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Aetna Medicare Premier (HMO-POS)

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

Aetna Medicare Premier (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H3192-013-000

$0.00 Monthly Premium

Illinois 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 Illinois 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$4,150.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit$0
Specialty doctor visit$25
Inpatient hospital care$250 per day, days 1-7; $0 per day, days 8-90 in-network / 40% per stay out-of-network
Urgent care
Urgent Care:
Copayment for Urgent Care $40.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $110.00
Emergency room visit$110 If you are admitted to the hospital within 0 hours you do not have to pay your cost share may be waived, for more information see the Evidence of Coverage
Ambulance transportation$250

Health Care Services and Medical Supplies

Aetna Medicare Premier (HMO-POS) covers a range of additional benefits. Learn more about Aetna Medicare Premier (HMO-POS) 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)20%
Diagnostic tests, lab and radiology services, and X-raysLab Services: Lab Services: $5 in-network, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $75 in-network, for more information see Evidence of Coverage
Imaging: Xray: $10 in-network / CT Scans: $125 in-network / Diagnostic Radiology other than CT Scans: $125 in-network / Diagnostic Radiology Mammogram: $0 in-network, for more information see Evidence of Coverage
Home health care$0
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
$250.00 per day for days 1 to 7
$0.00 per day for days 8 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient careMental Health - Group Sessions: $40 in-network/ Mental Health - Individual Sessions: $40 in-network, for more information see Evidence of Coverage Psychiatric Services - Group Sessions: $40 in-network/ Psychiatric Services - Individual Sessions: $40 in-network, for more information see Evidence of Coverage
Outpatient services/surgeryAmbulatory Surgical Center: $300 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network, for more information see Evidence of Coverage
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $40.00
Copayment for Medicare-covered Group Sessions $40.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter items In-Network:


Over-The-Counter (OTC) items:

Copayment for Over-The-Counter (OTC) items $0

Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit


$120 quarterly OTC allowance, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $5.00
Skilled Nursing Facility (SNF) care$10 per day, days 1-20; $196 per day, days 21-100 in-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 In-Network:


Preventive Dental:

Copayment for Oral Exams $0

Copayment for Dental X-Rays $0

Copayment for Prophylaxis (Cleaning) $0

Copayment for Fluoride Treatment $0


Comprehensive Dental:

Copayment for Non-routine Services $0

Copayment for Diagnostic Services $0

Copayment for Restorative Services $0


Out-Of-Network:


Co-Insurance for Preventive Dental 20%

Non-Medicare Covered Comprehensive Dental 20%


Frequency limitations may apply. See the Schedule of Benefits in your
Evidence of Coverage.


$1,750 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 In-Network:


Eye Exams:

Copayment for Medicare Covered Benefits $0-$30

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 $320 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 In-Network:


Hearing Exams:

Copayment for Medicare Covered Benefits $0

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 Illinois 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 Illinois 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

Illinois Counties Served

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