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Aetna Medicare Elite (HMO) - H3312-113-000
$109.00
Monthly Premium
Aetna Medicare Elite (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna®
Plan ID: H3312-113-000
** Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$109.00
Monthly Premium
If you have Medicare in New York, you may want to review your coverage options. Medicare Advantage plans cover services that aren’t covered by Original Medicare (Part A and Part B).
Aetna Medicare Advantage plans may cover prescription drugs, and offer other benefits that Original Medicare doesn’t cover.
Aetna Medicare Elite (HMO) basic costs and coverage
Learn more about the costs, benefits and coverage of Aetna Medicare Elite (HMO) below:
| Coverage | Details |
|---|---|
| Monthly plan premium | $109.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $700.00 |
| Out-of-pocket maximum | $9,850.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care provider visit | In-Network $0 |
| Specialty doctor visit | In-Network $50 |
| Inpatient hospital care | In-Network $490 per day, days 1-5; $0 per day, days 6-90 |
| Urgent care | Urgent Care: Copayment for Urgent Care $40 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $115 Maximum Plan Benefit of $250,000 |
| Emergency room visit | $115 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance transportation | In-Network $280 |
Additional health services and supplies coverage
Aetna Medicare Elite (HMO) covers additional health services and medical supplies. Learn more below:
| Coverage | Details |
|---|---|
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network 0% for continuous glucose monitors (CGM) at participating providers 0% for Accu-Chek/Roche and TRUE/Trividia blood glucose meters (BGM) and medical diabetic supplies 20% for blood glucose meters (BGM) and supplies manufactured by providers other than Accu-Chek/Roche and TRUE/Trividia with an approved prior authorization |
| Durable medical equipment (DME) | In-Network 20% |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: In-Network $0 for Hemoglobin A1C tests $10 for other lab services Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $50 for other diagnostic procedures and tests Imaging: In-Network Xray: $50 CT Scans: $250 for CT/CAT scans; $350 for all other complex imaging Diagnostic Radiology other than CT Scans: $250 for CT/CAT scans; $350 for all other complex imaging Diagnostic Radiology Mammogram: $0 |
| Home health care | In-Network $0 |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: $418 per day for days 1 to 5 $0 per day for days 6 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental health outpatient care | In-Network $50 for Mental Health - Group Sessions $50 for Mental Health - Individual Sessions $50 for Psychiatric Services - Group Sessions $50 for Psychiatric Services - Individual Sessions |
| Outpatient services/surgery | Ambulatory Surgical Center: In-Network $0 for preventive and diagnostic colonoscopy $400 all other ambulatory surgical center services |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $50 Copayment for Medicare-covered Group Sessions $50 Prior Authorization Required for Outpatient Substance Abuse Services |
| Podiatry services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $50 |
| Skilled Nursing Facility (SNF) care | In-Network $0 per day, days 1-20; $213 per day, days 21-100 |
Dental benefit
Aetna Medicare Elite (HMO) offers the following dental benefit and coverage. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.
| Coverage | Details |
|---|---|
| Dental care | In-Network Preventive dental services: $0 for oral exams $0 for cleanings $0 for x-rays Frequencies and medical necessity requirements vary by covered dental service. This plan does not include comprehensive dental coverage. You can purchase comprehensive dental coverage for dental services including fillings, extractions, crowns, and more through an Optional Supplemental Benefit (OSB). The OSB is available for an additional premium and you can sign up when you enroll or within 30 days of your plan's start date. Comprehensive dental services covered through the OSB: In-Network: 50% for restorative services 50% for endodontic services 50% for periodontic services 50% for removeable prosthodontics 50% for fixed prosthodontics 50% for oral and maxillofacial surgery 50% for adjunctive services When you sign up for the OSB at an additional premium, you get a $1,500 benefit amount (allowance) every year for covered comprehensive dental services. Frequencies and medical necessity requirements vary by covered dental service. See EOC for additional details on exclusions and limitations. |
Vision benefit
Aetna Medicare Elite (HMO) offers the following vision benefit. There may be provider network restrictions. You can find more information about network restrictions in the plan's Evidence of Coverage.
| Coverage | Details |
|---|---|
| Vision care | In-Network Eye Exams: $0 for Diabetic eye exams $50 for all other Medicare-covered eye exams $0 for non-Medicare covered routine eye exam Maximum one non-Medicare covered routine eye exam every calendar year with an EyeMed network provider Eyewear: $0 for Medicare-covered prescription eyewear $100 annual benefit amount (allowance) for non-Medicare covered prescription eyewear through an EyeMed network provider. $0 for Contacts $0 for Eyeglasses $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Upgrades |
Hearing benefit
Aetna Medicare Elite (HMO) offers the following hearing benefit and coverage. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.
| Coverage | Details |
|---|---|
| Hearing care | In-Network Hearing Exams: $50 for Medicare-covered hearing exams $0 for non-Medicare covered hearing exams (Maximum one non-Medicare covered hearing exam every year) $0 for fitting/evaluation for hearing aids (Maximum one hearing aid fitting/evaluation every year) Hearing Aids: $0-$1,700 for hearing aids (Maximum two hearing aids every year) |
Preventive services and health/wellness education programs
Aetna Medicare Elite (HMO) offers the following preventive services, benefits and wellness programs. There may be provider network restrictions. You can find more information about network restrictions in the plan’s Evidence of Coverage.
| Coverage | Details |
|---|---|
| Preventive services and health/wellness education programs | In-Network $0 for all preventive services covered under Original Medicare |
We can help you find out if your doctors are in a plan’s network when reviewing Aetna Medicare Advantage plans in New York. We can also help you look for plans that cover your prescription drugs.
There may be other Aetna Medicare Advantage plans available in New York. Call 1-800-891-6309 (TTY: 711), 24/7 to speak with a licensed TZ insurance agent* who can help you compare plans where you live.
Plan documents
Learn more about Aetna Medicare Elite (HMO) by reviewing the following documents:
| Links to plan documents |
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