided by your primary care physician in their office in-network; $285 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 careIn-Network:

Psychiatric Hospital Services:
Copayment for Psychiatric Hospital Services per Stay $1250.00
Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient careMental Health - Group Sessions: $40 in-network/ Mental Health - Individual Sessions: $40 in-network/ 45% out-of-network, for more information see Evidence of Coverage

Psychiatric Services - Group Sessions: $40 in-network/ Psychiatric Services - Individual Sessions: $35 in-network/ 45% out-of-network, for more information see Evidence of Coverage
Outpatient services/surgeryAmbulatory Surgical Center: $250 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network / 40% out-of-network, for more information see Evidence of Coverage
Outpatient substance abuse care
Out-of-Network:

Outpatient Substance Abuse Services:
Coinsurance for Medicare Covered Individual or Group Sessions 45%
Over-the-counter items$135 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $35.00
Copayment for Routine Foot Care $35.00
  • Maximum 1 visit every three months
Skilled Nursing Facility (SNF) care$0 per day, days 1-20; $196 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 care$3,000 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 benefits$200 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 benefits$1,250 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

Adams Berks Blair Bradford Carbon Centre Clinton Columbia Cumberland Dauphin Franklin Fulton Huntingdon Juniata Lackawanna Lancaster Lebanon Lehigh Luzerne Lycoming Mifflin Monroe Montour Northampton Northumberland Perry Pike Potter Schuylkill Snyder Sullivan Susquehanna Tioga Union Wayne Wyoming York
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