Aetna Medicare Dual Preferred Plan (D-SNP HMO) 2023 Evangeline Parish, Louisiana Medicare Advantage Special Needs Plan

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Aetna Medicare Dual Preferred Plan, by Aetna, is a 2023 Medicare Advantage Special Needs Plan (HMO D-SNP) available in Evangeline Parish, Louisiana. Delivery of healthcare services and costs are significantly different than in Original Medicare, and the plan offers additional benefits that are not included with Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Part B.

This plan has an overall rating of 4.0 (Good) out of 5 stars.

This page contains editorial content that is not endorsed or approved by Aetna^[2]. This is not a solicitation of insurance.

Key Takeaways

1. This is a Medicare Special Needs Plan, with a HMO provider network, exclusively for people with Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. benefits (dual-eligibleDual-eligible beneficiaries are those who receive both Medicare and Medicaid benefits. It includes beneficiaries enrolled in Medicare Part A and/or Part B while receiving full Medicaid and/or financial assistance through a Medicare Savings Program....).
2. This is a zero-dollar D-SNP cost-sharing plan. Members have no copays when they use Medicare-approved healthcare services.
3. To qualify, you must live in Evangeline Parish and have both Medicare Part A and Part B. Plus, you must qualify for full Medicaid.
4. Aetna Medicare Dual Preferred Plan includes a Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... prescription drug plan.
5. The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
6. If you qualify for the Social Security "Extra Help" program you can get financial assistance to help pay your Medicare Part D monthly premium, annual deductible, and prescription copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service..
7. Aetna Medicare Dual Preferred Plan provides the same coverage benefits as Medicare Part A and Part B (Original Medicare) and includes some extra benefits not covered by Original Medicare.
8. If you are not qualifed to enroll, one of the traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage.Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). available in Evangeline Parish, Louisiana might be your best option.

Plan Basics
Plan ID:	H3239-007-0
Plan Type:	D-SNP
Network Type:	HMO
Plan Year:	2023
Premium:	$24.00/mo Plus your Part B premium.
Health Plan Deductible:	$0.00
Out-of-Pocket Maximum:	$8,300 In-networkDoctors, hospitals, pharmacies, and other healthcare providers that agree to health plan members' services and supplies at a set price are in-network providers. With some health plans, your care is only covered if you get...
Drug Plan Benefit:	Basic $505.00 deductible
Rx Gap Coverage:	No
Supplemental Benefits:	Dental, Vision, Hearing
Availability:	Evangeline Parish, LA
Insured By:	Aetna

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Health Plan Costs & Benefits

Aetna Medicare Dual Preferred Plan is a Health Maintenance Organization (HMO) plan. HMO plan members usually receive health care services through the plan’s local network of providers. Referrals are almost always required to see a specialist and other providers. However, Aetna Medicare Dual Preferred Plan does allow out-of-network care for emergencies and out-of-area dialysis.

PremiumsA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. , deductiblesA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share., and copays vary widely from plan to plan. It is very important to compare costs and apply them to your personal financial and healthcare needs.

Monthly Premium

Aetna Medicare Dual Preferred Plan's total monthly premium in Evangeline Parish is $24.00. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above....

Annual Deductible

Aetna Medicare Dual Preferred Plan's annual health plan deductible is $0.00. This does not include the deductible for the prescription drug plan (if any), which is detailed below.

Maximum Out-of-Pocket Limit

The Maximum Out-of-Pocket (MOOP) with this Aetna plan is $8,300 in-network. Unlike Original Medicare, Medicare Advantage plans must set an annual Maximum Out-of-Pocket (MOOP) limit on inpatient and outpatient healthcare services. Once you reach this amount of spending on your copayments, all of your Medicare Part A and Part B services will be covered at no additional charge for the remainder of the year. MOOP does not include monthly premiums, prescriptions, or other extra benefits.

Health Plan Out-of-Pocket Costs

The following table is a summary of the most common out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. you will incur if you join this Aetna plan:

Feel free to download our Aetna Medicare Dual Preferred Plan Summary of Benefits information.

Prescription Drug Plan Costs & Benefits

Aetna Medicare Dual Preferred Plan includes an basic benefit Medicare Part D plan (PDP). This simply means that the plan covers the minimum amount required by the Centers for Medicare & Medicaid ServicesThe Centers for Medicare & Medicaid Services (CMS) is the U.S. Federal agency that runs the Medicare, Medicaid, and Children’s Health Insurance Programs., whereas enhanced benefit plans cover more.

