Aetna Medicare Premier (Regional PPO) is a Medicare Advantage (Part C) Plan by Aetna Medicare.
This page features plan details for 2023 Aetna Medicare Premier (Regional PPO) R6694 – 006 – 0 available in New Jersey Counties: All.
IMPORTANT: This page has been updated with plan and premium data for the 2023.
Aetna Medicare Premier (Regional PPO) is offered in the following locations.
Aetna Medicare Premier (Regional PPO) offers the following coverage and cost-sharing.
Insurer: | Aetna Medicare |
Health Plan Deductible: | $1,000 annual deductible |
MOOP: | $11,300 In and Out-of-network $7,550 In-network |
Drugs Covered: | Yes |
Ready to sign up for Aetna Medicare Premier (Regional PPO) ?
Get help from a licensed Medicare agent.
Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.
Part B | Part C | Part D | Part B Give Back | Total |
---|---|---|---|---|
$164.90 | $61.70 | $58.30 | $0.00 | $284.90 |
Aetna Medicare Premier (Regional PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.
Drug Deductible: | $350.00 |
Initial Coverage Limit: | $4,660.00 |
Catastrophic Coverage Limit: | $7,400.00 |
Drug Benefit Type: | Enhanced |
Gap Coverage: | Yes |
Formulary Link: | Formulary Link |
Part D | LIS 25% | LIS 50% | LIS 75% | LIS Full |
---|---|---|---|---|
$58.30 | $49.50 | $40.80 | $32.00 | $23.30 |
After you pay your $350.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00. Once you reach that amount, you will enter the next coverage phase.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $15.00 copay | $0.00 copay | $15.00 copay |
2 (Generic) | $10.00 copay | $20.00 copay | $10.00 copay | $20.00 copay |
3 (Preferred Brand) | $47.00 copay | $47.00 copay | $47.00 copay | $47.00 copay |
4 (Non-Preferred Drug) | $100.00 copay | $100.00 copay | $100.00 copay | $100.00 copay |
5 (Specialty Tier) | 27% | 27% | 27% | 27% |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | ||||
2 (Generic) | ||||
3 (Preferred Brand) | ||||
4 (Non-Preferred Drug) | ||||
5 (Specialty Tier) |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $45.00 copay | $0.00 copay | $45.00 copay |
2 (Generic) | $20.00 copay | $60.00 copay | $20.00 copay | $60.00 copay |
3 (Preferred Brand) | $141.00 copay | $141.00 copay | $141.00 copay | $141.00 copay |
4 (Non-Preferred Drug) | $300.00 copay | $300.00 copay | $300.00 copay | $300.00 copay |
5 (Specialty Tier) |
After your total drug costs (including what this plan has paid and what you have paid) reach $4,660.00, you will pay no more than the amounts below for any drug tier until you reach $7,400.00.
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $15.00 copay | $0.00 copay | $15.00 copay |
2 (Generic) | $10.00 copay | $20.00 copay | $10.00 copay | $20.00 copay |
Tier | Pref. Pharm | Std. Pharm | Pref. Mail | Std. Mail |
---|---|---|---|---|
1 (Preferred Generic) | $0.00 copay | $45.00 copay | $0.00 copay | $45.00 copay |
2 (Generic) | $20.00 copay | $60.00 copay | $20.00 copay | $60.00 copay |
Tier | Cost |
---|---|
All other tiers (Generic) | 25% |
All other tiers (Brand-name) | 25% |
After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $7,400.00, you will pay no more than the greater of the two amounts listed below for generic and brand-name drugs.
Drug Type | Cost Share |
---|---|
Generic drugs | $4.15 copay or 5% (whichever costs more) |
Brand-name drugs | $10.35 copay or 5% (whichever costs more) |
Aetna Medicare Premier (Regional PPO) also provides the following benefits.
