Aetna Copay For Therapy

Is Therapy Covered By Aetna
Aetna Copay For Therapy Near Me
Aetna Copay For Specialist
Does Aetna Pay For Therapy

Jump to:

Aetna Medicare Choice Plan (PPO) H9431-005 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Oregon. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Choice Plan (PPO) has a monthly premium of $19.00 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.

Using telemedicine to see a doctor is a great option to help you take care of your health, while protecting yourself and others from the coronavirus. Learn more about Aetna's telehealth services for members during the COVID-19 pandemic, including benefits, copays, how to use, and more.

Aetna Medicare Choice Plan (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Choice Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

The $0 copay for outpatient mental health counseling is for real-time virtual visits offered by in-network providers in participating plans. To confirm telemedicine and Teladoc telemedicine eligibility, check your member website for plan details or call the number on your ID card. If you choose a therapist who is in-network with Aetna, your therapy sessions likely cost between $15 - $50 per session, after you meet your deductible. The $15 - $50 amount is your copay, or the fixed amount that you owe at each therapy visit.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:	H9431-005
Provider:	Aetna Medicare
Year:	2021
Type:	Local PPO
Monthly Premium C+D:	$19.00
Part C Premium:	$3.90
MOOP:	$7,550
Part D (Drug) Premium:	$15.10
Part D Supplemental Premium	$0
Total Part D Premium:	$15.10
Drug Deductible:	$0
Tiers with No Deductible:	0
Gap Coverage:	Yes
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H9431-006

Aetna Medicare Choice Plan (PPO) Part-C Premium

Aetna Medicare plan charges a $3.90 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H9431-005 Part-D Deductible and Premium

Aetna Medicare Choice Plan (PPO) has a monthly drug premium of $15.10 and a $0 drug deductible. This Aetna Medicare plan offers a $15.10 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $15.10. The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA 'donut hole') You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The Aetna Medicare Choice Plan (PPO) medicare insurance offers a $0 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $3.80 for 75% low income subsidy $7.50 for 50% and $11.30 for 25%.

Full LIS Premium:	$0
75% LIS Premium:	$3.80
50% LIS Premium:	$7.50
25% LIS Premium:	$11.30

H9431-005 Formulary or Drug Coverage

Aetna Medicare Choice Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Aetna Medicare Choice Plan (PPO) Summary of Benefits

Additional Benefits

No

Comprehensive Dental

Diagnostic services	$0 copay
Diagnostic services	$0 copay (Out-of-Network)
Endodontics	$0 copay
Endodontics	$0 copay (Out-of-Network)
Extractions	$0 copay
Extractions	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Non-routine services	$0 copay (Out-of-Network)
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Restorative services	$0 copay
Restorative services	$0 copay (Out-of-Network)

Deductible

$0

Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$0-295 copay
Diagnostic radiology services (e.g., MRI)	45% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-15 copay
Diagnostic tests and procedures	45% coinsurance (Out-of-Network)
Lab services	$0 copay
Lab services	45% coinsurance (Out-of-Network)
Outpatient x-rays	$0 copay
Outpatient x-rays	45% coinsurance (Out-of-Network)

Doctor Visits

Primary	$0 copay
Primary	45% coinsurance per visit (Out-of-Network)
Specialist	$45 copay per visit
Specialist	45% coinsurance per visit (Out-of-Network)

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$45 copay per visit (always covered)

Foot Care (podiatry services)

Foot exams and treatment	$45 copay
Foot exams and treatment	45% coinsurance (Out-of-Network)
Routine foot care	Not covered

Ground Ambulance

$260 copay
$260 copay (Out-of-Network)

Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	45% coinsurance (Out-of-Network)
Hearing aids	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing exam	$0 copay
Hearing exam	45% coinsurance (Out-of-Network)

Inpatient Hospital Coverage

$420 per day for days 1 through 4 $0 per day for days 5 through 90
45% per stay (Out-of-Network)

Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item
Diabetes supplies	0-20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	45% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	45% coinsurance per item (Out-of-Network)

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	45% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	45% coinsurance (Out-of-Network)

Mental Health Services

Inpatient hospital - psychiatric	$1,871 per stay
Inpatient hospital - psychiatric	45% per stay (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	45% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient group therapy visit with a psychiatrist	45% coinsurance (Out-of-Network)
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	45% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit with a psychiatrist	45% coinsurance (Out-of-Network)

MOOP

$11,300 In and Out-of-network $7,550 In-network

Option

No

Optional supplemental benefits

No

Outpatient Hospital Coverage

$0-325 copay per visit
45% coinsurance per visit (Out-of-Network)

Preventive Care

$0 copay
0-45% coinsurance (Out-of-Network)

Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Oral exam	$0 copay
Oral exam	$0 copay (Out-of-Network)

Rehabilitation Services

Occupational therapy visit	$30 copay
Occupational therapy visit	45% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$30 copay
Physical therapy and speech and language therapy visit	45% coinsurance (Out-of-Network)

Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100
35% per stay (Out-of-Network)

Transportation

Not covered

Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	$0 copay
Other	45% coinsurance (Out-of-Network)
Routine eye exam	$0 copay
Routine eye exam	45% coinsurance (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

Wellness Programs (e.g. fitness nursing hotline)

Covered

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST

Coverage Area for Aetna Medicare Choice Plan (PPO)

(Click county to compare all available Advantage plans)

State:	Oregon
County:	Clackamas,Marion,Multnomah,Polk,Washington, Yamhill,

Go to top

Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit.Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Jump to:

Aetna Medicare Freedom Plan (PPO) H5521-178 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in Louisiana. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Freedom Plan (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Freedom Plan (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of 'preferred' providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Freedom Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.

Ready to Enroll?

