FALLON HAS A NEW MEDICARE PLAN
and it is accepted at Banner Health…
AETNA 2020 PLAN GUIDE – FALLON, NEVADA
Below are some of the in-network costs and benefit information for Aetna Medicare plans in Fallon, NV. But it’s not a complete list. For more information about these plans, refer to the Summary of Benefits, visit https://www.aetnamedicare.com or call us at 1-888-333-5853 (TTY: 711).
| BENEFITS LISTED ARE FOR SERVICES RECEIVED IN-NETWORK AND PER VISIT UNLESS OTHERWISE STATED | AETNA MEDICARE PREMIER PLAN (HMO) H4711-005 | AETNA MEDICARE CHOICE PLAN (PPO) H5521-055 | AETNA MEDICARE SELECT PLAN (PPO) H5521-022 |
|---|---|---|---|
| SERVICE AREA | NV: CARSON CITY, CHURCHILL, DOUGLAS, STOREY, WASHOE | NV: CARSON CITY, CHURCHILL, CLARK, DOUGLAS, NYE, STOREY, WASHOE | NV: CARSON CITY, CHURCHILL, CLARK, DOUGLAS, NYE, STOREY, WASHOE |
| MONTHLY PLAN PREMIUM IN ADDITION TO PART B PREMIUM | $0 | $0 | $73 |
| PCP REFERRALS REQUIRED | YES | N/A | N/A |
| ANNUAL MAXIMUM OUT-OF-POCKET (MOOP)MAXIMUM AMOUNT YOU WILL PAY FOR IN-NETWORK SERVICES. | $3,900 | $6,700 | $5,500 |
| ANNUAL DEDUCTIBLE FOR MEDICAL SERVICES | $0 | $500 deductible for some hospital and medical services. The deductible applies to out-of-network services only. (See Summary of Benefits or Evidence of Coverage for more information). | $0 |
| PRIMARY CARE PHYSICIAN (PCP) | $0 | $10 | $0 |
| SPECIALIST | $35 | $40 | $35 |
| INPATIENT HOSPITAL | $275 per day, days 1-6; $0 per day, days 7-90 $0 copay for additional days Plan covers unlimited hospital days. | $350 per day, days 1-5; $0 per day, days 6-90 $0 copay for additional days Plan covers unlimited hospital days. | $325 per day, days 1-5; $0 per day, days 6-90 $0 copay for additional days Plan covers unlimited hospital days. |
| OUTPATIENT HOSPITAL OBSERVATION SERVICES | $300 | $295 | $260 |
| OUTPATIENT SURGERY – OUTPATIENT HOSPITAL: SURGICAL SERVICES YOU GET FROM A HOSPITAL. | $300 | $295 | $260 |
| OUTPATIENT SURGERY – AMBULATORY SURGERY CENTER (ASC): CARE FROM STANDALONE SURGERY FACILITIES. | $250 | $295 | $260 |
| X-RAYS AND DIAGNOSTIC RADIOLOGY | X-Rays $10Diagnostic Radiology $0 – $125 Lower cost sharing applies to services performed in the member’s primary care physician’s office. Higher cost sharing applies to services provided in any other location. | X-Rays $20Diagnostic Radiology $10 – $295 Lower cost sharing applies to services performed in the member’s primary care physician’s office. Higher cost sharing applies to services provided in any other location. | X-Rays $15Diagnostic Radiology $0 – $225 Lower cost sharing applies to services performed in the member’s primary care physician’s office. Higher cost sharing applies to services provided in any other location. |
| LAB SERVICES | $0 | $0 | $0 |
| URGENT CARE FACILITY | $50 | $50 | $50 |
| EMERGENCY ROOM | $90 | $90 | $90 |
| WORLDWIDE COVERAGE (I.E. OUTSIDE OF THE UNITED STATES) | $90 for emergency and urgent care worldwide | $90 for emergency and urgent care worldwide | $90 for emergency and urgent care worldwide |
| VISION SERVICES – ROUTINE EYE EXAMS | $0 (one exam every year) | $0 (one exam every year) | $0 (one exam every year) |
| VISION SERVICES – CONTACTS AND EYEGLASSES AND UPGRADES | $125 allowance* every year No network; member reimbursement | $150 allowance* every year No network; member reimbursement | $150 allowance* every year No network; member reimbursement |
| PREVENTIVE DENTAL SERVICES | $300 allowance* every year for preventive and comprehensive dental combined (See the Evidence of Coverage for details.) | $250 allowance* every year for preventive and comprehensive dental combined (See the Evidence of Coverage for details.) | $750 allowance* every year for preventive and comprehensive dental combined (See the Evidence of Coverage for details.) |
| COMPREHENSIVE DENTAL SERVICES (NON-MEDICARE COVERED) | Allowance* included under preventive dental | Allowance* included under preventive dental | Allowance* included under preventive dental |
| DENTAL NETWORK | No network; member reimbursement | No network; member reimbursement | No network; member reimbursement |
| HEARING SERVICES – HEARING AIDS | $1,000 (per ear) maximum benefit every year HCS network All hearing aids must be purchased through Hearing Care Solutions. | $1,000 (per ear) maximum benefit every year HCS network All hearing aids must be purchased through Hearing Care Solutions. | $1,250 (per ear) maximum benefit every year HCS network All hearing aids must be purchased through Hearing Care Solutions. |
| HEARING SERVICES – ROUTINE HEARING EXAMS | $0 (one exam every year) All appointments must be scheduled through Hearing Care Solutions. | $0 (one exam every year) All appointments must be scheduled through Hearing Care Solutions. | $0 (one exam every year) All appointments must be scheduled through Hearing Care Solutions. |
* allowance – member pays the provider and we pay member back. Plan coverage rules apply.
