Aetna Medicare Choice (HMO-POS)
Aetna Medicare Choice (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H1609-028-000
Florida 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 Florida 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 | $150.00 |
| Out-of-pocket maximum | $5,700.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $8,000.00 |
| Primary care doctor visit | $0 |
| Specialty doctor visit | $35 in-network | $50 out-of-network |
| Inpatient hospital care | $295 per day, days 1-4; $0 per day, days 5-90 in-network | 50% per stay out-of-network |
| Urgent care | Urgent Care: Copayment for Urgent Care $30.00 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 | $255 in-network | $255 out-of-network |
Health Care Services and Medical Supplies
Aetna Medicare Choice (HMO-POS) covers a range of additional benefits. Learn more about Aetna Medicare Choice (HMO-POS) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | POS (Out-of-Network): Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 50% |
| Diabetes supplies, training, nutrition therapy and monitoring | 0% - 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 |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: Lab Services: $0 for services performed at a non-hospital facility in-network; $125 for services performed at a hospital facility| 50% out-of-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $0 for services performed at a non-hospital facility in-network; $200 for services performed at a hospital facility| 50% out-of-network, for more information see Evidence of Coverage Imaging: Xray: $10 in-network | CT Scans: $0 for services performed at a non-hospital facility in-network; $200 for services performed at a hospital facility in-network | Diagnostic Radiology other than CT Scans: $0 for services performed at a non-hospital facility in-network; $200 for services performed at a hospital facility in-network | Diagnostic Radiology Mammogram: $0 in-network | 50% out-of-network, for more information see Evidence of Coverage |
| Home health care | $0 in-network | 50% out-of-network |
| Mental health inpatient care | Out-of-Network: Coinsurance for Psychiatric Hospital Services per Stay 50% |
| Mental health outpatient care | Mental Health - Group Sessions: $30 in-network| Mental Health - Individual Sessions: $35 in-network, for more information see Evidence of Coverage |Psychiatric Services - Group Sessions: $30 in-network| Psychiatric Services - Individual Sessions: $35 in-network, for more information see Evidence of Coverage |
| Outpatient services/surgery | Ambulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy | $175 All other in network ASC services | 50% out-of-network, for more information see Evidence of Coverage |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $35.00 Copayment for Medicare-covered Group Sessions $30.00 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter items | In Network: |Over-the-counter (OTC) items:|$35 monthly 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 monthly, 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 | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $35.00 |
| Skilled Nursing Facility (SNF) care | $0 per day, days 1-20; $178 per day, days 21-100 in-network| 50% 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 | In Network Dental Coverage|Preventive dental services: |Oral exams: $0 copay (see Evidence of Coverage)|Cleanings: $0 copay (two visits every year)|Bitewing x-rays: $0 copay (see Evidence of Coverage)|Comprehensive dental services:|Non-routine services: $0 copay (see Evidence of Coverage)|Diagnostic services: $0 copay (see Evidence of Coverage)|Restorative services: $0 copay (see Evidence of Coverage)|Periodontal services: $0 copay (see Evidence of Coverage)|Extractions: $0 copay (see Evidence of Coverage)|Prosthodontics and maxillofacial services: $0 copay (see Evidence of Coverage)|Preventive and comprehensive dental services are not covered out-of-network. |
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 | In-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0-$35|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|(Maximum two pairs every year)|Copayment for Upgrades $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $300 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 | In-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $35|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)|$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 |
Prescription Drug Costs and Coverage
The Aetna Medicare Choice (HMO-POS) offers prescription drug coverage, with an annual drug deductible of $150.00 (excludes Tiers 1 and 2)
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual drug deductible | $150.00 (excludes Tiers 1 and 2) |
| Tier 1 | |
| Tier 2 | |
| Annual drug deductible | $150.00 (excludes Tiers 1 and 2) |
| Tier 1 | |
| Tier 2 | |
| Annual drug deductible | $150.00 (excludes Tiers 1 and 2) |
| Tier 1 | |
| Tier 2 | |
When reviewing Florida 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 Florida 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 |
Florida Counties Served
We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.
