Plan ID: H0628-006

What You Need to Know:

  • Aetna Medicare Premier (HMO) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is .
  • The plan includes an out-of-pocket maximum of $6,100 per year (in-network).
  • Aetna Medicare Premier (HMO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $0.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 $0 $0 $0 $0 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H0628-007
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $6,100
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Campbell, Kentucky: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members New plan - No summary rating as of yet. New plan - not yet rated. New plan - not yet rated.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,780 drugs
Number of Members Enrolled in this Plan in Campbell, Kentucky: 68 members
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $0.00 $0.00 $0.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
337 $2.00 571 $5.00 915 $47.00 1247 $100.00 710 33%

Other Medicare Advantage Plans in Campbell, Kentucky

Plan Name Type Premium MOOP Rx Deduct. Rating
HumanaChoice R0865-001 (Regional PPO) (2023)Regional PPO *$6,200$-
4
CareSource Advantage (HMO) (2023)Local HMO$5,600$75
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CareSource Advantage Zero Premium (HMO) (2023)Local HMO$7,550$150
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Humana Community (HMO) (2023)Local HMO$4,900$0
5
Humana Gold Plus H0292-002 (HMO) (2023)Local HMO$4,200$0
5
WellCare Premier (PPO) (2023)Local PPO$5,500$100
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WellCare Value (HMO) (2023)Local HMO$6,000$0
5
WellCare Elite (HMO) (2023)Local HMO$5,000$0
5
Anthem MediBlue Plus (HMO) (2023)Local HMO$5,300$0
5
WellCare Essential (HMO-POS) (2023)Local HMO$5,000$0
5
WellCare Dividend (HMO) (2023)Local HMO$6,700$0
5
WellCare Compass (HMO) (2023)Local HMO$5,000$445
5
Anthem MediBlue Access Basic (Regional PPO) (2023)Regional PPO$6,400$100
5
Anthem MediBlue Access (PPO) (2023)Local PPO$5,900$0
4
AARP Medicare Advantage Walgreens (PPO) (2023)Local PPO$5,100$250
5
HumanaChoice R0865-003 (Regional PPO) (2023)Regional PPO$6,700$195
4
Anthem MediBlue Access Plus (PPO) (2023)Local PPO$6,400$125
4
Aetna Medicare Premier 2 (PPO) (2023)Local PPO$4,800$0
5
Aetna Medicare Value Plan (PPO) (2023)Local PPO$7,000$150
5
AARP Medicare Advantage Plan 3 (HMO) (2023)Local HMO$3,400$0
5
AARP Medicare Advantage Plan 6 (HMO) (2023)Local HMO$4,900$195
5
Anthem MediBlue Access Core (PPO) (2023)Local PPO *$4,900$-
4
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$4,200$150
5
Humana Gold Plus H6622-021 (HMO) (2023)Local HMO$5,900$0
4
Humana Gold Plus H6622-019 (HMO) (2023)Local HMO$3,900$125
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$4,500$-
5
HumanaChoice H5216-023 (PPO) (2023)Local PPO$6,200$100
4
HumanaChoice H5525-030 (PPO) (2023)Local PPO$3,400$100
4
WellCare Patriot (HMO-POS) (2023)Local HMO *$5,000$-
5
HumanaChoice H5216-109 (PPO) (2023)Local PPO$5,700$150
4
Humana Gold Choice H8145-021 (PFFS) (2023)PFFS$-$360
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-105 (PPO) (2023)Local PPO *$4,500$-
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Medicare Advantage Plans by Aetna Medicare
Aetna Medicare Premier 2 (PPO) (2023)Local PPO$4,800$0
5
Aetna Medicare Value Plan (PPO) (2023)Local PPO$7,000$150
5

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