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Your Medicare Advantage plan comparison is just one step away!
On the phone
Our licensed insurance agents can help you compare plans and keep your current doctor.
Aetna Medicare Prime Plan (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H4523-020-000
Texas 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 Texas Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $200.00 |
| Out-of-pocket maximum | $5,000.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $7,400.00 |
| Primary care doctor visit | $0 |
| Specialty doctor visit | $30 |
| Inpatient hospital care | $300 per day, days 1-6; $0 per day, days 7-90 |
| 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 $110.00 |
| Emergency room visit | $110 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 | $265 |
Aetna Medicare Prime Plan (HMO) covers a range of additional benefits. Learn more about Aetna Medicare Prime Plan (HMO) 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 $20.00 Prior Authorization Required for Chiropractic Services Referral 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: $0 in-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $40 in-network, for more information see Evidence of Coverage Imaging: Xray: $30 in-network / CT Scans: $325 in-network / Diagnostic Radiology other than CT Scans: $325 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: Copayment for Psychiatric Hospital Services per Stay $1871.00 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: $275 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 | 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 Seasonal 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 services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $30.00 Referral Required for Podiatry Services |
| 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.
| Coverage | Details |
|---|---|
| Dental care | In-Network: Preventive Dental: Copayment for Oral Exams $0 Copayment for Dental X-Rays $0 Copayment for Prophylaxis (Cleaning) $0 Comprehensive Dental: Co-Insurance for Non-routine Services 20%-50% Copayment for Diagnostic Services $0 Co-Insurance for Restorative Services 20%-50% Frequency limitations may apply. See the Schedule of Benefits in your Evidence of Coverage. $3,000 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.
| Coverage | Details |
|---|---|
| Vision benefits | In-Network: Eye Exams: Copayment for Medicare Covered Benefits $0 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 $250 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.
| Coverage | Details |
|---|---|
| Hearing benefits | In-Network: Hearing Exams: Copayment for Medicare Covered Benefits $30 Referral Required for Hearing Exams 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 $1,250 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.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | $0 copay for all preventive services covered under Original Medicare at zero cost sharing |
The Aetna Medicare Prime Plan (HMO) offers prescription drug coverage, with an annual drug deductible of $200.00 (excludes Tiers 1, 2 and 3)
| Coverage |
Cost
|
|---|---|
|
Coverage & Cost
|
|
| Annual drug deductible | $200.00 (excludes Tiers 1, 2 and 3) |
| Tier 1 | |
| Tier 2 | |
| Tier 3 | |
| Annual drug deductible | $200.00 (excludes Tiers 1, 2 and 3) |
| Tier 1 | |
| Tier 2 | |
| Tier 3 | |
| Annual drug deductible | $200.00 (excludes Tiers 1, 2 and 3) |
| Tier 1 | |
| Tier 2 | |
| Tier 3 | |
When reviewing Texas 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 Texas 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 |
Compare your Medigap plan options by visiting MedicareSupplement.com
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