Aetna Medicare Dual Choice Plan (PPO D-SNP)
Aetna Medicare Dual Choice Plan (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H2293-003-000
Georgia 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 Georgia 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 | $8,300.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $7,400.00 |
| Primary care doctor visit | $0 |
| Specialty doctor visit | $0 - $15 based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
| Inpatient hospital care | $0 - $373 per day, days 1-6; $0 per day, days 7-90 based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
| Urgent care | Urgent Care: Copayment for Urgent Care $0.00 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $95.00 Maximum Plan Benefit of $250000.00 |
| Emergency room visit | $0 - $95 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. For more information see Evidence of Coverage. |
| Ambulance transportation | $0 - $280 based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
Health Care Services and Medical Supplies
Aetna Medicare Dual Choice Plan (PPO D-SNP) covers a range of additional benefits. Learn more about Aetna Medicare Dual Choice Plan (PPO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $0.00 Copayment for Routine Care $10.00
|
| Diabetes supplies, training, nutrition therapy and monitoring | 0% |
| Durable medical equipment (DME) | $0 - 20% based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: $0, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $0 - $95 based on level of Medicaid eligibility, for more information see Evidence of Coverage Imaging: Xray: $0 / CT Scans: $0 - 20% / Diagnostic Radiology other than CT Scans: $0 - 20% based on level of Medicaid eligibility/ Diagnostic Radiology Mammogram: 0%. For more information see Evidence of Coverage. |
| Home health care | $0 in-network / $0 out-of-network |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: $0.00 per day for days 1 to 3 $0.00 per day for days 4 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental health outpatient care | $0 - $40 for Mental Health - Group Sessions, $0 - $40 for Mental Health - Individual Sessions based on level of Medicaid eligibility. For more information see Evidence of Coverage $0 - $40 for Psychiatric Services - Group Sessions, $0 - $40 for Psychiatric Services - Individual Sessions based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
| Outpatient services/surgery | Ambulatory Surgical Center: $0 - $300 based on level of Medicaid eligibility/ ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0, 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 40% |
| Over-the-counter items | $150 quarterly OTC allowance, for more information see Evidence of Coverage |
| Podiatry services | Out-of-Network: Podiatry Services: Copayment for Medicare Covered Podiatry Services $15.00 Podiatry Services: Coinsurance for Non-Medicare Covered Podiatry Services 40% |
| Skilled Nursing Facility (SNF) care | $0 - $0 per day, days 1-20; $194.50 per day, days 21-100 based on level of Medicaid eligibility. 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 | $2,500 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 | $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 | $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 Georgia 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 Georgia 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 |
