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Aetna Medicare Dual Select (HMO D-SNP) - H3239-011-000
$35.20
Monthly Premium
Aetna Medicare Dual Select (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3239-011-000
* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$35.20
Monthly Premium
Louisiana 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 Louisiana 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 | $35.20 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $0.00 |
| Out-of-pocket maximum | $5,400.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $8,000.00 |
| Primary care doctor visit | $0 |
| Specialty doctor visit | $0 - $25 based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
| Inpatient hospital care | $0 - $373 per day, days 1-7; $0 per day, days 8-90 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 $0.00 Maximum Plan Benefit of $250000.00 |
| Emergency room visit | $0 - $120 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 - $290 based on level of Medicaid eligibility. For more information see Evidence of Coverage. |
Health Care Services and Medical Supplies
Aetna Medicare Dual Select (HMO D-SNP) covers a range of additional benefits. Learn more about Aetna Medicare Dual Select (HMO 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 $0.00
|
| 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 |
| 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 in network for preventive and diagnostic colonoscopy |$0 - $300 based on level of Medicaid eligibilityfor all other ASC services, For more information see Evidence of Coverage |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $0.00 Copayment for Medicare-covered Group Sessions $0.00 Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter items | Over the counter (OTC) items are covered under the Extra Benefits Card, for more information see Evidence of Coverage|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 $0.00 Copayment for Routine Foot Care $0.00
|
| Skilled Nursing Facility (SNF) care | $0 - $0 per day, days 1-20; $203 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 | In 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 |$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 care | In-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0-$25|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|Maximum Plan Allowance for all Non-Medicare covered Eyewear $350 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 care | In-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $0-$25|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)|$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 Louisiana 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 Louisiana 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 |
Louisiana Counties Served
- Acadia
- Allen
- Ascension
- Assumption
- Avoyelles
- Beauregard
- Bienville
- Bossier
- Caddo
- Calcasieu
- De Soto
- East Baton Rouge
- Evangeline
- Iberia
- Iberville
- Jefferson
- Jefferson Davis
- Lafayette
- Lafourche
- Lincoln
- Livingston
- Natchitoches
- Orleans
- Ouachita
- Plaquemines
- Pointe Coupee
- Rapides
- Red River
- Sabine
- Saint Bernard
- Saint Charles
- Saint James
- Saint Landry
- Saint Martin
- Saint Mary
- Saint Tammany
- St John The Baptist
- Tangipahoa
- Terrebonne
- Vermilion
- Vernon
- Washington
- Webster
- West Baton Rouge
- Winn
Enrolling in H3239-011-000 Medicare Advantage Plans in Louisiana
Medicare beneficiaries from Louisiana 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.