4

4 out of 5 stars* for plan year 2024

Plan ID: H1608-026

What You Need to Know:

  • Aetna Medicare Advantra Gold (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 $68, 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 $7,550 per year (in-network).
  • Aetna Medicare Advantra Gold (PPO) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is .
  • This plan's Part D Initial Coverage Limit is $14.

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

$68

Monthly Premium

Medicare Plan Features
Monthly Premium: $68.00
Part C Premium: $53.80
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$68.00 $53.80 $14.20 $0 $14.20 $0 0.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local PPO
Similar Plan: H1608-027
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): $7,550
Annual Deductible: NULL
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Monongalia, West Virginia: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
187 members 3.5 out of 5 Stars. 4 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,800 drugs
Number of Members Enrolled in this Plan in Monongalia, West Virginia: 1,764 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
$53.80 $14.20 $0.00 $68.00
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
$53.80 $10.60 $64.40 $7.10 $60.90 $3.50 $57.30
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)
369 $0.00 575 $0.00 902 $47.00 1243 $100.00 711 33%

Other Medicare Advantage Plans in Monongalia, West Virginia

Plan Name Type Premium MOOP Rx Deduct. Rating
AARP Medicare Advantage Choice Plan 3 (PPO) (2023)Local PPO$6,700$150
5
HumanaChoice H5216-182 (PPO) (2023)Local PPO$6,700$195
4
The Health Plan SecureChoice - Option II (PPO) (2023)Local PPO$6,700$100
5
AARP Medicare Advantage Choice Plan 1 (PPO) (2023)Local PPO$5,900$200
5
HumanaChoice H5216-052 (PPO) (2023)Local PPO$5,500$100
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
AARP Medicare Advantage Choice Plan 2 (PPO) (2023)Local PPO$5,400$100
5
Aetna Medicare Advantra Value (PPO) (2023)Local PPO$7,550$0
4
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
The Health Plan SecureCare - Option II (HMO) (2023)Local HMO$6,700$100
5
HumanaChoice H5216-105 (PPO) (2023)Local PPO *$4,500$-
4
HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
3
HumanaChoice H5216-124 (PPO) (2023)Local PPO$6,700$0
4
AARP Medicare Advantage Patriot (PPO) (2023)Local PPO *$5,400$-
5
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
Aetna Medicare Advantra Elite (HMO) (2023)Local HMO$7,550$0
5
Humana Value Plus H5216-125 (PPO) (2023)Local PPO$7,550$445
4
The Health Plan SecureCare - Option I, MA Only (HMO) (2023)Local HMO *$6,700$-
5
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
WVU Medicine - The Health Plan SecureCare (HMO) (2023)Local HMO$6,700$100
5
Freedom Blue PPO Standard (PPO) (2023)Local PPO$6,500$0
5
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$195
4
Medicare Advantage Plans by Aetna Medicare
Aetna Medicare Advantra Value (PPO) (2023)Local PPO$7,550$0
4
Aetna Medicare Advantra Elite (HMO) (2023)Local HMO$7,550$0
5
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$195
4

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