On this page we help consumers: Compare Aetna Medicare Advantra Core with all 2020 Medicare Advantage Plans available in Berks County, Pennsylvania. This is a HMO plan with a $0.00/mo premium and $4,900 max out-of-pocket limit.
Aetna Medicare Advantra Core 2020 Medicare Advantage HMO Plan for Berks County, PA
Aetna Medicare Advantra Core is a Medicare Advantage plan, from Coventry by Aetna, that's available to Medicare beneficiaries living in Berks County, Pennsylvania.
- It's a Health Maintenance Organization (HMO) health plan.
- It offers the same basic benefits as Original Medicare.
- It may offer extras that Medicare does not cover.
- The maximum out-of-pocket cost with this plan is $4,900 .
- The monthly premium is $0.00 (plus your Part B premium).
- NOTE: It does not include a prescription drug plan (Part D).
Aetna Medicare Advantra Core vs. Original Medicare in Berks County
If you join this HMO plan, it will replace your Original Medicare coverage in Berks County and you must agree to let Coventry by Aetna manage your Medicare benefits, including:
- Medicare Part A (hospital insurance).
- Medicare Part B (medical insurance).
- Additional benefits included in the plan not covered by Medicare.
The benefit of an HMO plan is lower, predictable out-of-pocket expenses. Although more restrictive than Original Medicare, a HMO plan limits your annual out-of-pocket costs. With Medicare Parts A and B, there's no cap, leaving you vulnerable to excessive medical bills.
Aetna Medicare Advantra Core 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 5 different areas that will help you understand how well this plan will care for you.
- Prescription Coverage: Not included with this plan.
- 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.
NOTE: Aetna Medicare Advantra Core does not include prescription drug coverage (no drug plan). To get it, you can add one of the stand-alone Medicare Drug Plans in Pennsylvania. Prescription drug plans vary widely. Make sure you have the coverage you need.
How Much Does Aetna Medicare Advantra Core Cost?
The premium on this plan is $0.00 per month. 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 preventative care mandated by CMS (see H3959-041 Summary of Benefits below).
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 Advantra Core plan MOOP is $4,900 . 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 Berks 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 Coventry by Aetna 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 Advantra Core include Medicare Part D?
This plan does not include prescription drug coverage. You can get prescription coverage by joining one of the Medicare Part D Plans in Pennsylvania.
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. For complete details or assistance call: 1-855-266-4865.
Aetna Medicare Advantra Core vs. Medigap
To compare Aetna Medicare Advantra Core 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. It will help you understand how to compare Aetna Medicare Advantra Core with Medicare Supplement plans in Pennsylvania. Medicare Plan F in Pennsylvania is the most popular.
Contact Coventry by Aetna
For more information about this plan, call the Enrollment Assistance line, or visit the Enrollment Website or the plan 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. To learn more about this plan, visit the Coventry by Aetna Medicare website.
Additional Plan Options in Berks County
Are you eligible for a Berks County, PA Medicare Special Needs Plan (SNP)? SNPs are a special type of Medicare Advantage plan designed to help people with special needs. Here are some of the SNP plans in your area:
- UnitedHealthcare Nursing Home Plan 2 (Local PPO), for Institutional beneficiaries
- Allwell Dual Medicare (Local HMO), for Dual-Eligible beneficiaries
- UnitedHealthcare Dual Complete (Local HMO), for Dual-Eligible beneficiaries
- Geisinger Gold Secure Rx (Local HMO), for Dual-Eligible beneficiaries
- Aetna Medicare Advantra Cares (Local HMO), for Dual-Eligible beneficiaries
Not qualified for an SNP? Here are some additional plans you might consider:
- Lasso Healthcare (MSA)
- AARP Medicare Advantage (HMO)
- AARP Medicare Advantage Choice Plan 1 (PPO)
- AARP Medicare Advantage Choice Plan 2 (PPO)
- AARP Medicare Advantage Choice Plan 3 (PPO)
Medicare Part C Plan Availability
Aetna Medicare Advantra Core is available to beneficiaries living in Hereford, Bally, Barto, Bechtelsville, Bernville, Bethel, Birdsboro, Blandon, Bowers, Boyertown, Centerport, Douglassville, Earlville, Fleetwood, Geigertown, Hamburg, Kempton, Kutztown, Leesport, Lenhartsville, Limekiln, Lyon Station, Maxatawny, Mertztown, Mohnton, Mohrsville, Monocacy Station, Morgantown, Mount Aetna, New Berlinville, Oley, Pine Forge, Rehrersburg, Robesonia, Shartlesville, Shoemakersville, Strausstown, Temple, Topton, Virginville, Wernersville, Womelsdorf, Reading, and all other areas of Berks County, Pennsylvania; Medicare plans are the same throughout the County.