Council on Aging Answers 2016 - 104

COUNCIL ON AGING - ORANGE COUNTY

Medicare Advantage Plans Comparison Chart
AETNA MEDICARE

AETNA MEDICARE

Aetna Medicare Connect Plus
In-Network
H5521-052

Aetna Medicare Connect Plus
Out-of-Network
H5521-052

Aetna Medicare Choice Plan
In-Network
H5521-056

TELEPHONE NUMBERS AND WEBSITE

New enrollment: 855-338-7027
Current Members: 800-282-5366
aetnamedicare.com

PLAN TYPE

MA-PD (PPO)

$188 monthly premium deductibles for some
hospital and medical services

$188 monthly premium
$500 health plan deductible

$107 monthly premium
$750 health plan deductible
$150 drug plan deductible

SIZE OF NETWORK

251-500 providers

OUT OF POCKET MAXIMUM

$4,500 In-Network
$7,500 In & Out

$6,700 In-Network
$10,000 In & Out

DOCTOR/SPECIALIST VISIT

$0/$15 each visit

20%/20% of cost each visit

$10/$40 each visit

INPATIENT HOSPITALIZATION

Days 1-4: $200/day, Days 5-90:
20% of cost per stay. Unlimited days each benefit Days 1-6: $250/day, Days 7-90:
$0/day. $0/day after 90 days. Unlimited days each period.
$0/day. $0/day after 90 days. Unlimited days each
benefit period.
benefit period.

SKILLED NURSING FACILITY

Days 1-20: $0/day, Days 21100: $75/day. 100 days each benefit period.

20% of cost per stay. 100 days each benefit
period.

Days 1-20: $0/day, Days 21100: $160/day. 100 days each benefit period.

AMBULANCE

$100 each service

$300 each service

CHEMOTHERAPY DRUGS

20% of cost for Part B chemotherapy drugs

CHIROPRACTIC

$15 for subluxation manipulation

20% of cost for subluxation manipulation

$20 for subluxation manipulation

DIABETES

0-20% of cost for monitoring supplies. $0 for
self- management training. $0 for therapeutic
shoes or inserts.

20% of cost for monitoring supplies. 20% of cost
for self- management training. 20% of cost for
therapeutic shoes or inserts.

0-20% of cost for monitoring supplies. $0 for
self- management training. $0 for therapeutic
shoes or inserts.

$125 for diagnostic radiology services. $0 for
diagnostic tests and procedures. $0 for lab
services. $15 each x-ray. 20% of cost for
therapeutic radiology services.

20% of cost for diagnostic radiology services. 20%
of cost for diagnostic tests and procedures. 20%
of cost for lab services. 20% of cost each x-ray.
20% of cost for therapeutic radiology services.

20% of cost for diagnostic radiology services. $40
for diagnostic tests and procedures.
$40 for lab services. $40 each x- ray. 20% of cost
for therapeutic radiology services.

EMERGENCY ROOM VISIT

$75 each visit, waived if admitted within 24
hours.

$75 each visit, waived if admitted immediately.

OUTPATIENT HOSPITAL SERVICES

$15-$150 each visit

20% of cost each visit

$40-$250 each visit

$15 each visit

20% of cost each visit

$40 each visit

Not covered

$15 for limited dental. $0 for cleaning. $0 for
x-rays. $0 for oral exam. Plan pays up to $150 for
preventive dental services from any provider.

20% of cost for limited dental.
$0 for cleaning. $0 for x-rays. $0 for oral exam.
Plan pays up to $150 for preventive dental
services from any provider.

$40 for limited dental

$15 for diagnostic exam. $0 for routine hearing
exam. $0 for hearing aid fitting or evaluation.
$0 for hearing aid. Plan pays up to $500 for
hearing aids from any provider.

20% of cost for diagnostic exam. 20% of cost for $40 for diagnostic exam. $0 for routine hearing
routine hearing exam. 20% of cost for hearing aid exam. $40 for hearing aid fitting or evaluation.
fitting or evaluation. $0 for hearing aid. Plan pays
up to $500 for hearing aids from any provider.

$0-$15 for diagnostic exam. $0 for routine eye
exam. $0 for contact lenses. $0 for eyeglasses.
20% of cost for eyewear after cataract surgery.
Plan pays up to $150 for eyewear from any
provider.

20% of cost for diagnostic exam. 20% of cost for $0-$40 for diagnostic exam. $0 for routine eye
routine eye exam. $0 for contact lenses. $0 for
exam. $0 for eyewear after cataract surgery.
eyeglasses. 20% of cost for eyewear after cataract
surgery.
Plan pays up to $150 for eyewear from any
provider.

TOTAL MONTHLY PREMIUM & ANNUAL
DEDUCTIBLES

DIAGNOSTIC TESTS, LAB & RADIOLOGY SERVICES,
AND X-RAYS

OUTPATIENT REHAB SERVICES
TRANSPORTATION

DENTAL SERVICES

HEARING SERVICES

VISION SERVICES

Confused by Medicare? Call the Council on Aging Orange County HICAP experts at (800) 434-0222
104

Answers Guide 2016

THE INFORMATION ON THESE CHARTS IS SUBJECT TO CHANGE. Contact the plan to verify information.

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