• Aetna Medicare Copay Reduction Form
• Aetna Medicare Advantage Copays
• Aetna Medicare Coinsurance

A copay is like paying for repairs when something goes wrong. When your car gets serviced, you pay a set fee to the mechanic, just as you may pay a set fee, like $20, when you go to the doctor because you're sick. Every plan is different, so premiums, deductibles, coinsurance, and copays can vary in cost. Health care question answered. The Aetna Medicare Choice Plan (PPO) has a monthly premium of $19.00 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out.

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Aetna Medicare Select (HMO) H1609-016 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Florida. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Select (HMO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $3,000 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $3,000 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Select (HMO) is a Local HMO. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Select (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

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2021 Aetna Medicare Medicare Advantage Plan Costs

Aetna Medicare Select (HMO) Part-C Premium

Aetna Medicare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H1609-016 Part-D Deductible and Premium

Aetna Medicare Select (HMO) has a monthly drug premium of $0 and a $0 drug deductible. This Aetna Medicare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.

H1609-016 Formulary or Drug Coverage

Aetna Medicare Select (HMO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Aetna Medicare Select (HMO) Summary of Benefits

Additional Benefits

Comprehensive Dental

Deductible

Diagnostic Tests and Procedures

Doctor Visits

Emergency care/Urgent Care

Foot Care (podiatry services)

Ground Ambulance

Hearing

Inpatient Hospital Coverage

Medical Equipment/Supplies

Medicare Part B Drugs

Mental Health Services

MOOP

Option

Optional supplemental benefits

Outpatient Hospital Coverage

Preventive Care

Preventive Dental

Rehabilitation Services

Skilled Nursing Facility

Transportation

Vision

Wellness Programs (e.g. fitness nursing hotline)

Reviews for Aetna Medicare Select (HMO) H1609

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in Aetna Medicare Select (HMO) Plans Performance

Health Plan Customer Service Rating for Aetna Medicare Select (HMO)

Aetna Medicare Select (HMO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

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Coverage Area for Aetna Medicare Select (HMO)

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Aetna Medicare Copay Reduction Form

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Published April 2, 2020

Follow our Medicare Coronavirus News page for related information on coronavirus (COVID-19) and its impact on Medicare beneficiaries.

Aetna Medicare Advantage Copays

The Centers for Medicare & Medicaid Services (CMS) mandated in early March that all testing for COVID-19 be covered in full by Medicare and private Medicare insurance carriers. A COVID-19 vaccine will also be covered if and when one becomes available.

Now, some private insurance carriers are going a step further by eliminating cost-sharing for COVID-19 treatment protocols as well.

Cigna, Humana and Aetna have each taken measures to reduce out-of-pocket spending for their Medicare plan members who undergo treatment for the disease. These out-of-pocket costs can include plan deductibles, coinsurance and copayments.

Aetna Medicare Coinsurance

COVID-19 treatment can potentially include inpatient hospital stays, doctor’s office appointments, inpatient skilled nursing facility stays, home health visits and emergency ambulance transportation.

These services can typically come with costs such as copays and deductibles.

With waived coinsurance and deductibles for COVID-19 treatment, savings can add up

Cigna and Humana both waived COVID-19-related cost-sharing for their Medicare Advantage (Medicare Part C) plans.

Medicare Advantage plans cover the same inpatient and outpatient services and items that are covered by Original Medicare (Medicare Part A and Part B).

While Original Medicare is provided by the federal government, private insurance companies administer Medicare Advantage plans.

Some of the out-of-pocket costs that a beneficiary who has Original Medicare may face if they receive covered COVID-19 treatment include:

• Beneficiaries who have Original Medicare and who receive inpatient hospital treatment for COVID-19 will typically have to pay the 2020 Medicare Part A deductible of $1,408 for each benefit period that they receive inpatient care.
  There are also Part A daily coinsurance costs for lengthy hospital stays that last longer than 60 days.
  
• Beneficiaries who have Original Medicare and who receive outpatient care must pay the 2020 Part B deductible of $198 per year before Medicare covers the costs of their outpatient care.
  After meeting the Part B deductible, beneficiaries typically pay a 20 percent coinsurance or copay for covered services and items.

For members of Medicare Advantage plans from Cigna and Humana, however, those costs will be waived for covered COVID-19 treatment.

“Our customers with COVID-19 should focus on fighting this virus and preventing its spread,” David M. Cordani, President and CEO of Cigna¹

“While our customers focus on regaining their health, we have their backs,” David Cordani, President and CEO of Cigna, said in a statement.

Cigna’s cost-sharing waiver expires May 31, 2020.

“We know we’re uniquely positioned to help our members during this unprecedented health crisis,” said Bruce Broussard, President and CEO of Humana. “It’s why we’re taking this significant action to help ease the burden on seniors and others who are struggling right now.”²

Humana’s waivers includes costs related to COVID-19 treatment by both in-network and out-of-network facilities or physicians.

Humana’s cost sharing waivers currently have no end date, as the company plans to readdress the situation as needed.

Aetna, a CVS Health company, is also dismissing COVID-19-related inpatient cost-sharing for its members.

“The additional steps we’re announcing today are consistent with our commitment to delivering timely and seamless access to care as we navigate the spread of COVID-19,” said Karen S. Lynch, president of Aetna Business Unit. “We are doing everything we can to make sure our members have simple and affordable access to the treatment they need as we face the pandemic together.”³

Aetna’s cost-sharing waiver for inpatient admissions to any in-network facility for treatment of COVID-19 is currently in effect until June 1, 2020.