Aetna Medicare Eagle (HMO)
H0628 - 014 - 0
(4 / 5)
Aetna Medicare Eagle (HMO) is a Medicare Advantage (Part C) Plan by Aetna Medicare.
This page features plan details for 2024 Aetna Medicare Eagle (HMO) H0628 – 014 – 0 available in Select Counties in KY.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
Aetna Medicare Eagle (HMO) is offered in the following locations.
Plan Overview
Aetna Medicare Eagle (HMO) offers the following coverage and cost-sharing.
| Insurer: | Aetna Medicare |
| Health Plan Deductible: | $0.00 |
| MOOP: | $4,900 In-network |
| Drugs Covered: | No |
Ready to sign up for Aetna Medicare Eagle (HMO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
Aetna Medicare Eagle (HMO) qualifies for a monthly Medicare Give Back Benefit of $50.00.
| Premium Reduction: | $50.00 |
Premium Breakdown
Aetna Medicare Eagle (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $50.00 | $124.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
Aetna Medicare Eagle (HMO) also provides the following benefits.
| $0 |
| In-network | No |
| $4,900 In-network |
| No |
| In-network | No |
| $0-250 copay per visit (Authorization is required.) (Referral is not required.) |
| Primary | $0 copay (Not applicable.) (Not applicable.) |
| Specialist | $35 copay per visit (Authorization is not required.) (Referral is not required.) |
| $0 copay (Authorization is not required.) (Referral is not required.) |
| Emergency | $90 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $45 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Diagnostic tests and procedures | $0-100 copay (Authorization is required.) (Referral is not required.) |
| Lab services | $0 copay (Authorization is required.) (Referral is not required.) |
| Diagnostic radiology services (e.g., MRI) | $0-250 copay (Authorization is required.) (Referral is not required.) |
| Outpatient x-rays | $10-90 copay (Authorization is required.) (Referral is not required.) |
| Hearing exam | $35 copay (Authorization is not required.) (Referral is not required.) |
| Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Hearing aids | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Office visit | $0.00 (Authorization is not required.) (Referral is not required.) |
| Oral exam | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | 20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Diagnostic services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Restorative services | 20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Endodontics | 20% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Periodontics | 20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Extractions | 20-50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Prosthodontics, other oral/maxillofacial surgery, other services | 50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | $0 copay (There are no limits.) (Authorization is not required.) (Referral is not required.) |
| Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Occupational therapy visit | $25 copay (Authorization is not required.) (Referral is not required.) |
| Physical therapy and speech and language therapy visit | $25 copay (Authorization is not required.) (Referral is not required.) |
| $240 copay (Not applicable.) (Not applicable.) |
| $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Foot exams and treatment | $35 copay (Authorization is not required.) (Referral is not required.) |
| Routine foot care | $35 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Durable medical equipment (e.g., wheelchairs, oxygen) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Diabetes supplies | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Other Part B drugs | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| Part B Insulin drugs | $35 copay (Authorization is required.) (Not applicable.) |
| $250 per day for days 1 through 8 $0 per day for days 9 through 90 (Authorization is required.) (Referral is not required.) |
| Inpatient hospital – psychiatric | $250 per day for days 1 through 7 $0 per day for days 8 through 90 (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit with a psychiatrist | $25 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit with a psychiatrist | $25 copay (Authorization is required.) (Referral is not required.) |
| Outpatient group therapy visit | $25 copay (Authorization is required.) (Referral is not required.) |
| Outpatient individual therapy visit | $25 copay (Authorization is required.) (Referral is not required.) |
| $0 per day for days 1 through 20 $196 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
Ready to sign up for Aetna Medicare Eagle (HMO) ?
Table of Contents
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