Aetna Medicare Dual Select Plan (D-SNP HMO), Washington Parish, LA
Aetna Medicare Dual Select Plan (Plan ID: H3239-011) is a 2023 Medicare Special Needs Plan (D-SNP) for people who live in Washington Parish, Louisiana. This Aetna HMO plan is required to provide all of the same benefits as Original Medicare and includes some additional benefits, but out-of-pocket costs may be different.
This plan has an overall rating of 4.0 (Good) out of 5 stars.
GET NOTIFIED: 2024 Medicare Special Needs Plan Notification.
What You Need to Know
- This is a Medicare Special Needs Plan, with a HMO provider network, exclusively for people with Medicare and Medicaid benefits (dual-eligible).
- To qualify, you must live in Washington Parish and have both Medicare Part A and Part B. Plus, you must qualify for full Medicaid.
- Aetna Medicare Dual Select Plan includes a Medicare Part D prescription drug plan.
- The annual Part D deductible is $505.00. You pay this amount before cost-sharing begins.
- 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 copayments.
- Aetna Medicare Dual Select 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.
- If you are not qualified to enroll, one of the traditional Medicare Advantage plans available in Washington Parish, Louisiana might be your best option.
- 2024 costs and benefits for Aetna Medicare Dual Select Plan will be available in early October. Get Notification.
| H3239-011-0 Plan Basics | |
|---|---|
| Plan ID: | H3239-011-0 |
| Plan Type: | D-SNP |
| Network Type: | HMO |
| Plan Year: | 2023 |
| Premium: | $17.80/mo Plus your Part B premium. |
| Health Plan Deductible: | $0.00 |
| Out-of-Pocket Maximum: | $8,300 In-network |
| Drug Plan Benefit: | Basic $505.00 deductible |
| Rx Gap Coverage: | No |
| Supplemental Benefits: | None |
| Availability: | Washington Parish, LA |
| Insured By: | Aetna |
Health Plan Costs & Benefits
Aetna Medicare Dual Select 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 Select Plan does allow out-of-network care for emergencies and out-of-area dialysis.
Premiums, deductibles, 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 Select Plan's total monthly premium in Washington Parish is $17.80. This includes your prescription coverage, as well. Plus, you must continue to pay your monthly Medicare Part B premium.
Annual Deductible
Aetna Medicare Dual Select 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 costs you will incur if you join this Aetna plan:
| Healthcare Service | Member Cost |
|---|---|
| Health plan deductible | $0 |
| Maximum out-of-pocket enrollee responsibility (does not include prescription drugs) | $8,300 In-network |
| Doctor Visits | |
| Specialist | $0 or $25 copay per visit |
| Wellness programs (e.g., fitness, nursing hotline) | Covered |
| Preventive care | $0 copay |
| Mental Health Services | |
| Outpatient group therapy visit with a psychiatrist | $0 or $40 copay (authorization required) |
| Inpatient hospital - psychiatric | $0 or $624 per day for days 1 through 3 $0 per day for days 4 through 90 (authorization required) |
| Outpatient group therapy visit | $0 or $40 copay (authorization required) |
| Outpatient individual therapy visit | $0 or $40 copay (authorization required) |
| Rehabilitation Services | |
| Occupational therapy visit | $0 or $25 copay (authorization required) |
| Medical Equipment / Supplies | |
| Diabetes supplies | $0 copay (authorization required) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 0% or 20% coinsurance per item (authorization required) |
| Diagnostic Procedures / Lab Services / Imaging | |
| Lab services | $0 copay (authorization required) |
| Diagnostic tests and procedures | 0% or 0-20% coinsurance (authorization required) |
| Outpatient x-rays | $0 copay (authorization required) |
| Medicare Part B Drugs | |
| Chemotherapy | 0% or 20% coinsurance (authorization required) |
| Foot Care (podiatry Services) | |
| Routine foot care | $25 copay (limits may apply) |
| Hearing | |
| Hearing exam | $0 or $25 copay |
| Fitting/evaluation | $0 copay (limits may apply) |
| Preventive Dental | |
| Fluoride treatment | $0 copay (limits may apply) |
| Oral exam | $0 copay (limits may apply) |
| Cleaning | $0 copay (limits may apply) |
| Comprehensive Dental | |
| Periodontics | $0 copay (authorization required, limits may apply) |
| Extractions | $0 copay (authorization required, limits may apply) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (authorization required, limits may apply) |
| Diagnostic services | $0 copay (authorization required, limits may apply) |
| Endodontics | $0 copay (authorization required, limits may apply) |
| Restorative services | $0 copay (authorization required, limits may apply) |
| Vision | |
| Other | $0 copay |
| Routine eye exam | $0 copay (limits may apply) |
| Eyeglass lenses | $0 copay (limits may apply) |
| Eyeglass frames | $0 copay (limits may apply) |
| Contact lenses | $0 copay (limits may apply) |
| Eyeglasses (frames and lenses) | $0 copay (limits may apply) |
| Emergency Care / Urgent Care | |
| Emergency | $0 or $95 copay per visit (always covered) |
| Ground ambulance | $0 or $290 copay |
| Inpatient hospital coverage | $0 or $373 per day for days 1 through 6 $0 per day for days 7 through 90 |
| Outpatient hospital coverage | $0 or $0-225 copay per visit |
| Skilled Nursing Facility | $0 per day for days 1 through 20 $0 or $194.50 per day for days 21 through 100 |
| Optional supplemental benefits | No |
Feel free to download our Aetna Medicare Dual Select Plan Summary of Benefits information.
Prescription Drug Plan Costs & Benefits
Aetna Medicare Dual Select 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 Services, 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 subsidy (LIS) assistance. The following table outlines the prescription drug plan premium details of this plan.
| Basic Part D Premium: | $17.80 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $17.80 |
| Part D Premium with Full LIS Assistance: | $0.00 |
| Part D Premium with 75% LIS Assistance: | $4.40 |
| Part D Premium with 50% LIS Assistance: | $8.90 |
| Part D Premium with 25% LIS Assistance: | $13.30 |
For more information about the Low-Income Subsidy (aka, "Extra Help") program, refer to the Social Security Extra Help page.
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 Select 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.
| Tier | Preferred | Standard |
|---|---|---|
| $0 copay on all covered generic and brand-name prescriptions. | ||
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. MedicareWire 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 Select 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.
| CMS Measure | Star Rating |
|---|---|
| 2023 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How to Qualify to Enroll in
Aetna Medicare Dual Select Plan
To qualify for enrollment in Aetna Medicare Dual Select Plan in Washington 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 Select 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 formulary? 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 that might be worth reviewing:
- Humana Gold Plus SNP-DE H1951-056
- UnitedHealthcare Dual Complete Choice
- Healthy Blue Enhanced Care
- Aetna Medicare Dual Preferred Plan
- HumanaChoice SNP-DE H5216-332
Contact Aetna
Call 1-855-728-0510 (TTY 711) to speak with a licensed insurance agent (Mon-Fri, 8am-9pm , Sat 8am-8pm EST) and learn more about this Special Needs Plan and other plans on this site. You may also Enroll Online using our safe and secure online enrollment website or take advantage of the following plan resources:
| Plan Website: | http://www.aetnamedicare.com |
|---|---|
| Formulay Information: | http://www.aetnamedicare.com/findpharmacy |
| Pharmacy Information: | Aetna Pharmacy Page |
| Prospective Members: | (833)859-6031 |
| TTY Users: | (711)- |
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.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Centene Corporation, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna-HealthSpring, Humana, Molina Healthcare, Mutual of Omaha, Oscar Health Insurance, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, and UnitedHealthcare.
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