Aetna Medicare Freedom Core Plan (PPO)

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

Aetna Medicare Freedom Core Plan (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H3288-020-000

$0.00 Monthly Premium

Oklahoma 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 Oklahoma 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$6,700.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit$0 in-network / 50% out-of-network
Specialty doctor visit$40 in-network / 50% out-of-network
Inpatient hospital care$260 per day, days 1-6; $0 per day, days 7-90 in-network / 40% per stay out-of-network
Urgent care
Urgent Care:
Copayment for Urgent Care $0.00 to $60.00

Minimum copayment applies to urgently needed services provided in a PCP office.
Maximum copayment applies to urgently needed services provided in an urgent care facility or location other than PCP.

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $95.00
Emergency room visit$95 If you are admitted to the hospital within 0 hours your cost share may be waived, for more information see the Evidence of Coverage
Ambulance transportation$290 in-network / $290 out-of-network

Health Care Services and Medical Supplies

Aetna Medicare Freedom Core Plan (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Freedom Core Plan (PPO) 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 $20.00
Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.
Durable medical equipment (DME)18% in-network / 40% out-of-network
Diagnostic tests, lab and radiology services, and X-raysLab Services: Lab Services: $0 in-network/ 50% out-of-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $50 in-network/ 50% out-of-network, for more information see Evidence of Coverage
Imaging: Xray: $40 in-network / CT Scans: $375 in-network / Diagnostic Radiology other than CT Scans: $375 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 / $0 out-of-network
Mental health inpatient care
Out-of-Network:
Coinsurance for Psychiatric Hospital Services per Stay 50%
Mental health outpatient careMental Health - Group Sessions: $40 in-network/ Mental Health - Individual Sessions: $40 in-network/ 50% out-of-network, for more information see Evidence of Coverage

Psychiatric Services - Group Sessions: $40 in-network/ Psychiatric Services - Individual Sessions: $40 in-network/ 50% out-of-network, for more information see Evidence of Coverage
Outpatient services/surgeryAmbulatory Surgical Center: $325 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network / 50% out-of-network, for more information see Evidence of Coverage
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $45.00
Copayment for Medicare-covered Group Sessions $45.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter itemsSeasonal Over-the-Counter (OTC) kit of preselected OTC items mailed twice a year and $120 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $40.00
Skilled Nursing Facility (SNF) care$0 per day, days 1-20; $196 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$2,000 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$250 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 Oklahoma 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 Oklahoma 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

Oklahoma Counties Served

Adair Atoka Blaine Bryan Caddo Canadian Carter Cherokee Cleveland Coal Cotton Craig Custer Delaware Garfield Garvin Grady Grant Haskell Hughes Jefferson Johnston Kay Kingfisher Latimer Le Flore Love Major Marshall Mayes Mcclain Mcintosh Murray Muskogee Noble Nowata Okfuskee Osage Ottawa Pawnee Pittsburg Pontotoc Pottawatomie Pushmataha Seminole Sequoyah Stephens
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