Plan ID: H3288-019

What You Need to Know:

  • Aetna Medicare Freedom Preferred 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 $15, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $250 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $6,500 per year (in-network).
  • Aetna Medicare Freedom Preferred Plan (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $250 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $15.

$15

Monthly Premium

Medicare Plan Features
Monthly Premium: $15.00
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:
$15.00 $0 $15.00 $0 $15.00 $250.0 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H3288-020
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): $6,500
Annual Deductible: $250 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Creek, Oklahoma: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
55 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 Creek, Oklahoma: 577 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 $15.00 $0.00 $15.00
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 $11.20 $11.20 $7.50 $7.50 $3.70 $3.70
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 28%

Other Medicare Advantage Plans in Creek, Oklahoma

Plan Name Type Premium MOOP Rx Deduct. Rating
HumanaChoice R4845-001 (Regional PPO) (2023)Regional PPO *$3,400$-
5
HumanaChoice R4845-002 (Regional PPO) (2023)Regional PPO$6,700$395
5
Generations Classic (HMO) (2023)Local HMO$3,900$0
5
HumanaChoice H5216-083 (PPO) (2023)Local PPO$6,700$195
4
AARP Medicare Advantage Plan 1 (HMO-POS) (2023)Local HMO$3,900$0
5
AARP Medicare Advantage Plan 2 (HMO-POS) (2023)Local HMO$5,500$100
5
HumanaChoice H5216-139 (PPO) (2023)Local PPO$6,700$0
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Senior Health Plan Platinum (HMO) (2023)Local HMO$4,500$0
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$4,900$0
5
Generations Value (HMO) (2023)Local HMO *$3,000$-
5
Senior Health Plan Silver (HMO) (2023)Local HMO *$3,400$-
4
Humana Honor (PPO) (2023)Local PPO *$4,500$-
4
Senior Health Plan Platinum Plus (HMO) (2023)Local HMO$4,500$0
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$4,400$-
5
Senior Health Plan Silver Plus (HMO) (2023)Local HMO$4,700$0
4
Generations Select (HMO) (2023)Local HMO$3,900$0
5
Advantage Choice (HMO) (2023)Local HMO *$3,400$-
5
Advantage Premier (HMO) (2023)Local HMO$4,900$0
5
Advantage Choice Plus (HMO) (2023)Local HMO$6,100$0
5
Generations Classic Choice (HMO-POS) (2023)Local HMO$3,900$0
5
HumanaChoice H5216-230 (PPO) (2023)Local PPO$4,900$0
4
Humana Value Plus H9070-002 (PPO) (2023)Local PPO$7,550$350
5
HumanaChoice H5216-081 (PPO) (2023)Local PPO$6,700$195
4
HumanaChoice H9070-006 (PPO) (2023)Local PPO$5,900$0
5
Humana Gold Plus H6622-033 (HMO) (2023)Local HMO$5,900$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Aetna Medicare Freedom Core Plan (PPO) (2023)Local PPO$7,550$300
New plan - not yet rated.
Medicare Advantage Plans by Aetna Medicare
Aetna Medicare Freedom Core Plan (PPO) (2023)Local PPO$7,550$300
New plan - not yet rated.

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