Or Call
1-855-778-4180
Mon-Fri 8am-9pm EST
Sat 9am-9pm EST

2021 Aetna Medicare Medicare Advantage Plan Costs

Name:
Plan ID:	H5521-178
Provider:	Aetna Medicare
Year:	2021
Type:	Local PPO
Monthly Premium C+D:	$0
Part C Premium:	$0
MOOP:	$7,550
Part D (Drug) Premium:	$0
Part D Supplemental Premium	$0
Total Part D Premium:	$0
Drug Deductible:	$195.0
Tiers with No Deductible:	1
Gap Coverage:	Yes
Benchmark:	not below the regional benchmark
Type of Medicare Health:	Enhanced Alternative
Drug Benefit Type:	Enhanced
Similar Plan:	H5521-184

Aetna Medicare Freedom Plan (PPO) Part-C Premium

Aetna Medicare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H5521-178 Part-D Deductible and Premium

Aetna Medicare Freedom Plan (PPO) has a monthly drug premium of $0 and a $195.0 drug deductible. This Aetna Medicare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.

Aetna Medicare Gap Coverage

H5521-178 Formulary or Drug Coverage

Aetna Medicare Freedom Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers.By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.

2021 Aetna Medicare Freedom Plan (PPO) Summary of Benefits

Additional Benefits

No

Comprehensive Dental

Diagnostic services	$0 copay
Diagnostic services	$0 copay (Out-of-Network)
Endodontics	$0 copay
Endodontics	$0 copay (Out-of-Network)
Extractions	$0 copay
Extractions	$0 copay (Out-of-Network)
Non-routine services	$0 copay
Non-routine services	$0 copay (Out-of-Network)
Periodontics	$0 copay
Periodontics	$0 copay (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay (Out-of-Network)
Restorative services	$0 copay
Restorative services	$0 copay (Out-of-Network)

Deductible

$0

Diagnostic Tests and Procedures

Is Therapy Covered By Aetna

Diagnostic radiology services (e.g., MRI)	$0-175 copay
Diagnostic radiology services (e.g., MRI)	35% coinsurance (Out-of-Network)
Diagnostic tests and procedures	$0-95 copay
Diagnostic tests and procedures	35% coinsurance (Out-of-Network)
Lab services	$0-20 copay
Lab services	35% coinsurance (Out-of-Network)
Outpatient x-rays	$5-35 copay
Outpatient x-rays	35% coinsurance (Out-of-Network)

Doctor Visits

Primary	$30 copay per visit (Out-of-Network)
Primary	$5 copay per visit
Specialist	$40 copay per visit
Specialist	$50 copay per visit (Out-of-Network)

Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$50 copay per visit (always covered)

Foot Care (podiatry services)

Foot exams and treatment	$40 copay
Foot exams and treatment	$50 copay (Out-of-Network)
Routine foot care	Not covered

Ground Ambulance

$290 copay
$290 copay (Out-of-Network)

Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$50 copay (Out-of-Network)
Hearing aids	$0 copay
Hearing aids	$0 copay (Out-of-Network)
Hearing exam	$40 copay
Hearing exam	$50 copay (Out-of-Network)

Inpatient Hospital Coverage

$245 per day for days 1 through 7 $0 per day for days 8 through 90
35% per stay (Out-of-Network)

Medical Equipment/Supplies

Diabetes supplies	0-20% coinsurance per item
Diabetes supplies	0-20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)	35% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	35% coinsurance per item (Out-of-Network)

Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	35% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance
Other Part B drugs	35% coinsurance (Out-of-Network)

Mental Health Services

Inpatient hospital - psychiatric	$295 per day for days 1 through 5 $0 per day for days 6 through 90
Inpatient hospital - psychiatric	35% per stay (Out-of-Network)
Outpatient group therapy visit	$30 copay
Outpatient group therapy visit	$50 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$30 copay
Outpatient group therapy visit with a psychiatrist	$50 copay (Out-of-Network)
Outpatient individual therapy visit	$30 copay
Outpatient individual therapy visit	$50 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$30 copay
Outpatient individual therapy visit with a psychiatrist	$50 copay (Out-of-Network)

MOOP

$11,300 In and Out-of-network $7,550 In-network

Option

No

Optional supplemental benefits

No

Outpatient Hospital Coverage

$0-225 copay per visit
35% coinsurance per visit (Out-of-Network)

Preventive Care

$0 copay
$0 copay (Out-of-Network)

Preventive Dental

Cleaning	$0 copay
Cleaning	$0 copay (Out-of-Network)
Dental x-ray(s)	$0 copay
Dental x-ray(s)	$0 copay (Out-of-Network)
Fluoride treatment	$0 copay
Fluoride treatment	$0 copay (Out-of-Network)
Oral exam	$0 copay
Oral exam	$0 copay (Out-of-Network)

Rehabilitation Services

Occupational therapy visit	$25 copay
Occupational therapy visit	$50 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$25 copay
Physical therapy and speech and language therapy visit	$50 copay (Out-of-Network)

Skilled Nursing Facility

$0 per day for days 1 through 20 $184 per day for days 21 through 100
35% per stay (Out-of-Network)

Transportation

Not covered

Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	$40 copay
Other	$50 copay (Out-of-Network)
Routine eye exam	$0 copay
Routine eye exam	$50 copay (Out-of-Network)
Upgrades	$0 copay
Upgrades	$0 copay (Out-of-Network)

Wellness Programs (e.g. fitness nursing hotline)

Covered

Reviews for Aetna Medicare Freedom Plan (PPO) H5521

2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Aetna Medicare Freedom Plan (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals

Health Plan Customer Service Rating for Aetna Medicare Freedom Plan (PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Aetna Medicare Freedom Plan (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes