2022 Aetna Medicare Essential Plan (PPO)
Aetna Medicare Essential Plan (PPO) H5521-354 is a 2022 Medicare Advantage Plan or Part-C by Aetna Medicare available to residents in North Carolina. This plan includes additional prescription drug (Part-D) coverage. The Aetna Medicare Essential Plan (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $7,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,500 out-of-pocket. This can be a extremely nice safety net.
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Aetna Medicare Essential Plan (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 Essential Plan (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 you are always covered for urgently needed and emergency care. Plus you receive all 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 Medicare Advantage.
2022 Aetna Medicare Medicare Advantage Plan Costs
| Name: | Aetna Medicare Essential Plan (PPO) |
|---|---|
| Plan ID: | H5521-354 |
| Provider: | Aetna Medicare |
| Year: | 2022 |
| Type: | Local PPO |
| Monthly Premium C+D: | $0 |
| Part C Premium: | $0.00 |
| MOOP: | $7,500 |
| Part D (Drug) Premium: | $0.00 |
| Part D Supplemental Premium | $0.00 |
| Total Part D Premium: | $0.00 |
| Drug Deductible: | $200.00 |
| 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: | H5521-355 |
| New Plan: | 2023 H5521-355 |
Aetna Medicare Essential Plan (PPO) Part-C Premium
Aetna Medicare charges a $0.00 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.
H5521-354 Part-D Deductible and Premium
Aetna Medicare Essential Plan (PPO) has a monthly drug premium of $0.00 and a $200.00 drug deductible. This Aetna Medicare plan offers a $0.00 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 $0.00 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 $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.
Aetna Medicare Gap Coverage
In 2022 once you and your plan provider have spent $4430 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.
H5521-354 Formulary or Drug Coverage
Aetna Medicare Essential 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. 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. You can see complete 2022 Aetna Medicare Essential Plan (PPO) H5521-354 Formulary here.
| Drug Tier | Copay Preferred Pharmacy |
Copay Nonpreferred Pharmacy |
|---|---|---|
| Tier 1 | $0 | $15 |
| Tier 2 | $10 | $20 |
| Tier 3 | $47 | $47 |
| Tier 4 | $100 | $100 |
| Tier 5 | 29% | 29% |
CMS Star Ratings for Aetna Medicare Essential Plan (PPO) H5521
| 2021 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 | ||
| Monitoring Physical Activity |
Managing Chronic And Long Term Care for Older Adults
| Total Rating | ||
|---|---|---|
| SNP Care Management | ||
| Medication Review | ||
| Functional Status Assessment | ||
| 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 | ||
| Getting Appointments | ||
| Customer Service | ||
| Health Care Quality | ||
| Rating of Health Plan | ||
| Care Coordination |
Member Complaints and Changes in Aetna Medicare Essential Plan (PPO) Plans Performance
| Total Rating | ||
|---|---|---|
| Complaints about Health Plan | ||
| Members Leaving the Plan | ||
| Health Plan Quality Improvement |
Health Plan Customer Service Rating for Aetna Medicare Essential Plan (PPO)
| Total Customer Service Rating | ||
|---|---|---|
| Timely Decisions About Appeals | ||
| Reviewing Appeals Decisions | ||
| Call Center, TTY, Foreign Language |
Aetna Medicare Essential Plan (PPO) Drug Plan Customer Service Ratings
| Total Rating | ||
|---|---|---|
| Call Center, TTY, Foreign Language |
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
| 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 |
Coverage Area for Aetna Medicare Essential Plan (PPO)
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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.