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Aetna Medicare Dual Extra Care (PPO D-SNP) - H2293-002-000
$0.00
Monthly Premium
Aetna Medicare Dual Extra Care (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H2293-002-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
Monthly Premium
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 additional 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.
Enrollment may be limited to certain times of the year. See why you may be able to enroll today.
Basic Costs and Coverage
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $615.00 |
| Out-of-pocket maximum | $9,250.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | Out-of-Network|$0 - 30% based on level of Medicaid eligibility |
| Specialty doctor visit | In-Network|$0 - 20% based on level of Medicaid eligibility. |
| Inpatient hospital care | Out-of-Network|$0 - $2230 per stay based on level of Medicaid eligibility. |
| Urgent care | Urgent Care: Copayment for Urgent Care $0 or $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $0 Maximum Plan Benefit of $250,000 |
| Emergency room visit | $0 - $115 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. |
| Ambulance transportation | In-Network|$0 - 20% based on level of Medicaid eligibility |
Health Care Services and Medical Supplies
Aetna Medicare Dual Extra Care (PPO D-SNP) covers a range of additional benefits. Learn more about Aetna Medicare Dual Extra Care (PPO D-SNP) 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 0% or 30% |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network|0% |
| Durable medical equipment (DME) | In-Network|0% for continuous glucose monitors|20% for all other Medicare-covered DME items |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: Out-of-Network|$0 - 50% based on level of Medicaid eligibility Diagnostic Procedures: Out-of-Network|$0 - 50% based on level of Medicaid eligibility Imaging: Out-of-Network|$0 - 50% based on level of Medicaid eligibility |
| Home health care | In-Network|$0 |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 or $1900 Prior Authorization Required for Psychiatric Hospital Services |
| Mental health outpatient care | In-Network|$0 - 20% for Mental Health - Group Sessions|$0 - 20% for Mental Health - Individual Sessions|$0 - 20% for Psychiatric Services - Group Sessions|$0 - 20% for Psychiatric Services - Individual Sessions||based on level of Medicaid eligibility |
| Outpatient services/surgery | Ambulatory Surgical Center: In-Network|0% for preventive and diagnostic colonoscopy|$0 - 20% for all other ambulatory surgical center services based on level of Medicaid eligibility |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare-covered Individual Sessions 0% or 20% Coinsurance for Medicare-covered Group Sessions 0% or 20% Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter items | Over-the-Counter (OTC) Wallet with a $110 monthly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating locations including CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions.||Qualifying members may be eligible for additional spending categories on the Extra Supports Wallet. See EOC for more information on the Extra Supports Wallet. |
| Podiatry services | In-Network: Podiatry Services: Coinsurance for Medicare-Covered Podiatry Services 0% or 20% Copayment for Routine Foot Care $0
|
| Skilled Nursing Facility (SNF) care | In-Network|$0 - $0 per day, days 1-20; $218 per day, days 21-100 based on level of Medicaid eligibility |
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 | Out-of-Network||Preventive dental services:|20% for oral exams|20% for cleanings|20% for fluoride treatments|20% for x-rays|20% for other diagnostic dental services|20% for other preventive dental services||Comprehensive dental services:|20% for restorative services|20% for endodontic services|20% for periodontic services|20% for removeable prosthodontics|20% for fixed prosthodontics|20% for oral and maxillofacial surgery|20% for adjunctive services||$1,750 benefit amount (allowance) every year in and out-of-network for covered preventive and comprehensive dental services combined.||ADA recognized dental services are covered up to the benefit amount excluding implants and implant related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions. |
Vision Benefits
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage
| Coverage | Details |
|---|---|
| Vision care | In-Network||Eye Exams:|0%-20% for Medicare-covered eye exams based on level of Medicaid eligibility|$0 for non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network with an EyeMed provider||Eyewear:|0%-20% for Medicare-covered prescription eyewear|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades |
Hearing Benefits
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | In-Network||Hearing Exams:|0%-20% based on level of level of Medicaid eligibility for Medicare-covered hearing exams|$0 for non-Medicare covered hearing exams|(Maximum one non-Medicare covered hearing exam every year in or out-of-network)|$0 for fitting/evaluation for hearing aids|(Maximum one hearing aid fitting/evaluation every year)||Hearing Aids:|$0 for hearing aids|$1,250 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year) |
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 | Out-of-Network|$0 based on level of Medicaid eligibility for all preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
The Aetna Medicare Dual Extra Care (PPO D-SNP) offers prescription drug coverage, with an annual drug deductible of $615.00 (excludes Tier 1)
Coverage & Cost | |
|---|---|
| Coverage | Cost |
| Annual drug deductible | $615.00 (excludes Tier 1) |
| Tier 1 |
|
| Annual drug deductible | $615.00 (excludes Tier 1) |
| Tier 1 |
|
| Annual drug deductible | $615.00 (excludes Tier 1) |
| Tier 1 |
|
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 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.
Plan Documents
| Links to plan documents |
Georgia Counties Served
- Appling
- Atkinson
- Bacon
- Baker
- Baldwin
- Banks
- Barrow
- Bartow
- Ben Hill
- Berrien
- Bibb
- Bleckley
- Brantley
- Brooks
- Bryan
- Burke
- Butts
- Calhoun
- Camden
- Candler
- Carroll
- Catoosa
- Charlton
- Chatham
- Chattahoochee
- Chattooga
- Cherokee
- Clarke
- Clay
- Clayton
- Clinch
- Cobb
- Coffee
- Colquitt
- Columbia
- Cook
- Coweta
- Crawford
- Crisp
- Dade
- Dawson
- Decatur
- Dekalb
- Dodge
- Dooly
- Dougherty
- Douglas
- Early
- Echols
- Effingham
- Elbert
- Emanuel
- Evans
- Fannin
- Fayette
- Floyd
- Forsyth
- Franklin
- Fulton
- Gadsden
- Gilmer
- Glascock
- Glynn
- Gordon
- Grady
- Greene
- Gwinnett
- Habersham
- Hall
- Hancock
- Haralson
- Harris
- Hart
- Heard
- Henry
- Houston
- Irwin
- Jackson
- Jasper
- Jeff Davis
- Jefferson
- Jenkins
- Johnson
- Jones
- Lamar
- Lanier
- Laurens
- Lee
- Liberty
- Lincoln
- Long
- Lowndes
- Lumpkin
- Macon
- Madison
- Marion
- Mcduffie
- Mcintosh
- Meriwether
- Miller
- Mitchell
- Monroe
- Montgomery
- Morgan
- Murray
- Muscogee
- Newton
- Oconee
- Oglethorpe
- Paulding
- Peach
- Pickens
- Pierce
- Pike
- Polk
- Pulaski
- Putnam
- Quitman
- Rabun
- Randolph
- Richmond
- Rockdale
- Russell
- Schley
- Screven
- Seminole
- Spalding
- Stephens
- Stewart
- Sumter
- Talbot
- Taliaferro
- Tattnall
- Taylor
- Telfair
- Terrell
- Thomas
- Tift
- Toombs
- Towns
- Treutlen
- Troup
- Turner
- Twiggs
- Union
- Upson
- Walton
- Ware
- Warren
- Washington
- Wayne
- Webster
- Wheeler
- White
- Whitfield
- Wilcox
- Wilkes
- Wilkinson
- Worth
We offer plans from Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Healthspring, Wellcare, or Kaiser Permanente.
Enrollment may be limited to certain times of the year. See why you may be able to enroll today.