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Aetna Medicare Signature Extra (PPO) - H1608-081-000
$0.00
Monthly Premium
Aetna Medicare Signature Extra (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna®
Plan ID: H1608-081-000
** 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 North Dakota, 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 (PPO) Basic Costs and Coverage
Learn more about the costs, benefits and coverage of Aetna Medicare Signature Extra (PPO) below:
| Coverage | Details |
|---|---|
| Monthly plan premium | $0.00 |
| Vision coverage | |
| Dental coverage | |
| Hearing coverage | |
| Prescription drugs | |
| Medical deductible | $615.00 |
| Out-of-pocket maximum | $4,500.00 |
| Initial drug coverage limit | $0.00 |
| Catastrophic drug coverage limit | $2,100.00 |
| Primary care doctor visit | Out-of-Network|40% |
| Specialty doctor visit | Out-of-Network|40% |
| Inpatient hospital care | In-Network|$350 per day, days 1-6; $0 per day, days 7-90||Out-of-Network|40% per stay |
| Urgent care | Urgent Care: Copayment for Urgent Care $50 Worldwide Coverage: Copayment for Worldwide Urgent Coverage $130 Maximum Plan Benefit of $250,000 |
| Emergency room visit | $130 If you are admitted to the hospital within 24 hours your cost share may be waived |
| Ambulance transportation | Out-of-Network|$310 |
Additional Health Services and Supplies Coverage
Aetna Medicare Signature Extra (PPO) 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) | Out-of-Network|40% |
| Diagnostic tests, lab and radiology services, and X-rays | Lab Services: Out-of-Network|40% Diagnostic Procedures: Out-of-Network|40% Imaging: Out-of-Network|40% |
| Home health care | Out-of-Network|40% |
| Mental health inpatient care | In-Network: Psychiatric Hospital Services: $370 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|$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|$300 all other ambulatory surgical center services |
| Outpatient substance abuse care | Out-of-Network: Outpatient Substance Abuse Services: Coinsurance for Medicare Covered Individual Sessions 40% Coinsurance for Medicare Covered Group Sessions 40% |
| Over-the-counter items | Over-the-Counter (OTC) Wallet with a $30 quarterly benefit amount (allowance) on the Extra Benefits Card to help pay for approved OTC health and wellness products like first aid supplies, cold and allergy medicine, pain relievers, and more. Approved products can be purchased in-store at participating locations including CVS retail locations (excluding locations inside other stores), and online or by phone through CVS OTC Health Solutions. |
| Podiatry services | Out-of-Network: Podiatry Services: Coinsurance for Medicare Covered Podiatry Services 40% Minimum cost-share applies to services rendered in a nursing home. |
| Skilled Nursing Facility (SNF) care | Out-of-Network|40% per stay |
Dental Benefits
Aetna Medicare Signature Extra (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 vary by covered dental service. |
Vision Benefits
Aetna Medicare Signature Extra (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 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 |
Hearing Benefits
Aetna Medicare Signature Extra (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 | 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 Signature Extra (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 Signature Extra (PPO) 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 North Dakota. We can also help you look for plans that cover your prescription drugs.
There may be other Aetna Medicare Advantage plans available in North Dakota. 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 (PPO) by reviewing the following documents:
| Links to plan documents |