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Aetna Medicare Longevity (HMO I-SNP) - H3959-066-000
$32.70
Monthly Premium
Aetna Medicare Longevity (HMO I-SNP) is a HMO I-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna®
Plan ID: H3959-066-000
** Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$32.70
Monthly Premium
If you have Medicare in Pennsylvania, 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 Longevity (HMO I-SNP) Basic Costs and Coverage
Learn more about the costs, benefits and coverage of Aetna Medicare Longevity (HMO I-SNP) below:
| Coverage | Details |
|---|---|
| Monthly plan premium | $32.70 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $615.00 |
| Out-of-pocket maximum | $9,250.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | In-Network|$0 |
| Specialty doctor visit | In-Network|20% |
| Inpatient hospital care | In-Network|$1,676 deductible plus $0 per day, days 1-60; $419 per day, days 61-90 per benefit period |
| Urgent care | Urgent Care: Copayment for Urgent Care $40 |
| Emergency room visit | $115 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance transportation | In-Network|20% |
Additional Health Services and Supplies Coverage
Aetna Medicare Longevity (HMO I-SNP) may cover additional health services and medical supplies. Learn more below:
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Chiropractic Services: Coinsurance for Medicare-covered Chiropractic Services 20% |
| Diabetes supplies, training, nutrition therapy and monitoring | In-Network|20% |
| Durable medical equipment (DME) | In-Network|20% |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: In-Network|$0 Diagnostic Procedures: In-Network|0% for certain Medicare-covered diagnostic tests and services including Retinal fundus, Spirometry, Peripheral arterial disease (PAD)||20% for other diagnostic procedures and tests Imaging: In-Network|Xray: 20%|CT Scans: 20%|Diagnostic Radiology other than CT Scans: 20%|Diagnostic Radiology Mammogram: 0% |
| Home health care | In-Network|$0 |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: Copayment for Psychiatric Hospital Services per Stay $0 Prior Authorization Required for Psychiatric Hospital Services |
| Mental health outpatient care | In-Network|20% for Mental Health - Group Sessions|20% for Mental Health - Individual Sessions|20% for Psychiatric Services - Group Sessions|20% for Psychiatric Services - Individual Sessions |
| Outpatient services/surgery | Ambulatory Surgical Center: In-Network|0% for preventive and diagnostic colonoscopy|20% all other ambulatory surgical center services |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare-covered Individual Sessions 20% Coinsurance for Medicare-covered Group Sessions 20% Prior Authorization Required for Outpatient Substance Abuse Services |
| Over-the-counter items | $255 quarterly benefit amount (allowance) to help pay for approved over-the-counter (OTC) health and wellness products. Approved products can be purchased in-store at participating CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions. |
| Podiatry services | In-Network: Podiatry Services: Coinsurance for Medicare-Covered Podiatry Services 20% Copayment for Routine Foot Care $0
|
| Skilled Nursing Facility (SNF) care | In-Network|$0 per stay |
Dental Benefits
Aetna Medicare Longevity (HMO I-SNP) 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 | In-Network||Preventive dental services:|$0 for oral exams|$0 for cleanings|$0 for fluoride treatment|$0 for x-rays|$0 for other diagnostic dental services|$0 for other preventive dental services||Comprehensive dental services:|$0 for restorative services|$0 for endodontic services|$0 for periodontic services|$0 for removeable prosthodontics|$0 for fixed prosthodontics|$0 for oral and maxillofacial surgery|$0 for adjunctive services||$2,000 benefit amount (allowance) every year for covered preventive and comprehensive dental services combined. Frequencies and medical necessity requirements vary by covered dental service.||ADA recognized dental services are covered up to the benefit amount excluding implants and implant related services, orthodontics, cosmetic services, those considered medical in nature, and administrative charges. See EOC for a full list of exclusions. |
Vision Benefits
Aetna Medicare Longevity (HMO I-SNP) 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 non-Medicare covered eye exams|Maximum one non-Medicare covered routine eye exam every calendar year with an EyeMed provider||Eyewear:|$0 for Contacts|$0 for Eyeglasses|$0 for Eyeglass Frames|$0 for Eyeglass Lenses|$0 for Upgrades||$250 annual benefit amount (allowance) for non-Medicare covered prescription eyewear. |
Hearing Benefits
Aetna Medicare Longevity (HMO I-SNP) 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:|20% 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 for hearing aids|$750 benefit amount (allowance) per ear, every year for hearing aids|(Maximum two hearing aids every year) |
Preventive Services and Health/Wellness Education Programs
Aetna Medicare Longevity (HMO I-SNP) 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 Pennsylvania. We can also help you look for plans that cover your prescription drugs.
There may be other Aetna Medicare Advantage plans available in Pennsylvania. 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 Longevity (HMO I-SNP) by reviewing the following documents:
| Links to plan documents |