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Aetna Medicare Signature Extra (HMO) - H3152-082-000
$0.00
Monthly Premium
Aetna Medicare Signature Extra (HMO) is a HMO Medicare Advantage (Medicare Part C) plan offered by Aetna®
Plan ID: H3152-082-000
** Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.
$0.00
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 Signature Extra (HMO) Basic Costs and Coverage
Learn more about the costs, benefits and coverage of Aetna Medicare Signature Extra (HMO) below:
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| 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|$10 |
| Specialty doctor visit | In-Network|$0 for services provided in a nursing home|$40 for services provided outside a nursing home |
| Inpatient hospital care | In-Network|$395 per day, days 1-6; $0 per day, days 7-90 |
| 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|$285 |
Additional Health Services and Supplies Coverage
Aetna Medicare Signature Extra (HMO) may cover additional health services and medical supplies. Learn more below:
| Coverage | Details |
|---|---|
| Chiropractic services | In-Network: Chiropractic Services: Copayment for Medicare-covered Chiropractic Services $15 |
| 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 |
| Durable medical equipment (DME) | In-Network|0% for continuous glucose monitors|20% for all other Medicare-covered DME items |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: In-Network|$0 for Hemoglobin A1C tests|$5 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)||$40 for other diagnostic procedures and tests Imaging: In-Network|Xray: $40|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: $346 per day for days 1 to 6 $0 per day for days 7 to 90 Prior Authorization Required for Psychiatric Hospital Services |
| Mental health outpatient care | In-Network|$40 for Mental Health - Group Sessions|$40 for Mental Health - 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|$350 all other ambulatory surgical center services |
| Outpatient substance abuse care | In-Network: Outpatient Substance Abuse Services: Copayment for Medicare-covered Individual Sessions $40 Copayment for Medicare-covered Group Sessions $40 Prior Authorization Required for Outpatient Substance Abuse Services |
| Podiatry services | In-Network: Podiatry Services: Copayment for Medicare-Covered Podiatry Services $40 |
| Skilled Nursing Facility (SNF) care | In-Network|$0 per day, days 1-20; $218 per day, days 21-100 |
Dental Benefits
Aetna Medicare Signature Extra (HMO) 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 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 Signature Extra (HMO) 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|$40 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 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||$100 annual benefit amount (allowance) for non-Medicare covered prescription eyewear. |
Hearing Benefits
Aetna Medicare Signature Extra (HMO) 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:|$40 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 Signature Extra (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 |
Prescription Drug Costs and Coverage
Aetna Medicare Signature Extra (HMO) offers prescription drug coverage, with an annual drug deductible of $615.00 (excludes Tiers 1 and 2)
Coverage & Cost | |
|---|---|
| Coverage | Cost |
| Annual drug deductible | $615.00 (excludes Tiers 1 and 2) |
| Tier 1 - Preferred Generic |
|
| Tier 2 - Generic |
|
| Annual drug deductible | $615.00 (excludes Tiers 1 and 2) |
| Tier 1 - Preferred Generic |
|
| Tier 2 - Generic |
|
| Annual drug deductible | $615.00 (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 Signature Extra (HMO) by reviewing the following documents:
| Links to plan documents |