In-Network: No |
Diagnostic services: | Not covered (no limits) |
Endodontics: | Not covered (no limits) |
Extractions: | Not covered (no limits) |
Non-routine services: | Not covered (no limits) |
Periodontics: | Not covered (no limits) |
Prosthodontics, other oral/maxillofacial surgery, other services: | Not covered (no limits) |
Restorative services: | Not covered (no limits) |
Cleaning: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Cleaning: | Out-of-Network: 30% coinsurance (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Dental x-ray(s): | Out-of-Network: 30% coinsurance (limits may apply) (authorization not required) (referral not required) |
Fluoride treatment: | Not covered (no limits) |
Oral exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Oral exam: | Out-of-Network: 30% coinsurance (limits may apply) (authorization not required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | In-Network: $0-300 copay (authorization required) (referral not required) |
Diagnostic radiology services (e.g., MRI): | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Diagnostic tests and procedures: | In-Network: $0-50 copay (authorization required) (referral not required) |
Diagnostic tests and procedures: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Lab services: | In-Network: $0 copay (authorization required) (referral not required) |
Lab services: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Outpatient x-rays: | In-Network: $50 copay (authorization required) (referral not required) |
Outpatient x-rays: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Primary: | In-Network: $15 copay per visit |
Primary: | Out-of-Network: 30% coinsurance per visit |
Specialist: | In-Network: $50 copay per visit (authorization not required) (referral not required) |
Specialist: | Out-of-Network: 30% coinsurance per visit (authorization not required) (referral not required) |
Emergency: | $95 copay per visit (always covered) |
Urgent care: | $60 copay per visit (always covered) |
Foot exams and treatment: | In-Network: $50 copay (authorization not required) (referral not required) |
Foot exams and treatment: | Out-of-Network: 30% coinsurance (authorization not required) (referral not required) |
Routine foot care: | Not covered |
In-Network: $300 copay | |
Out-of-Network: $300 copay |
$1,000 annual deductible |
In-Network: No |
Fitting/evaluation: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Fitting/evaluation: | Out-of-Network: 30% coinsurance (limits may apply) (authorization not required) (referral not required) |
Hearing aids: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Hearing aids: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Hearing exam: | In-Network: $50 copay (authorization not required) (referral not required) |
Hearing exam: | Out-of-Network: 30% coinsurance (authorization not required) (referral not required) |
In-Network: $335 per day for days 1 through 6 $0 per day for days 7 through 90 (authorization required) (referral not required) | |
Out-of-Network: 30% per stay (authorization required) (referral not required) |
In-Network: $0-375 copay per visit (authorization required) (referral not required) | |
Out-of-Network: 30% coinsurance per visit (authorization required) (referral not required) |
$11,300 In and Out-of-network $7,550 In-network |
Diabetes supplies: | In-Network: 0-20% coinsurance per item (authorization required) |
Diabetes supplies: | Out-of-Network: 0-20% coinsurance per item (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | In-Network: 0-20% coinsurance per item (authorization required) |
Durable medical equipment (e.g., wheelchairs, oxygen): | Out-of-Network: 30% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | In-Network: 20% coinsurance per item (authorization required) |
Prosthetics (e.g., braces, artificial limbs): | Out-of-Network: 30% coinsurance per item (authorization required) |
Chemotherapy: | In-Network: 20% coinsurance (authorization required) |
Chemotherapy: | Out-of-Network: 30% coinsurance (authorization required) |
Other Part B drugs: | In-Network: 20% coinsurance (authorization required) |
Other Part B drugs: | Out-of-Network: 30% coinsurance (authorization required) |
Inpatient hospital – psychiatric: | In-Network: $374 per day for days 1 through 5 $0 per day for days 6 through 90 (authorization required) (referral not required) |
Inpatient hospital – psychiatric: | Out-of-Network: 30% per stay (authorization required) (referral not required) |
Outpatient group therapy visit: | In-Network: $40 copay (authorization required) (referral not required) |
Outpatient group therapy visit: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | In-Network: $40 copay (authorization required) (referral not required) |
Outpatient group therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Outpatient individual therapy visit: | In-Network: $40 copay (authorization required) (referral not required) |
Outpatient individual therapy visit: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | In-Network: $40 copay (authorization required) (referral not required) |
Outpatient individual therapy visit with a psychiatrist: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Yes |
In-Network: $0 copay (authorization not required) (referral not required) | |
Out-of-Network: 0-30% coinsurance (authorization not required) (referral not required) |
Occupational therapy visit: | In-Network: $40 copay (authorization required) (referral not required) |
Occupational therapy visit: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
Physical therapy and speech and language therapy visit: | In-Network: $40 copay (authorization required) (referral not required) |
Physical therapy and speech and language therapy visit: | Out-of-Network: 30% coinsurance (authorization required) (referral not required) |
In-Network: $0 per day for days 1 through 20 $196 per day for days 21 through 100 (authorization required) (referral not required) | |
Out-of-Network: 30% per stay (authorization required) (referral not required) |
Not covered |
Contact lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Contact lenses: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass frames: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass frames: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass lenses: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglass lenses: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglasses (frames and lenses): | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Eyeglasses (frames and lenses): | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Other: | In-Network: $0 copay (no limits) (authorization not required) (referral not required) |
Other: | Out-of-Network: 30% coinsurance (no limits) (authorization not required) (referral not required) |
Routine eye exam: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Routine eye exam: | Out-of-Network: 30% coinsurance (limits may apply) (authorization not required) (referral not required) |
Upgrades: | In-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Upgrades: | Out-of-Network: $0 copay (limits may apply) (authorization not required) (referral not required) |
Covered (authorization not required) (referral not required) |
Comprehensive dental: | Monthly Premium: | $10.00 |
Comprehensive dental: | Deductible: | N/A |
Ready to sign up for Aetna Medicare Premier (Regional PPO) ?
Get help from a licensed Medicare agent.
Click to Call 1-877-354-4611 TTY 711. Mon-Fri 8am-9pm EST | Sat 8am-8pm EST.
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