Aetna Medicare Dual Select Plan (HMO D-SNP)

4 out of 5 stars* for plan year 2023
$0.00 Monthly Premium

Aetna Medicare Dual Select Plan (HMO D-SNP) is a HMO D-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H3239-011-000

$0.00 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$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 - $25 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 - $290 based on level of Medicaid eligibility. For more information see Evidence of Coverage.

Health Care Services and Medical Supplies

Aetna Medicare Dual Select Plan (HMO D-SNP) covers a range of additional benefits. Learn more about Aetna Medicare Dual Select Plan (HMO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $0.00
Copayment for Routine Care $0.00
  • Maximum 12 Routine Care every year
Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring0%
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-raysLab Services: $0, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $0 - 20% 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 careIn-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/surgeryAmbulatory 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 careIn-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$225 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $0.00
Copayment for Routine Foot Care $25.00
  • Maximum 12 visits every year
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$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$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 benefits$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 1-877-890-1409 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

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
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