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. Applicable plans: Applies to all Aetna plans; self-insured plan sponsors can opt out. Description: Until at least June 4th, 2020, Aetna will waive member cost sharing for any covered telemedicine visits — regardless of diagnosis. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. Aetna members should use telemedicine as their first line of defense in order to limit potential exposure in physician offices. For all Aetna plans offering Teladoc® coverage, cost sharing will be waived for all Teladoc® virtual visits. Cost sharing will also be waived for real-time virtual visits offered by in-network providers (live video. Aetna’s liberalized coverage of Commercial telemedicine services, as described in its telemedicine policy, will continue until further notice. 5 All member cost-sharing waivers for covered in-network telemedicine visits for outpatient behavioral and mental health counseling services for Commercial plans are active until January 31, 2021. 6 Aetna self-insured plan sponsors offer this waiver.
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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.
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2021 Aetna Medicare Medicare Advantage Plan Costs
| Name: |
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| Plan ID: | H3152-082 |
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| Provider: | Aetna Medicare |
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| Year: | 2021 |
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| Type: | Local HMO |
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| Monthly Premium C+D: | $0 |
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| Part C Premium: | $0 |
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| MOOP: | $7,550 |
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| Part D (Drug) Premium: | $0 |
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| Part D Supplemental Premium | $0 |
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| Total Part D Premium: | $0 |
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| Drug Deductible: | $195.0 |
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| Tiers with No Deductible: | 1 |
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| Gap Coverage: | Yes |
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| Benchmark: | not below the regional benchmark |
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| Type of Medicare Health: | Enhanced Alternative |
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| Drug Benefit Type: | Enhanced |
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| Similar Plan: | H3152-084 |
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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
Comprehensive Dental
| Diagnostic services | Not covered |
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| Endodontics | Not covered |
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| Extractions | Not covered |
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| Non-routine services | Not covered |
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| Periodontics | Not covered |
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| Prosthodontics, other oral/maxillofacial surgery, other services | Not covered |
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| Restorative services | Not covered |
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Deductible
Diagnostic Tests and Procedures
| Diagnostic radiology services (e.g., MRI) | $0-300 copay |
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| Diagnostic tests and procedures | $0-50 copay |
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| Lab services | $0 copay |
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| Outpatient x-rays | $50 copay |
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Doctor Visits
| Primary | $25 copay per visit |
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| Specialist | $50 copay per visit |
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Emergency care/Urgent Care
| Emergency | $90 copay per visit (always covered) |
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| Urgent care | $65 copay per visit (always covered) |
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Foot Care (podiatry services)
| Foot exams and treatment | $50 copay |
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| Routine foot care | Not covered |
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Ground Ambulance
Hearing
| Fitting/evaluation | $0 copay |
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| Hearing aids | $0 copay |
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| Hearing exam | $50 copay |
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Inpatient Hospital Coverage
$395 per day for days 1 through 5
$0 per day for days 6 through 90 |
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Medical Equipment/Supplies
| Diabetes supplies | 0-20% coinsurance per item |
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| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item |
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| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item |
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Medicare Part B Drugs
| Chemotherapy | 20% coinsurance |
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| Other Part B drugs | 20% coinsurance |
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Mental Health Services
| Inpatient hospital - psychiatric | $1,871 per stay |
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| Outpatient group therapy visit | $40 copay |
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| Outpatient group therapy visit with a psychiatrist | $40 copay |
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| Outpatient individual therapy visit | $40 copay |
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| Outpatient individual therapy visit with a psychiatrist | $40 copay |
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MOOP
Option
Optional supplemental benefits
Outpatient Hospital Coverage
Package #1
| Deductible | $50.00 |
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| Monthly Premium | $19.00 |
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Preventive Care
Preventive Dental
| Cleaning | $0 copay |
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| Dental x-ray(s) | $0 copay |
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| Fluoride treatment | Not covered |
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| Oral exam | $0 copay |
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Rehabilitation Services
| Occupational therapy visit | $40 copay |
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| Physical therapy and speech and language therapy visit | $40 copay |
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Skilled Nursing Facility
$0 per day for days 1 through 20
$184 per day for days 21 through 100 |
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Transportation
Vision
| Contact lenses | $0 copay |
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| Eyeglass frames | $0 copay |
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| Eyeglass lenses | $0 copay |
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| Eyeglasses (frames and lenses) | $0 copay |
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| Other | $50 copay |
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| Routine eye exam | $0 copay |
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| Upgrades | $0 copay |
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Copays For Telemedicine
Wellness Programs (e.g. fitness nursing hotline)
Reviews for Aetna Medicare Explorer Value (HMO) H3152
| 2019 Overall Rating |
|---|
| Part C Summary Rating |
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| 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 |
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| Complaints and Changes in the Drug Plan |
|---|
| Member Experience with the Drug Plan |
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| 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 |
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| Improving Mental Health |
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| Monitoring Physical Activity |
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| Adult BMI Assessment |
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Managing Chronic And Long Term Care for Older Adults
| Total Rating |
|---|
| SNP Care Management |
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| Medication Review |
|---|
| Functional Status Assessment |
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| Pain Screening |
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| Osteoporosis Management |
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| Diabetes Care - Eye Exam |
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| Diabetes Care - Kidney Disease |
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| Diabetes Care - Blood Sugar |
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| Rheumatoid Arthritis |
|---|
| Reducing Risk of Falling |
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| Improving Bladder Control |
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| Medication Reconciliation |
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| Statin Therapy |
|---|
Aetna Telehealth Copay
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 Explorer Value (HMO) 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 Explorer Value (HMO)
| Total Customer Service Rating |
|---|
| Reviewing Appeals Decisions |
|---|
| Call Center, TTY, Foreign Language |
|---|
Aetna Medicare Explorer Value (HMO) Drug Plan Customer Service Ratings
| Total Rating |
|---|
| Call Center, TTY, Foreign Language |
|---|
| Appeals Auto |
|---|
| Appeals Upheld |
|---|
Is There A Copay For Telemedicine
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 |
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Drug Safety and Accuracy of Drug Pricing
| Total Rating |
|---|
| MPF Price Accuracy |
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| Drug Adherence for Diabetes Medications |
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| Drug Adherence for Hypertension (RAS antagonists) |
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| Drug Adherence for Cholesterol (Statins) |
|---|
| MTM Program Completion Rate for CMR |
|---|
| Statin with Diabetes |
|---|
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Sun 9am-6pm EST
Coverage Area for Aetna Medicare Explorer Value (HMO)
(Click county to compare all available Advantage plans)
| State: | New Jersey
|
|---|
| County: | Atlantic,Burlington,Camden,Cape May,Cumberland,
Gloucester,Middlesex,Monmouth,Ocean,
Salem, |
|---|
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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.
CVS Health said March 6 it is making diagnostic testing and telemedicine visits available with no copay for Aetna members to help reduce the spread of the novel coronavirus.
The company said it will waive copays for all diagnostic testing related to COVID-19, the disease caused by the new coronavirus, for those who meet CDC guidelines for testing.
For the next 90 days, Aetna is offering zero copays for telemedicine visits for any reason as a way to limit potential exposure to the coronavirus in physician offices. It will apply to all video visits made through the CVS Minuteclinic app, Aetna-covered Teladoc visits and in-network providers offering video visits.
Aetna members diagnosed with COVID-19 will be sent a care package containing over-the-counter drugs to help relieve symptoms and personal and household cleaning supplies to help keep others in the home protected from exposure.
Aetna also said it will reach out to its members that are most at-risk for COVID-19 and walk them through what they should do to protect themselves, where to get information and where to get tested.
Read the full news release here.
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