Luckily, his health plan has some fixed costs and only requires $30 copays for visits to his regular doctor and $50 copays to see specialists like an orthopedist. (He also once paid a $150 copay the night he landed in the emergency room when his knee was so swollen he couldn’t bend it.). Aetna Medicare Choice Plan (PPO) 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. Testing, treatment: 100% after $10 copay Weill network; 100% after $20 PCP co-pay/$30 Specialist Aetna Network. Shots: 100% no deductible 70% after deductible Deductible, then 90% Deductible, then 80% Chiropractic Visits 100% after $20 copay 80% after deductible 100% after $10 copay Weill network; 100% after $30 copay Aetna network.
2021 Biweekly rates for zip code
Members, Aetna is here to keep you informed during the coronavirus (COVID-19) pandemic. Visit our COVID-19 FAQ page for answers to the most frequently asked questions regarding the coronavirus and to get the latest information. 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.
These rates do not apply to all Enrollees. If you are in a special enrollment category, please refer to the FEHB Program website or contact the agency or Tribal Employer which maintains your health benefits enrollment.
| Open Access® HMO - High Option | Code | Non-Postal | Postal 1 | Postal 2 |
|---|
Your 2021 benefits
| Plan Details | High Option |
|---|---|
| Preventive care copay | $0 |
| Primary care visit copay | $20 |
| Specialist visit copay | $35 |
| Maternity | |
| Prenatal Care | $0 |
| Hospital Care | $250 per day, $1000 max per stay |
| Inpatient hospital copay | $250/day, $1,000 max per stay |
| Outpatient surgery copay | $175 |
| Emergency room copay | $125 |
| Urgent care center copay | $50 |
| Lab/X-ray/diagnostic services | $20 PCP / $35 specialist ($75 for certain tests) |
| Prescription drug copays (for a 30-day supply at a retail pharmacy) | |
| Generic formulary* | $10 |
| Brand-name formulary* | $35 |
| Non-formulary* | $100 |
| For specialty drug information, see the federal plan brochure. Your plan requires the use of generic medication when a generic equivalent exists. *** Or get a 90-day supply for only 2 copays, not 3, through mail-order service or available at CVS retail. | |
| Built-in Vision | |
| Routine eye exam copay | $35 |
| Money toward prescription eyewear | You get $100 every 24 months |
| Discounts on eyeglasses, contacts, eye exams and more | Included |
| Built-in dental, too Use our Basic Dental Network. Call 1-800-537-9384 to select a dentist OR to switch to our larger PPO network at no additional cost. It's your choice! Basic - Pay a $5 copay for cleanings, fillings and X-rays when you visit your primary care dentist (PCD). PPO - After a $20 deductible per member, cleanings, fillings, and X-rays are covered at 100% with network dentists.** | |
*A formulary is a list of generic and brand-name drugs your health plan prefers. | |
- Large nationwide Aetna HMO Network
- 24/7 access to doctors via phone or video with Teladoc®†
- Built-in dental and vision coverage
- Predictable costs
- No referrals to network specialists*
- Discounts on eyewear, LASIK surgery, gym memberships, massage, acupuncture, weight-loss programs and more
*A formulary is a list of generic and brand-name drugs your health plan prefers.
** Out of Network for cleanings, composite fillings and X-rays – you pay 50% of negotiated rate plus any difference between our allowance and the billed amount.
*** If you choose the brand name drug over the generic equivalent, you will owe the corresponding copay plus the difference between the generic and brand name costs. Please see the plan brochure for details.
†Teladoc® is covered at the member cost share.
] Teladoc and Teladoc physicians are independent contractors and are neither agents nor employees of Aetna. Teladoc does not replace the primary care physician. Teladoc does not guarantee that a prescription will be written. Teladoc operates subject to state regulation and may not be available in certain states. Teladoc does not prescribe DEA controlled substances, non-therapeutic drugs and certain other drugs which may be harmful because of their potential for abuse. Teladoc physicians reserve the right to deny care for potential misuse of services.
Health insurance plans are offered, underwritten and/or administered by Aetna Life Insurance Company (Aetna).
This is a brief description of the features of this Aetna health benefits plan. Before making a decision, please read the Plan's applicable Federal brochure(s). All benefits are subject to the definitions, limitations, and exclusions set forth in the Federal brochure. Plan features and availability may vary by location and are subject to change. Pharmacy clinical programs such as precertification, step therapy, and quantity limits may apply to your prescription drug coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. Discount programs are neither offered nor guaranteed under our contract with the FEHB Program, but are made available to all enrollees and their families who become members under an Aetna Health Insurance Plan. Discount programs provide access to discounted prices and are NOT insured benefits. The member is responsible for the full cost of the discounted services. Incentive-based activity awards will only be given for completing select wellness programs as determined by the plan sponsor. Information is believed to be accurate as of the production date; however, it is subject to change.
Postal and Non-Postal rates
How To Pay Aetna Copay
- Non-Postal rates apply to most non-Postal employees.
