Aetna Medicare Premier (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H3192-013-000
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.
|Monthly plan premium||$0.00|
|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|
Copayment for Urgent Care $40.00
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|
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).
Copayment for Medicare-covered Chiropractic Services $20.00
Prior Authorization Required for Chiropractic Services
|Diabetes supplies, training, nutrition therapy and monitoring||0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies.|
|Durable medical equipment (DME)||20%|
|Diagnostic tests, lab and radiology services, and X-rays||Lab 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 care||In-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 care||Mental 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/surgery||Ambulatory 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 care||In-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||$120 quarterly OTC allowance, for more information see Evidence of Coverage|
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|
The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Dental care||$1,750 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.|
The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Vision benefits||$320 every year, see the Evidence of Coverage|
The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|Hearing benefits||$500 per ear every year, for more information see the Evidence of Coverage|
The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.
|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.
|Links to plan documents|
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