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Aetna Medicare Dual Select Choice (PPO D-SNP) - H2293-022-000

Plan too new to be measured* for plan year 2024

$31.80

Monthly Premium

Aetna Medicare Dual Select Choice (PPO D-SNP) is a PPO D-SNP Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.

Plan ID: H2293-022-000

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$31.80

Monthly Premium

Georgia Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Georgia Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Enrollment may be limited to certain times of the year. See why you may be able to enroll.

Basic Costs and Coverage

CoverageDetails
Monthly plan premium$31.80
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$0.00
Out-of-pocket maximum$8,850.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$8,000.00
Primary care doctor visit$0
Specialty doctor visit$0 - $15 based on level of Medicaid eligibility. For more information see Evidence of Coverage.
Inpatient hospital care$0 - $373 per day, days 1-6; $0 per day, days 7-90 based on level of Medicaid eligibility. For more information see Evidence of Coverage.
Urgent care
Urgent Care:
Copayment for Urgent Care $0.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $0.00
Maximum Plan Benefit of $250000.00
Emergency room visit$0 - $100 based on level of Medicaid eligibility. If you are admitted to the hospital within 24 hours your cost share may be waived. For more information see Evidence of Coverage.
Ambulance transportation$0 - $270 based on level of Medicaid eligibility. For more information see Evidence of Coverage.

Health Care Services and Medical Supplies

Aetna Medicare Dual Select Choice (PPO D-SNP) covers a range of additional benefits. Learn more about Aetna Medicare Dual Select Choice (PPO D-SNP) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

CoverageDetails
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $0.00
Copayment for Routine Care $0.00
  • Maximum 12 Routine Care every year
Prior Authorization Required for Chiropractic Services
Diabetes supplies, training, nutrition therapy and monitoring0%
Durable medical equipment (DME)$0 - 20% based on level of Medicaid eligibility. For more information see Evidence of Coverage.
Diagnostic tests, lab and radiology services, and X-raysLab Services: $0, for more information see Evidence of Coverage
Diagnostic Procedures: Diagnostic Procedures/Tests: $0 - $95 based on level of Medicaid eligibility| $0 Diagnostic Procedures/Tests: $0, for more information see Evidence of Coverage
Imaging: Xray: $0 | CT Scans: $0 - 20% | Diagnostic Radiology other than CT Scans: $0 - 20% based on level of Medicaid eligibility| Diagnostic Radiology Mammogram: 0%. For more information see Evidence of Coverage.
Home health care$0 in-network | $0 out-of-network
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
$0.00 per day for days 1 to 3
$0.00 per day for days 4 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient care$0 - $40 for Mental Health - Group Sessions, $0 - $40 for Mental Health - Individual Sessions based on level of Medicaid eligibility. For more information see Evidence of Coverage |$0 - $40 for Psychiatric Services - Group Sessions, $0 - $40 for Psychiatric Services - Individual Sessions based on level of Medicaid eligibility. For more information see Evidence of Coverage.
Outpatient services/surgeryAmbulatory Surgical Center: $0 in network for preventive and diagnostic colonoscopy |$0 - $300 based on level of Medicaid eligibilityfor all other ASC services, For more information see Evidence of Coverage
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $0.00
Copayment for Medicare-covered Group Sessions $0.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter itemsOver the counter (OTC) items are covered under the Extra Benefits Card, for more information see Evidence of Coverage|Nicotine Replacement Therapy(NRT) offered as a Part C OTC benefit, for more information see Evidence of Coverage
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $0.00
Copayment for Routine Foot Care $0.00
  • Maximum 12 visits every year
Skilled Nursing Facility (SNF) care$0 - $0 per day, days 1-20; $203 per day, days 21-100 based on level of Medicaid eligibility. For more information see Evidence of Coverage.

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Dental careIn Network Dental Coverage|For covered services: ADA recognized dental services are covered excluding only cosmetic services, those considered medical in nature, and administrative changes.|Preventive dental services: |Oral exams: $0 copay |Cleanings: $0 copay |Fluoride treatment: $0 copay |Bitewing x-rays: $0 copay |Comprehensive dental services:|Non-routine services: $0 copay |Diagnostic services: $0 copay |Restorative services: $0 copay |Endodontics: $0 copay |Periodontics: $0 copay |Extractions: $0 copay |Prosthodontics and maxillofacial services: $0 copay |Out Of Network Dental Coverage|Preventive dental services:| $0 copay |Comprehensive dental services:| $0 copay |$2,500 maximum benefit for preventive and comprehensive dental services combined - see Evidence of Coverage.

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage

CoverageDetails
Vision careIn-Network:|Eye Exams:|Copayment for Medicare Covered Benefits $0-$15|Copayment for Routine Eye Exams $0 |(Maximum one exam every year)|Eyewear:|Copayment for Medicare Covered Benefits $0|Copayment for Contacts $0|Copayment for Eyeglasses $0|Copayment for Eyeglass Frames $0|Copayment for Eyeglass Lenses $0|Copayment for Upgrades $0|Out-of-Network:|Eye Exams: |Copayment for Medicare-Covered Benefits $15|Coinsurance for Routine Eye Exams 0%|Eyewear:|Coinsurance for Medicare-Covered Benefits 40%|Copayment for Non-Medicare covered Benefits $0|Maximum Plan Allowance for all Non-Medicare covered Eyewear $300 every year. See the Evidence of Coverage

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Hearing careIn-Network:|Hearing Exams:|Copayment for Medicare Covered Benefits $0-$15|Copayment for Routine hearing Exams $0|(Maximum one exam every year)|Copayment for Fitting/Evaluation for Hearing Aid $0|(Maximum one hearing aid fitting/evaluation every year)|Hearing Aids:|Copayment for Hearing Aids $0|(Maximum two hearing aids every year) |Out-of-Network:|Copayment for Medicare Covered Hearing Exams $15|Coinsurance for Non-Medicare Covered Hearing Exams 0% |Member must purchase hearing aids through NationsHearing|$1,250 per ear every year, for more information see the Evidence of Coverage

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

CoverageDetails
Preventive services and health/wellness education programs$0 copay for all preventive services covered under Original Medicare at zero cost sharing

When reviewing Georgia Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

You may be able to find plans in your part of Georgia that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

Plan Documents

Links to plan documents

Georgia Counties Served

We represent carriers such as Humana, UnitedHealthcare®, Anthem Blue Cross and Blue Shield*, Aetna, Cigna Healthcare, Wellcare, or Kaiser Permanente.

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