- Postal rates apply to United States Postal Service employees.
- Postal Category 1 rates apply to career bargaining unit employees represented by the APWU, IT/AS, NALC and NPMHU.
- Postal Category 2 rates apply to career bargaining unit employees represented by the PPOA.
- Non-Postal rates apply to all career non-bargaining unit Postal Service employees and career employees represented by the NRLCA agreement.
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Aetna Medicare Advantra Value (PPO) H1608-040 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in West Virginia. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Advantra Value (PPO) has a monthly premium of $0 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 of pocket. This can be a extremely nice safety net.
Aetna Medicare Advantra Value (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.
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 Advantra Value (PPO) 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
| Name: | |
|---|---|
| Plan ID: | H1608-040 |
| Provider: | Aetna Medicare |
| Year: | 2021 |
| Type: | Local PPO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0 |
| MOOP: | $7,550 |
| Part D (Drug) Premium: | $0 |
| Part D Supplemental Premium | $0 |
| Total Part D Premium: | $0 |
| Drug Deductible: | $0 |
| Tiers with No Deductible: | 0 |
| Gap Coverage: | Yes |
| Benchmark: | not below the regional benchmark |
| Type of Medicare Health: | Enhanced Alternative |
| Drug Benefit Type: | Enhanced |
| Similar Plan: | H1608-041 |
Aetna Medicare Advantra Value (PPO) 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.
H1608-040 Part-D Deductible and Premium
Aetna Medicare Advantra Value (PPO) 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.
H1608-040 Formulary or Drug Coverage
Aetna Medicare Advantra Value (PPO) 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 Advantra Value (PPO) Summary of Benefits
Additional Benefits
| No |
|---|
Comprehensive Dental
| Diagnostic services | $0 copay |
|---|---|
| Diagnostic services | $0 copay (Out-of-Network) |
| Endodontics | $0 copay (Out-of-Network) |
| Endodontics | $0 copay |
| Extractions | $0 copay |
| Extractions | $0 copay (Out-of-Network) |
| Non-routine services | $0 copay (Out-of-Network) |
| Non-routine services | $0 copay |
| Periodontics | $0 copay |
| Periodontics | $0 copay (Out-of-Network) |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay |
| Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Out-of-Network) |
| Restorative services | $0 copay (Out-of-Network) |
| Restorative services | $0 copay |
Deductible
| $950 annual deductible |
|---|
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-325 copay |
|---|---|
| Diagnostic radiology services (e.g., MRI) | 40% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | 40% coinsurance (Out-of-Network) |
| Diagnostic tests and procedures | $0-20 copay |
| Lab services | 40% coinsurance (Out-of-Network) |
| Lab services | $0-10 copay |
| Outpatient x-rays | 40% coinsurance (Out-of-Network) |
| Outpatient x-rays | $25 copay |
Doctor Visits
| Primary | $10 copay per visit |
|---|---|
| Primary | 40% coinsurance per visit (Out-of-Network) |
| Specialist | $45 copay per visit |
| Specialist | 40% coinsurance per visit (Out-of-Network) |
Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
|---|---|
| Urgent care | $50 copay per visit (always covered) |
Foot Care (podiatry services)
| Foot exams and treatment | $30 copay |
|---|---|
| Foot exams and treatment | 40% coinsurance (Out-of-Network) |
| Routine foot care | $30 copay |
| Routine foot care | 40% coinsurance (Out-of-Network) |
Ground Ambulance
| $275 copay (Out-of-Network) |
|---|
| $275 copay |
Hearing
| Fitting/evaluation | $0 copay |
|---|---|
| Fitting/evaluation | 40% coinsurance (Out-of-Network) |
| Hearing aids | $0 copay |
| Hearing aids | $0 copay (Out-of-Network) |
| Hearing exam | $40 copay |
| Hearing exam | 40% coinsurance (Out-of-Network) |
Inpatient Hospital Coverage
| $195 per day for days 1 through 9 $0 per day for days 10 through 90 |
|---|
| 40% per stay (Out-of-Network) |
Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
|---|---|
| Diabetes supplies | 0-20% coinsurance per item (Out-of-Network) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Out-of-Network) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Out-of-Network) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
Medicare Part B Drugs
| Chemotherapy | 40% coinsurance (Out-of-Network) |
|---|---|
| Chemotherapy | 20% coinsurance |
| Other Part B drugs | 20% coinsurance |
| Other Part B drugs | 40% coinsurance (Out-of-Network) |
Mental Health Services
| Inpatient hospital - psychiatric | 40% per stay (Out-of-Network) |
|---|---|
| Inpatient hospital - psychiatric | $1,590 per stay |
| Outpatient group therapy visit | 45% coinsurance (Out-of-Network) |
