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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 Value (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.
Plan ID: H5521-263-000
Pennsylvania 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 Pennsylvania 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 | $0.00 |
| Out-of-pocket maximum | $7,550.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $7,400.00 |
| Primary care doctor visit | $10 in-network / 40% out-of-network |
| Specialty doctor visit | $50 in-network / 40% out-of-network |
| Inpatient hospital care | $255 per day, days 1-8; $0 per day, days 9-90 in-network / 40% per stay out-of-network |
| Urgent care | Urgent Care: Copayment for Urgent Care $10.00 to $50.00 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 24 hours your cost share may be waived, for more information see the Evidence of Coverage |
| Ambulance transportation | $265 in-network / $265 out-of-network |
Aetna Medicare Value (PPO) covers a range of additional benefits. Learn more about Aetna Medicare Value (PPO) 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 |
| Diabetes supplies, training, nutrition therapy and monitoring | 0% - 20% Higher cost-share applies to non-OneTouch/LifeScan diabetic supplies. |
| Durable medical equipment (DME) | 20% in-network / 40% out-of-network |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: Lab Services: $10 in-network/ 40% out-of-network, for more information see Evidence of Coverage Diagnostic Procedures: Diagnostic Procedures/Tests: $20 in-network/ 40% out-of-network, for more information see Evidence of Coverage Imaging: Xray: $30 in-network / CT Scans: $10 for services provided by your primary care physician in their office in-network; $295 for services performed by a provider other than your primary care physician in-network / Diagnostic Radiology other than CT Scans: $10 for services provided by your primary care physician in their office in-network; $295 for services performed by a provider other than your primary care physician in-network / Diagnostic Radiology Mammogram: $0 in-network / 40% out-of-network, for more information see Evidence of Coverage |
| Home health care | $0 in-network / $0 out-of-network |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $1590.00 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/ 45% out-of-network, for more information see Evidence of Coverage Psychiatric Services - Group Sessions: $40 in-network/ Psychiatric Services - Individual Sessions: $40 in-network/ 45% out-of-network, for more information see Evidence of Coverage |
| Outpatient services/surgery | Ambulatory Surgical Center: $250 in-network / ASC Screening Colonoscopy Polyp Removal and Post-FIT: $0 in-network / 40% out-of-network, for more information see Evidence of Coverage |
| Outpatient substance abuse care | Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual or Group Sessions 45% |
| 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 $90 quarterly OTC allowance, for more information see Evidence of Coverage |
| Podiatry services | Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 40% Podiatry Services: Coinsurance for Non-Medicare Covered Podiatry Services 40% |
| Skilled Nursing Facility (SNF) care | $0 per day, days 1-20; $196 per day, days 21-100 in-network/ 40% per stay out-of-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 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. $1,000 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-$50 Copayment for Routine Eye Exams $0 - Maximum one exam every year Eyewear: Copayment for Medicare Covered Benefits $0 Out-of-Network: Eye Exams: Coinsurance for Medicare-Covered Benefits 40% Coinsurance for Routine Eye Exams 40% Eyewear: Coinsurance for Medicare-Covered Benefits 40% |
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 $50 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 Out-of-Network: Coinsurance for Medicare Covered Hearing Exams 40% Coinsurance for Non-Medicare Covered Hearing Exams 40% Member must purchase hearing aids through NationsHearing $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 |
When reviewing Pennsylvania 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 Pennsylvania 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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