What is Aetna Medicare Prime Plan?
Aetna Medicare Prime Plan is a 2019 Medicare Advantage plan, from Aetna Medicare, available in El Paso County, Colorado.
- It's a Health Maintenance Organization (HMO) health plan.
- It includes a prescription drug plan (Part D).
- It has the same health insurance benefits as Original Medicare.
- It offers extras that Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $6,700 .
- The monthly premium is $0.00 (plus your Part B premium).
Aetna Medicare Prime Plan vs. Medicare
This HMO plan replaces your Original Medicare coverage. If you enroll, you agree to let Aetna Medicare manage your Medicare benefits.
The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, HMOs limit your annual out-of-pocket costs. With traditional Medicare there's no cap, leaving you vulnerable to excessive medical bills.
Aetna Medicare Prime Plan Review
These are the areas of the plan that are important to compare and review:
- Premium: This is the amount you will pay monthly, above and beyond your Medicare Part B.
- Maximum-Out-Of-Pocket (MOOP): This is the most you will pay for co-pays and co-insurance before the plan pays 100%.
- CMS Ratings: Important measurements across 9 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Medications are expensive, so you'll want to know how this plan covers your prescriptions.
- Co-pays & Co-insurance: If you see the doctor regularly, including specialists, you need to know what you'll pay for each visit.
IMPORTANT: With an HMO you are required to use healthcare providers in the plan's network. If you don't you will incur additional costs. Also, be aware that your primary care physician must refer you before you can see a specialist.
CRITICAL: Aetna Medicare Prime Plan includes a Medicare Drug Plan which has its own deductible and co-pays. If you have regular prescriptions, make sure they are covered at a favorable price before you join this plan. Prescription drug plans vary significantly by plan. Make sure you have the best coverage.
How Much Does Aetna Medicare Prime Plan Cost?
The premium on this plan is $0.00 per month. That includes your prescription drugs, as well. Plus, you must continue to pay your monthly Medicare Part B premium. Co-payments and/or co-insurances also apply with most healthcare services, except preventive care mandated by CMS (see H3931-135 Summary of Benefits below).
Although the health plan itself does not have a deductible, the prescription drug plan does. It's $195.00 per year. That means you pay 100% of your prescription costs until you've spent $195.00, then the plan will begin paying it's share.
IMPORTANT: When evaluating this plan, look past the monthly premium. Identify the costs of the healthcare services you use most. Only then will you uncover the plan's value for your personal situation.
What is the Maximum Out-of-Pocket (MOOP) Limit?
Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket limit on inpatient and outpatient healthcare services. The Aetna Medicare Prime Plan plan MOOP is $6,700 . Once you reach this amount of spending on your co-payments, all of your Medicare Part A and Part B services will be covered at no additional charge.
Plans can set their MOOP at a voluntary level of $0 to $3,400 (for in-network services) or a mandatory $3,401 to $6,700 (in-network). Combined totals for in-network and out-of-network are generally higher.
NOTE: MOOP does not include what you spend on monthly premiums. It also does not apply to your prescription drugs or Part D deductible.
CRITICAL: It is important to evaluate the combined annual MA/MAPD premiums and MOOP versus what you might expect to pay for a Medicare Supplement in El Paso County. Some Medicare Supplements offer less overall financial risk than Medicare Advantage.
Medicare 5-Star Ratings
In this section we show you the quality rating for this Aetna Medicare plan. Each year CMS rates health plans (Part C) in five broad categories and drug plans (Part D) in four broad categories. We do not recommend joining a plan with an overall rating less than 3.0. The following marks will give you an idea of the level of care you will receive if you join this health plan.
Does Aetna Medicare Prime Plan include Medicare Part D?
This plan includes prescription drug coverage (Medicare Part D). If you have regular prescriptions, it's critical that you evaluate your costs using the plan's formulary.
In addition to the monthly premium and Part D deductible, the drug plan has copayments (fixed dollar amount) and/or coinsurances (percentage) that you must pay when you pickup your medications. Here's the drug coverage schedule for this plan:
|1 (Preferred Generic)||$0.00 copay||$15.00 copay|
|2 (Generic)||$10.00 copay||$20.00 copay|
|3 (Preferred Brand)||$47.00 copay||$47.00 copay|
|4 (Non-Preferred Drug)||$100.00 copay||$100.00 copay|
|5 (Specialty Tier)||29%||29%|
How Much are the Copays & Co-Insurance?
In this Summary of Benefits section we outline high-level information about the plan's co-payment and co-insurance costs for inpatient, outpatient, preventive care, transportation and other healthcare services.
Aetna Medicare Prime Plan vs. Medigap
To compare Aetna Medicare Prime Plan with a Medigap plan (Medicare supplemental insurance), you need to evaluate your healthcare and financial needs. Look at the total potential cost with each plan type, not just the monthly premium, and choose how you want to use medical care (locally or nationally).
To help you make a better decision, we created our How-to Choose the Best Medicare Plan guide (opens in a new tab). It will help you understand how to compare Aetna Medicare Prime Plan with Medicare Supplement plans in Colorado. Medicare Plan F in Colorado is the most popular.
Contact Aetna Medicare
For more information about this plan, call their prospective members line, or visit their website:
For assistance 24 hours a day, call 800-633-4227. TTY users should call 877-486-2048. If you qualify for Medicare but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Advantage program on www.medicare.gov or the Wikipedia page.
Medicare Part C Plan Availability
Aetna Medicare Prime Plan is available to beneficiaries living in Elbert, Monument, Palmer Lake, Calhan, Cascade, Fountain, Green Mountain Falls, Manitou Springs, Peyton, Ramah, Rush, Usaf Academy, Yoder, Colorado Springs, and all other areas of El Paso County, Colorado; Medicare plans are the same throughout the County.
The Medicare Advantage plan data on MedicareWire comes directly from CMS.gov and is subject to change. CMS has neither reviewed nor endorsed the information on this site.
The health insurance benefit information provided on this page is a brief summary only, not a complete description. Limitations, co-payments, and restrictions may apply. For more information contact the plan directly at (855)338-7027 or (711)- for TTY users.
The MedicareWire website is available for educational purposes. Our goal is to present information accurately and without bias, based on our interpretation of factual information. However, this site is not intended as a substitute for legal, health, or financial advice from a licensed professional. On this page we help consumers research and compare:
Aetna Medicare Prime Plan for El Paso County, Colorado is a 2019 Medicare Advantage Plan (HMO H3931-135), with a $0.00/mo premium and $6,700 max out-of-pocket limit. Compare star ratings, benefits, premiums, co-pays, deductibles and prescription coverage with other Part C plans.
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This Medicare Advantage plan information is maintained by David Bynon and was last updated on .