Aetna Copay For Specialist

2021 Biweekly rates for zip code

Aetna’s National network allows you to seek care within the State or outside of Florida within our network of providers; No deductible; You pay a copay when you receive care from network providers – NO REFERRALS NEEDED; You pay the entire cost if you receive care from a non-network provider, except in a health emergency; Preventive Care.
Your Aetna health benefits or insurance plan may pay part of the doctor’s bill. But it pays less of the bill than it would if you got care from a network doctor. Also, some plans cover out-of-network care only in an emergency.

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.

Table of rates.
Aetna Open Access® HMO Plan	Code	Non-Postal	Postal 1	Postal 2

Click to learn more about non-postal, postal 1 and postal 2 rates

Your 2021 benefits - DC, MD, Northern VA

Aetna Medicare Platinum Plus Plan (HMO) H3748-004 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Washington. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Platinum Plus Plan (HMO) has a monthly premium of $37.00 and has an in-network Maximum Out-of-Pocket limit of $7,000 (MOOP). This Aetna Medicare plan does offer additional coverage through the gap. H5521-178 Formulary or Drug Coverage. Aetna Medicare Freedom 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.

Table of rates.
Plan Details	Basic Option
Preventive care copay	$0
Primary care visit copay	$25
Specialist visit copay	$55
Maternity	You pay 20%
Prenatal Care	$0
Hospital Care	You pay 20%
Inpatient hospital copay	You pay 20%
Outpatient surgery copay	$350
Emergency room copay	$200
Urgent care center copay	$50
Lab/X-ray/diagnostic services	$25 PCP / $55 specialist ($100 for certain tests)
Prescription drug copays (for a 30-day supply at a retail pharmacy)
Generic formulary*	$10
Brand-name formulary*	50% up to $200 maximum
Non-formulary*	50% up to $300
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 $20 for generics, 50% up to $400 max for brand name, 50% up to $600 max for nonformulary.
Built-in Vision
Routine eye exam copay	$55
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.**

Large nationwide Aetna 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

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.

Jump to:

Aetna Medicare Explorer Value (HMO) H3152-082 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in New Jersey. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Explorer Value (HMO) 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 Explorer Value (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 Explorer Value (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.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:	H3152-082
Provider:	Aetna Medicare
Year:	2021
Type:	Local HMO
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:	$195.0
Tiers with No Deductible:	1
Gap Coverage:	Yes
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H3152-084

Aetna Medicare Explorer Value (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.

H3152-082 Part-D Deductible and Premium

Aetna Medicare Explorer Value (HMO) has a monthly drug premium of $0 and a $195.0 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.

H3152-082 Formulary or Drug Coverage

Aetna Medicare Explorer Value (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 Explorer Value (HMO) Summary of Benefits

Additional Benefits

Yes

Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

Deductible

$0

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-300 copay
Diagnostic tests and procedures	$0-50 copay
Lab services	$0 copay
Outpatient x-rays	$50 copay

Aetna Copay Plans

Doctor Visits

Primary	$25 copay per visit
Specialist	$50 copay per visit

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$65 copay per visit (always covered)

Foot Care (podiatry services)

Foot exams and treatment	$50 copay
Routine foot care	Not covered

Ground Ambulance

$295 copay

Hearing

Fitting/evaluation	$0 copay
Hearing aids	$0 copay
Hearing exam	$50 copay

Inpatient Hospital Coverage

$395 per day for days 1 through 5 $0 per day for days 6 through 90

Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance

Mental Health Services

Inpatient hospital - psychiatric	$1,871 per stay
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit with a psychiatrist	$40 copay

MOOP

$7,550 In-network

Option

No

Optional supplemental benefits

Yes

Outpatient Hospital Coverage

$0-450 copay per visit

Package #1

Deductible	$50.00
Monthly Premium	$19.00

Preventive Care

$0 copay

Preventive Dental

Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay

Rehabilitation Services

Occupational therapy visit	$40 copay
Physical therapy and speech and language therapy visit	$40 copay

Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100

Transportation

Not covered

Vision

Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Other	$50 copay
Routine eye exam	$0 copay
Upgrades	$0 copay

Wellness Programs (e.g. fitness nursing hotline)

Covered

Reviews for Aetna Medicare Explorer Value (HMO) H3152