| Outpatient group therapy visit | $40 copay |
| Outpatient group therapy visit with a psychiatrist | $40 copay |
| Outpatient group therapy visit with a psychiatrist | 45% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit | 45% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit | $40 copay |
| Outpatient individual therapy visit with a psychiatrist | 45% coinsurance (Out-of-Network) |
| Outpatient individual therapy visit with a psychiatrist | $40 copay |
MOOP
| $11,300 In and Out-of-network $7,550 In-network |
|---|
Option
| No |
|---|
Optional supplemental benefits
| No |
|---|
Outpatient Hospital Coverage
Aetna Medicare Copays
| 40% coinsurance per visit (Out-of-Network) |
|---|
| $0-325 copay per visit |
Preventive Care
| 0-40% coinsurance (Out-of-Network) |
|---|
| $0 copay |
Preventive Dental
| Cleaning | $0 copay |
|---|---|
| Cleaning | $0 copay (Out-of-Network) |
| Dental x-ray(s) | $0 copay (Out-of-Network) |
| Dental x-ray(s) | $0 copay |
| Fluoride treatment | $0 copay (Out-of-Network) |
| Fluoride treatment | $0 copay |
| Oral exam | $0 copay |
| Oral exam | $0 copay (Out-of-Network) |
Rehabilitation Services
| Occupational therapy visit | 40% coinsurance (Out-of-Network) |
|---|---|
| Occupational therapy visit | $30 copay |
| Physical therapy and speech and language therapy visit | $30 copay |
| Physical therapy and speech and language therapy visit | 40% coinsurance (Out-of-Network) |
Skilled Nursing Facility
| 40% per stay (Out-of-Network) |
|---|
| $0 per day for days 1 through 20 $184 per day for days 21 through 100 |
Transportation
| Not covered |
|---|
Vision
| Contact lenses | Not covered |
|---|---|
| Eyeglass frames | Not covered |
| Eyeglass lenses | Not covered |
| Eyeglasses (frames and lenses) | Not covered |
| Other | $40 copay |
| Other | 40% coinsurance (Out-of-Network) |
| Routine eye exam | $0 copay |
| Routine eye exam | 40% coinsurance (Out-of-Network) |
| Upgrades | Not covered |
Wellness Programs (e.g. fitness nursing hotline)
| Covered |
|---|
Reviews for Aetna Medicare Advantra Value (PPO) H1608
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
| Part D Summary 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 |
Staying Healthy, Screening, Testing, & Vaccines
| Total Preventative Rating |
|---|
| Breast Cancer Screening |
| Colorectal Cancer Screening |
| Annual Flu Vaccine |
| Improving Physical |
| Improving Mental Health |
| Monitoring Physical Activity |
| Adult BMI Assessment |
Aetna Not Payable Remark Codes
Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
| Medication Review |
| Functional Status Assessment |
| Pain Screening |
| Osteoporosis Management |
| Diabetes Care - Eye Exam |
| Diabetes Care - Kidney Disease |
| Diabetes Care - Blood Sugar |
| Rheumatoid Arthritis |
| Reducing Risk of Falling |
| Improving Bladder Control |
| Medication Reconciliation |
| Statin Therapy |
Member Experience with Health Plan
| Total Experience Rating |
|---|
| Getting Needed Care |
| Customer Service |
| Health Care Quality |
| Rating of Health Plan |
| Care Coordination |
Member Complaints and Changes in Aetna Medicare Advantra Value (PPO) Plans Performance
| Total Rating |
|---|
| Complaints about Health Plan |
| Members Leaving the Plan |
| Health Plan Quality Improvement |
| Timely Decisions About Appeals |
Health Plan Customer Service Rating for Aetna Medicare Advantra Value (PPO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
| Call Center, TTY, Foreign Language |
How To Find Aetna Copay
Aetna Medicare Advantra Value (PPO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
| Appeals Auto |
| Appeals Upheld |
Ratings For Member Complaints and Changes in the Drug Plans Performance
| Total Rating |
|---|
| Complaints about the Drug Plan |
| Members Choosing to Leave the Plan |
| Drug Plan Quality Improvement |
Member Experience with the Drug Plan
Aetna Copays Waived
| Total Rating |
|---|
| Rating of Drug Plan |
| Getting Needed Prescription Drugs |
Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
| Drug Adherence for Diabetes Medications |
| Drug Adherence for Hypertension (RAS antagonists) |
| Drug Adherence for Cholesterol (Statins) |
| MTM Program Completion Rate for CMR |
| Statin with Diabetes |
Ready to Enroll?
Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST
Aetna Chiropractic Copay
Coverage Area for Aetna Medicare Advantra Value (PPO)
(Click county to compare all available Advantage plans)
| State: | West Virginia |
|---|---|
| County: | Boone,Braxton,Cabell,Calhoun,Clay, Fayette,Gilmer,Greenbrier,Jackson, Kanawha,Lincoln,Logan,Mason, McDowell,Mercer,Mingo,Monroe, Nicholas,Pendleton,Pleasants,Pocahontas, Putnam,Raleigh,Ritchie,Roane, Summers,Wayne,Webster,Wirt, Wood,Wyoming, |
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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.