Aetna Medicare Premier Plan for Palm Beach, FL
Medicare Advantage Plan Summary & Benefits
Aetna Medicare Premier Plan is a Preferred Provider Organization (PPO) healthcare plan for seniors and other beneficiaries in Palm Beach County, FL with Medicare benefits. A Medicare Advantage PPO plan gives you freedom to choose which doctors, specialists, and hospitals you visit. You can lower your costs when you use network providers. Plus, predictable copayments and coinsurance make it easier for you to budget healthcare costs.
The plan information presented on this page is a summary, but not a complete description of available benefits. Comprehensive information about the plan benefits is available from your agent.
Summary of Benefits
The information on this page is a brief summary. We recommend that you download and print the Summary of Benefits PDF document for this 2014 health plan and read it thoroughly. Please Contact an Agent or the plan if you have unanswered questions.
The monthly premium for this health insurance plan in Palm Beach County is $35.00 plus your monthly Medicare Part B premium. Most Medicare beneficiaries pay the standard monthly Part B premium in addition to their MA or MAPD plan premium. However, some beneficiaries are required to pay slightly higher Part B and Medicare Part D premiums because of their income (over $85,000 per year for singles or $170,000 for married couples), or due to late enrollment penalties.
Part D Prescription Drug Plan Information
This plan includes prescription drug coverage. The formulary (00014429) has a total of 3,134 prescription medications.
If you have Part D assistance, your premium will be adjusted based on your percentage.
|Formulary Drug Details:||Tier 1||Tier 2||Tier 3||Tier 4||Tier 5|
|— Drugs per Tier:||1589||517||651||329||48|
|— Cost-Sharing in ICP:||$4.00||$45.00||$95.00||25%||$0.00|
The Medicare Part D deductible with this health plan is $310.00. This is the amount you will pay until the plan begins to pay its portion.
Maximum Out of Pocket (MOOP) Benefit
The new healthcare law allows for a maximum limit of $6,700 on your out of pocket medical costs for 2014 Medicare Advantage plans. This amount is commonly called the plan MOOP (Maximum Out of Pocket). A plan's MOOP does not include your prescription drugs or the monthly premiums you pay for your health plan. Although the mandatory MOOP limit is $6,700, the Affordable Care Act law allows for a “Voluntary MOOP” that can be as low as $3,400. The MOOP on this plan is $6,700 .
Most Medicare health plans require you to make a co-payment (aka, copay) when you visit your primary care physician or a doctor. Here's how this plan works:
- $10 co-payment for each visit to your primary care physician.
- $45 co-payment for each visit to a specialist covered by Medicare.
- 30% of the cost for each visit to your primary care physician.
- 30% of the cost for each visit to a specialist covered by Medicare.
Urgent Care Doctor Visits
Urgent care is the delivery of ambulatory medical care outside of a hospital emergency department on a walk-in basis without a scheduled appointment. Here's how Urgent Care works with this plan:
- $55 co-payment for urgent care treatment covered by Medicare.
Emergency care is medical attention for patients with acute illnesses or injuries which require immediate medical attention. Here's how Emergency Care works with this plan:
- $65 co-payment for emergency room treatments covered by Medicare.
- Worldwide coverage.
- If you are immediately admitted to the hospital you pay $0 for the emergency room treatment.
Most health plans do not cover transportation to and from medical services. The exception, of course, is when you have an emergency or when non-ambulatory. Here's how this plan covers ambulance service:
- $300 co-payment for ambulance benefits covered by Medicare.
- $300 co-payment for ambulance benefits covered by Medicare.
Inpatient Treatment (Hospital Stays)
A patient who is admitted to a hospital or clinic for treatment that requires at least one overnight stay is an inpatient. Most health plans have a tiered cost structure for inpatient treatment. Here's how this plan covers hospital stays:
- There is no limit to the number of days covered by the plan per stay in the hospital.
- For hospital stay covered by Medicares:
- Days 1 - 6: $275 co-payment per day. .
- Days 7 - 90: $0 co-payment per day.
Diagnostic services include X-rays, diagnostic tests, lab services, and radiology services. Here's how this plan covers diagnostic services:
- $10 to $45 co-payment for Medicare-covered lab services.
- $10 to $45 co-payment for diagnostic procedures and tests covered by Medicare.
- $10 to $45 co-payment for X-Rays covered by Medicare.
- 20% of the cost for Medicare-covered diagnostic radiology services (not including X-rays).
- 20% of the cost for therapeutic radiology treatments covered by Medicare.
- If the physician provides you services in addition to Outpatient Diagnostic and Therapeutic Radiology Services separate cost sharing of $10 to $45 may apply.
- 30% of the cost for therapeutic radiology treatments covered by Medicare.