Basic plans typically have less cost-sharing by the plan than plans with an enhanced benefit. But, close to a third of all enhanced plans charge more than the average for preferred brand name drugs, and over 50% charge more for non-preferred brand drugs. For most people, a basic plan is their best bet, due to lower premiums and lower cost-sharing, even if the plan has a deductible.

Prescription Drug Plan Premium

Although the prescription drug plan (Part D) premium is bundled with the total plan cost, some plans have supplemental costs and/or offer low-income subsidySocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.

Prescription Drug Plan Deductible

The Medicare Part D annual deductible with this plan is $505.00. This is the amount you must pay at the pharmacy before Aetna begins paying its share.

Prescription Drug Plan Out-of-Pocket Costs

In addition to the plan's monthly premium and deductible, Aetna Medicare Dual Preferred Plan has copayments (a fixed dollar amount) and/or coinsurances (a percentage amount) that you must pay when you pick up your prescriptions. The following table shows you those costs.

Our Review & 2023 CMS Rating Marks

Each year the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage D-SNP's in nine broad categories. MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. does not recommend joining a plan with an overall rating of less than 3.0. (3 stars)

It's not a 5-star D-SNP plan, but its quality of care is better than most Medicare Advantage plans in Louisiana. From MedicareWire's perspective, Aetna Medicare Dual Preferred Plan does an average job keeping plan members healthy through preventive care measures, including screenings, tests, and vaccines. This plan is good at managing its member's chronic (long-term) health conditions. Medicare beneficiaries enrolled in this Aetna plan enjoy a good member experience. Complaints and changes in performance with this plan are average. The plan shines at customer service with an overall excellent mark on this important metric.

How to Qualify to Enroll in
Aetna Medicare Dual Preferred Plan

To qualify for enrollment in Aetna Medicare Dual Preferred Plan in Evangeline Parish, you must be eligible for both Medicare and Medicaid. To be eligible for Medicare, you must be age 65 or older, or have Social Security Disability Insurance for 24 months. To be eligible for Medicaid, your income and assets must be at or below Louisiana's state thresholds.

Before enrolling in Aetna Medicare Dual Preferred Plan, or any other dual-eligible SNP, be sure to ask the following questions:

• What costs should I expect to pay out-of-pocket (premiums, deductibles, copayments)?
• Will I be able to use my doctors? Are they in the plan's network?
• Are the plan's in-network providers and facilities in convenient locations?
• Does the plan provide coverage for services I receive from out-of-network providers?
• Do I need a referral to see a specialist?
• Are my medications on the Part D plan's formularyA formulary is a list of prescription drugs covered by a prescription drug plan or another insurance plan offering prescription drug benefits. Medications not on a plan's formulary are generally not covered.? What if I can't afford my medications?
• What special accommodations does the plan make for persons with disabilities?
• Does the plan offer free meal delivery after a stay in the hospital?
• What help is offered for caregivers? Is adult day care covered?
• Does the plan offer a prepaid card for over the counter medications and covered groceries?

Additional D-SNP Plan Options

Here are some additional Medicare SNP plans in Evangeline Parish (D-SNPs) that might be worth reviewing:

1. UnitedHealthcare Dual Complete Choice
2. Humana Gold Plus SNP-DE H1951-056
3. Aetna Medicare Dual Select Plan
4. Healthy Blue Enhanced Care
5. Humana Gold Plus SNP-DE H1951-057

Contact Aetna

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.

Citations & References

• Aetna, http://www.aetnamedicare.com, Last Accessed October 13, 2022
• Medicaid.gov, "Medicaid & CHIP in Louisiana", Last Accessed January 20, 2023
• CMS.gov, "Dual Eligible Special Needs Plans (D-SNPs)", Last Accessed January 20, 2023
• CMS.gov, Landscape Source Files, Last Accessed January 21, 2023
• CMS.gov, Medicare Part C & D Performance, Last Accessed January 21, 2023
• CMS.gov, Plan Benefits Package, Last Accessed January 21, 2023

The Medicare Special Needs Plans in Evangeline Parish, Louisiana for 2023 information on this page was last updated on January 25, 2023.