ADDITIONAL PLAN INFORMATION:
| BENEFITS | AETNA MEDICARE PREMIER PLAN (HMO) H4711-005 | AETNA MEDICARE CHOICE PLAN (PPO) H5521-055 | AETNA MEDICARE SELECT PLAN (PPO) H5521-022 |
|---|---|---|---|
| ADDITIONAL RESOURCES AND SUPPORT | Resources for Living (SM) helps connect you to resources in your community such as senior housing, adult daycare, meal subsidies, community activities and more. | Resources for Living (SM) helps connect you to resources in your community such as senior housing, adult daycare, meal subsidies, community activities and more. | Resources for Living (SM) helps connect you to resources in your community such as senior housing, adult daycare, meal subsidies, community activities and more. |
| VISITOR/TRAVELER PROGRAM | N/A | Explorer: See an Aetna participating provider anywhere in the United States and pay in-network cost sharing. | Explorer: See an Aetna participating provider anywhere in the United States and pay in-network cost sharing. |
| FITNESS BENEFIT | SilverSneakers | SilverSneakers | SilverSneakers |
| POST-HOSPITAL MEALS | Our plan covers up to 14 home delivered meals over a 7 day period after an inpatient hospital discharge. | Our plan covers up to 14 home delivered meals over a 7 day period after an inpatient hospital discharge. | Our plan covers up to 14 home delivered meals over a 7 day period after an inpatient hospital discharge. |
| OVER-THE-COUNTER ITEMS (OTC) | $75 maximum benefit every three months | $30 maximum benefit every three months | $75 maximum benefit every three months |
PRESCRIPTION DRUGS
| BENEFITS | AETNA MEDICARE PREMIER PLAN (HMO) H4711-005 PREFERRED/STANDARD | AETNA MEDICARE CHOICE PLAN (PPO) H5521-055 PREFERRED/STANDARD | AETNA MEDICARE SELECT PLAN (PPO) H5521-022 PREFERRED/STANDARD |
|---|---|---|---|
| GAP COVERAGE | Yes Tier 1 & 2 | Yes Tier 1 & 2 | Yes Tier 1 & 2 |
| RX DEDUCTIBLE | $0 | $250 Deductible does not apply to Tier 1, Tier 2 drugs. | $0 |
| TIER 1 DRUGS: RETAIL PHARMACY: 30 DAY SUPPLY RETAIL PHARMACY: 90 DAY SUPPLY MAIL ORDER: 90 DAY SUPPLY | $0/$15 $0/$45 $0/$45 | $0/$15 $0/$45 $0/$45 | $0/$15 $0/$45 $0/$45 |
| TIER 2 DRUGS: RETAIL PHARMACY: 30 DAY SUPPLY RETAIL PHARMACY: 90 DAY SUPPLY MAIL ORDER: 90 DAY SUPPLY | $0/$20 $0/$60 $0/$60 | $5/$20 $15/$60 $15/$60 | $10/$20 $25/$60 $25/$60 |
| TIER 3 DRUGS: RETAIL PHARMACY: 30 DAY SUPPLY RETAIL PHARMACY: 90 DAY SUPPLY MAIL ORDER: 90 DAY SUPPLY | $47/$47 $141/$141 $141/$141 | $47/$47 $141/$141 $141/$141 | $47/$47 $141/$141 $141/$141 |
| TIER 4 DRUGS: RETAIL PHARMACY: 30 DAY SUPPLY RETAIL PHARMACY: 90 DAY SUPPLY MAIL ORDER: 90 DAY SUPPLY | $100/$100 $300/$300 $300/$300 | $100/$100 $300/$300 $300/$300 | $100/$100 $300/$300 $300/$300 |
| TIER 5 DRUGS: RETAIL PHARMACY: 30 DAY SUPPLY RETAIL PHARMACY: 90 DAY SUPPLY MAIL ORDER: 90 DAY SUPPLY | 33%/33% N/A N/A | 28%/28% N/A N/A | 28%/28% N/A N/A |
AETNA MEDICARE ADVANTAGE PLANS INCLUDE BANNER HEALTH
Beginning on January 1, 2020, Aetna will offer three new Medicare Advantage plans to people with Medicare in Churchill County. People with Medicare Part A and Part B are eligible to join one of the three plans. All three plans use Aetna’s vast network of doctors, specialists, and hospitals including Banner Health. The plans all include Prescription Drug Coverage (Part D) at no additional cost.
If you have Medicare Parts A&B and you have been paying for a Medicare Supplement and/or a Prescription Drug Plan (Part D), you may want to consider the benefits of an Aetna Medicare Plan.
You must enroll during the Annual Election Period (AEP) between October 15th and December 7th if you want your plan to start on January 1, 2020.
Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company, Coventry Health and Life Insruance Company and their affiliates (Aetna). Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Members who get “extra help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. ATTENTION: if you speak Spanish, language assistance services, free of charge, are available to you. Call 1-888-333-5853 (TTY: 711). ATENĆION: si habla español, tiene a su disposición servicios gratuitos de asistencia lingüística. Llama al 1-833-333-5853 (TTY: 711). Members in our HMO POS/PPO plans can go to doctors, specialists or hospitals in- or out-of-network. With the exception of emergency or urgentc care, it may cost more to get care from out-of-network providers. Out-of-network/non-contractedproviders are under no obligation to treat Aetna members, except in emergency situations. Please call our custsomer service nuber or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Participation physicians, hostpitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provicer network compusition is subject to change.