- 30% of the cost for Medicare-covered outpatient X-rays.
- 30% of the cost for Medicare-covered diagnostic radiology services.
- 30% of the cost for diagnostic procedures and tests covered by Medicare.
- 30% of the cost for Medicare-covered lab services.
Medicare covers a wide range of preventive services, including cardiovascular screenings, alcohol misuse screening and counseling, depression screen, and diabedes screening, to name just a few. Here's how this plan covers preventive services:
- $0 co-payment for all preventive services covered by traditional Medicare at zero cost sharing. All additional preventive services approved by Medicare mid-year will be paid by the plan or by Medicare.
- $0 co-payment for a supplemental annual physical exam.
- 30% of the cost for preventive treatment covered by Medicare.
- 30% of the cost for a supplemental annual physical exam.
Skilled Nursing Facility
Medicare covers skilled nursing care in a skilled nursing facility (SNF) under certain conditions for a limited time (no long-term care). Here's how this plan covers SNF services:
- The plan will cover up to 100 days per benefit period.
- Prior inpatient treatment (hospital stay) is not required.
- For SNF stays:
- Days 1 - 20: $25 co-payment per day. .
- Days 21 - 100: $152 co-payment per day.
Medicare covers both inpatient and outpatient mental health care services. Here's how this plan covers mental health
- $40 co-payment for each individual therapy visit covered by Medicare
- $40 co-payment for each group therapy visit covered by Medicare
- $40 co-payment for each individual therapy visit with a psychiatrist covered by Medicare.
- $40 co-payment for each Medicare-covered group therapy visit with a psychiatrist.
- $55 co-payment for partial hospitalization program services covered by Medicare.
- 30% of the cost for Medicare-covered Mental Health visits with a psychiatrist.
- 30% of the cost for Medicare-covered Mental Health visits.
- 30% of the cost for partial hospitalization program services covered by Medicare.
- You are allowed a maximum of 190 days of inpatient (hospitalized) psychiatric care in a lifetime. Inpatient services are applied to the 190-day lifetime limitation only if certain conditions are met. This limitation does not apply to inpatient psychiatric care given in a general hospital.
- For hospital stay covered by Medicares:
- Days 1 - 5: $295 co-payment per day. .
- Days 6 - 90: $0 co-payment per day.
In general, Original Medicare does not cover routine dental care. Currently, Medicare will pay for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury), or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw. Here's how this plan covers dental care:
- Preventive dental benefits, including cleanings, are not covered.
- $45 co-payment for dental benefits covered by Medicare.
- 30% of the cost for comprehensive dental benefits covered by Medicare
In general, Original Medicare does not cover routine vision care. Currently, Medicare will pay for Glaucoma screenigs, eye prostheses, Astigmatism-Correcting Intraocular Lenses, and A conventional IOL is covered when implanted following cataract surgery. Here's how this plan covers vision services:
- $0 to $45 co-payment for exams covered by Medicare to diagnose and treat diseases and conditions of the eye including an annual glaucoma screening for people at risk.
- $0 co-payment for up to 1 supplemental routine eye exam each year.
- $0 co-payment for one pair of eyeglasses covered by Medicare (lenses and frames) or contact lenses after cataract surgery.
- If the doctor provides you services in addition to eye exams separate cost sharing of $10 to $45 may apply.
- 30% of the cost for eye exams covered by Medicare.
- 30% of the cost for supplemental routine eye exams.
- 30% of the cost for corrective lenses covered by Medicare.
Medicare doesn't cover routine hearing exams, hearing aids, or exams for fitting hearing aids. Medicare covers diagnostic hearing and balance exams if your doctor or other health care provider orders these tests to see if you need medical treatment. Here's how this plan covers hearing services:
- Hearing aids are not covered.
- $45 co-payment for diagnostic hearing exams covered by Medicare.
- $0 co-payment for up to 1 supplemental routine hearing exam each year.
- 30% of the cost for diagnostic hearing exams covered by Medicare.
- 30% of the cost for supplemental hearing exams.
Compare Medicare Advantage Plans
Compare Aetna Medicare Premier Plan with these top rated Medicare Advantage Plans available in Palm Beach County:
- Humana Gold Plus H1036-062C
- Freedom Medicare Plan Rx
- Freedom Savings Plan Rx
- Freedom Savings Plan
Related Medicare Plans in Palm Beach, FL
- Medicare Advantage Plans in Palm Beach County, FL
- Florida Medigap Medicare Supplements
- Senior Dental Insurance Available in Florida
- Florida Medicare Part D Prescription Drug Plans
This page was last updated on: 10/28/2013
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The summary (overall) rating for this Aetna Medicare plan is 4.0 out of 5 based on reviews from 938 user ratings from the previous year. For more information about the review process, visit http://cms.gov.