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Aetna Medicare Elite (PPO) - H5521-123-000
$54.00
Monthly Premium
Aetna Medicare Elite (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna®
Plan ID: H5521-123-000
** Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$54.00
Monthly Premium
If you have Medicare in New Jersey, 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 plans may offer other benefits that Original Medicare doesn’t cover.
Enrollment may be limited to certain times of the year. See why you may be able to enroll.
Aetna Medicare Elite (PPO) Basic Costs and Coverage
Learn more about the costs, benefits and coverage of Aetna Medicare Elite (PPO) below:
| Coverage | Details |
|---|---|
| Monthly plan premium | $54.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $500.00 |
| Out-of-pocket maximum | $9,250.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | Out-of-Network|40% |
| Specialty doctor visit | In-Network $0 for services provided in a nursing home $35 for services provided outside a nursing home Out-of-Network 40% |
| Inpatient hospital care | Out-of-Network|40% per stay |
| 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 Out-of-Network $280 |
Additional Health Services and Supplies Coverage
Aetna Medicare Elite (PPO) may cover additional health services and medical supplies. Learn more below:
| Coverage | Details |
|---|---|
| Chiropractic services | Out-of-Network: Chiropractic Services: Coinsurance for Medicare Covered Chiropractic Services 40% |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network 0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies 20% for other covered diabetic supplies Out-of-Network 0% for Roche/Accu-Chek and TRUE/Trividia diabetic supplies 20% for other covered diabetic supplies |
| Durable medical equipment (DME) | In-Network 0% for continuous glucose monitors 18% for all other Medicare-covered DME items Out-of-Network 40% |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: In-Network $0 for Hemoglobin A1C tests $5 for other lab services Out-of-Network 40% Diagnostic Procedures: In-Network $0 for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD) $35 for other diagnostic procedures and tests Out-of-Network 40% Imaging: In-Network Xray: $35 CT Scans: $250 for CT/CAT scans; $325 for all other complex imaging Diagnostic Radiology other than CT Scans: $250 for CT/CAT scans; $325 for all other complex imaging Diagnostic Radiology Mammogram: $0 Out-of-Network 40% |
| Home health care | Out-of-Network|40% |
| Mental health inpatient care | Out-of-Network: Psychiatric Hospital Services: Coinsurance for Psychiatric Hospital per Stay 40% |
| Mental health outpatient care | In-Network $35 for Mental Health - Group Sessions $35 for Mental Health - Individual Sessions $35 for Psychiatric Services - Group Sessions $35 for Psychiatric Services - Individual Sessions Out-of-Network 40% for Mental Health Services- Group Sessions 40% for Mental Health Services - Individual Sessions 40% for Psychiatric Services - Group Sessions 40% for Psychiatric Services - Individual Sessions |
| Outpatient services/surgery | Ambulatory Surgical Center: In-Network $0 for preventive and diagnostic colonoscopy $325 all other ambulatory surgical center services Out-of-Network 40% |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $35 Copayment for Medicare-covered Group Sessions $35 Prior Authorization Required for Outpatient Substance Abuse Services |
| Podiatry services | Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 40% |
| Skilled Nursing Facility (SNF) care | Out-of-Network|40% per stay |
Dental Benefits
Aetna Medicare Elite (PPO) offers the following dental benefits 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 | Out-of-Network||Preventive dental services:|50% for oral exams|50% for cleanings|50% 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) for an additional premium when you enroll or within 30 days of the plan's start date. See EOC for additional details on exclusions and limitations. |
Vision Benefits
Aetna Medicare Elite (PPO) offers the following vision benefits. There may be provider network restrictions. You can find more information about network restrictions in the Evidence of Coverage.
| Coverage | Details |
|---|---|
| Vision care | In-Network Eye Exams: $0 for Diabetic eye exams $35 for all other Medicare-covered eye exams $0 for non-Medicare covered eye exams Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network with an EyeMed provider Eyewear: $0 for Medicare-covered prescription eyewear $0 for Contacts $0 for Eyeglasses $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Upgrades Out-of-Network Eye Exams: 40% for Medicare-covered eye exams 0% for non-Medicare covered eye exams Maximum one non-Medicare covered routine eye exam every calendar year in or out-of-network (out of network covered up to $50) Eyewear: 40% for Medicare-covered prescription eyewear $0 for Contacts $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Eyeglass Lenses and Frames $0 for Upgrades $150 annual benefit amount (allowance) for non-Medicare covered prescription eyewear. |
Hearing Benefits
Aetna Medicare Elite (PPO) offers the following hearing benefits 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: $35 for Medicare-covered hearing exams $0 for non-Medicare covered hearing exams (Maximum one non-Medicare covered hearing exam every year in or out-of-network) $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) Out-of-Network: Hearing Exams: 40% for Medicare-covered hearing exams 40% for non-Medicare covered hearing exam every year in or out-of-network Hearing Aids: You must purchase hearing aids through NationsHearing |
Preventive Services and Health/Wellness Education Programs
Aetna Medicare Elite (PPO) 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 | Out-of-Network|0% for the pneumonia, influenza, Hepatitis B, and Covid-19 vaccines|40% for all other preventive services covered under Original Medicare |
Prescription Drug Costs and Coverage
Aetna Medicare Elite (PPO) offers prescription drug coverage, with an annual drug deductible of $500.00 (excludes Tiers 1 and 2)
|
Coverage & Cost |
|
|---|---|
Coverage |
Cost |
Annual drug deductible |
$500.00 (excludes Tiers 1 and 2) |
Tier 1 - Preferred Generic |
|
Tier 2 - Generic |
|
Annual drug deductible |
$500.00 (excludes Tiers 1 and 2) |
Tier 1 - Preferred Generic |
|
Tier 2 - Generic |
|
Annual drug deductible |
$500.00 (excludes Tiers 1 and 2) |
Tier 1 - Preferred Generic |
|
Tier 2 - Generic |
|
We can help you find out if your doctors are in a plan’s network when reviewing Aetna Medicare Advantage plans in New Jersey. We can also help you look for plans that cover your prescription drugs.
There may be other Aetna Medicare Advantage plans available in New Jersey. 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 (PPO) by reviewing the following documents:
| Links to plan documents |
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