2022 Aetna Medicare Value Plan (PPO)

Aetna Medicare Value Plan (PPO) H5521-085 is a 2022 Medicare Advantage Plan or Part-C by Aetna Medicare available to residents in Kentucky. This plan includes additional prescription drug (Part-D) coverage. The Aetna Medicare Value Plan (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be a extremely nice safety net.

Aetna Medicare Value 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 Value 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.

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2022 Aetna Medicare Medicare Advantage Plan Costs

Aetna Medicare Value 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.

H5521-085 Part-D Deductible and Premium

Aetna Medicare Value Plan (PPO) has a monthly drug premium of $0.00 and a $0.00 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.

H5521-085 Formulary or Drug Coverage

Aetna Medicare Value 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 Value Plan (PPO) H5521-085 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	$0	$15
Tier 2	$5	$20
Tier 3	$47	$47
Tier 4	$100	$100
Tier 5	33%	33%

*Initial Coverage Phase and 30 day supply

2021 Aetna Medicare Value Plan (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	70% coinsurance (Out-of-Network)
Endodontics	50% coinsurance
Extractions	70% coinsurance (Out-of-Network)
Extractions	50% coinsurance
Non-routine services	70% coinsurance (Out-of-Network)
Non-routine services	50% coinsurance
Periodontics	50% coinsurance
Periodontics	70% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	70% coinsurance (Out-of-Network)
Restorative services	50% coinsurance

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Deductible

$650 annual deductible

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	50% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$0-250 copay
Diagnostic tests and procedures	$0-50 copay
Diagnostic tests and procedures	50% coinsurance (Out-of-Network)
Lab services	$0-25 copay
Lab services	50% coinsurance (Out-of-Network)
Outpatient x-rays	50% coinsurance (Out-of-Network)
Outpatient x-rays	$10-110 copay

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Doctor Visits

Primary	50% coinsurance per visit (Out-of-Network)
Primary	$10 copay per visit
Specialist	50% coinsurance per visit (Out-of-Network)
Specialist	$45 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$10-45 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$45 copay
Foot exams and treatment	50% coinsurance (Out-of-Network)
Routine foot care	$45 copay
Routine foot care	50% coinsurance (Out-of-Network)

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Ground Ambulance

$250 copay (Out-of-Network)
$250 copay

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Hearing

Fitting/evaluation	50% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	50% coinsurance (Out-of-Network)
Hearing exam	$45 copay

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Inpatient Hospital Coverage

$375 per day for days 1 through 5 $0 per day for days 6 through 90
50% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item (Out-of-Network)
Diabetes supplies	0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	50% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	50% coinsurance (Out-of-Network)
Other Part B drugs	50% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	50% per stay (Out-of-Network)
Inpatient hospital - psychiatric	$375 per day for days 1 through 4 $0 per day for days 5 through 90
Outpatient group therapy visit	50% 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	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	50% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	50% coinsurance (Out-of-Network)

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MOOP

$11,300 In and Out-of-network $7,000 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$0-275 copay per visit
50% coinsurance per visit (Out-of-Network)

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Preventive Care

0-50% coinsurance (Out-of-Network)
$0 copay

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Preventive Dental

Cleaning	30% coinsurance (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Dental x-ray(s)	30% coinsurance (Out-of-Network)
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	30% coinsurance (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	$40 copay
Occupational therapy visit	50% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$40 copay
Physical therapy and speech and language therapy visit	50% coinsurance (Out-of-Network)

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Skilled Nursing Facility

50% per stay (Out-of-Network)
$0 per day for days 1 through 20 $184 per day for days 21 through 100

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Transportation

$0 copay
$0 copay (Out-of-Network)

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Vision

Contact lenses	$0 copay (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	$45 copay
Other	50% coinsurance (Out-of-Network)
Routine eye exam	50% coinsurance (Out-of-Network)
Routine eye exam	$0 copay
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for Aetna Medicare Value Plan (PPO) H5521

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 Value Plan (PPO) Plans Performance

Health Plan Customer Service Rating for Aetna Medicare Value Plan (PPO)

Aetna Medicare Value Plan (PPO) 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

Ready to Enroll?

Click Here

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

Coverage Area for Aetna Medicare Value 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.