Plan ID: H3288-043

What You Need to Know:

  • Aetna Medicare Preferred Premium Plan (PPO) is a Medicare Advantage Health Maintenance Organization Local PPO 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 $32, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $195 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,900 per year (in-network).
  • Aetna Medicare Preferred Premium Plan (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $195 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $21.

$32

Monthly Premium

Medicare Plan Features
Monthly Premium: $32.00
Part C Premium: $11.40
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$32.00 $11.40 $20.60 $0 $20.60 $195.0 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3288-044
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): $6,900
Annual Deductible: $195 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Wayne, Georgia: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
63 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 Wayne, Georgia: 875 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
$11.40 $20.60 $0.00 $32.00
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
$11.40 $15.40 $26.80 $10.30 $21.70 $5.10 $16.50
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 $0.00 571 $0.00 915 $47.00 1247 $100.00 710 29%

Other Medicare Advantage Plans in Wayne, Georgia

Plan Name Type Premium MOOP Rx Deduct. Rating
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice R3392-001 (Regional PPO) (2023)Regional PPO *$6,700$-
4
UnitedHealthcare Medicare Advantage Choice (Regional PPO) (2023)Regional PPO$6,700$295
5
HumanaChoice R3392-002 (Regional PPO) (2023)Regional PPO$6,700$340
4
UnitedHealthcare Medicare Advantage Patriot (Regional PPO (2023)Regional PPO *$6,700$-
5
HumanaChoice H5525-024 (PPO) (2023)Local PPO$6,700$295
4
HumanaChoice H5216-157 (PPO) (2023)Local PPO *$6,700$-
4
HumanaChoice H5216-207 (PPO) (2023)Local PPO$7,550$75
4
Clover Health Choice (PPO) (2023)Local PPO$7,550$0
4
WellCare Flex Complete (PPO) (2023)Local PPO$2,500$0
5
Clover Health Choice Value (PPO) (2023)Local PPO$7,550$445
4
Aetna Medicare Freedom Plan (PPO) (2023)Local PPO$6,900$200
New plan - not yet rated.
WellCare Dividend (HMO) (2023)Local HMO$6,700$200
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
WellCare Premier (PPO) (2023)Local PPO$4,900$75
5
HumanaChoice H5216-154 (PPO) (2023)Local PPO$7,550$400
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
WellCare Patriot (HMO-POS) (2023)Local HMO *$3,400$-
5
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.
WellCare Endurance (PPO) (2023)Local PPO$4,900$0
5
WellCare Compass (HMO) (2023)Local HMO$3,450$445
5
WellCare Prime (PPO) (2023)Local PPO$5,100$0
5
WellCare Value (HMO) (2023)Local HMO$3,450$0
5
Medicare Advantage Plans by Aetna Medicare
Aetna Medicare Freedom Plan (PPO) (2023)Local PPO$6,900$200
New plan - not yet rated.
Aetna Medicare Eagle Plan (PPO) (2023)Local PPO *$6,900$-
New plan - not yet rated.

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