5

5 out of 5 stars* for plan year 2024

Plan ID: H5521-122

What You Need to Know:

  • Aetna Medicare Gold 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 $169, 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 Gold Plan (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 $39.

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

$169

Monthly Premium

Medicare Plan Features
Monthly Premium: $169.00
Part C Premium: $130.0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$169.00 $130.0 $39.00 $0 $39.00 $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: H5521-123
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 Huntingdon, Pennsylvania: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
less than 10 members 4 out of 5 Stars. 5 out of 5 Stars. 3 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,780 drugs
Number of Members Enrolled in this Plan in Huntingdon, Pennsylvania: 2,287 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
$130.00 $39.00 $0.00 $169.00
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
$131.50 $29.60 $159.60 $20.30 $150.30 $10.90 $140.90
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 $2.00 571 $5.00 915 $47.00 1247 $100.00 710 33%

Other Medicare Advantage Plans in Huntingdon, Pennsylvania

Plan Name Type Premium MOOP Rx Deduct. Rating
Vibra Health Plan Enhanced Complete (PPO) (2023)Local PPO$5,800$0
3
UPMC for Life PPO Rx Enhanced (PPO) (2023)Local PPO$7,550$0
3
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$250
5
HumanaChoice H5525-006 (PPO) (2023)Local PPO$6,700$0
4
Vibra Essential Advocate (PPO) (2023)Local PPO$6,700$0
3
Aetna Medicare Value (PPO) (2023)Local PPO$7,550$0
5
HumanaChoice R0923-001 (Regional PPO) (2023)Regional PPO *$4,900$-
3
Aetna Medicare Advantra Premier Plus (PPO) (2023)Local PPO$4,900$0
5
HumanaChoice H5525-038 (PPO) (2023)Local PPO$6,700$0
4
Humana Gold Choice H8145-052 (PFFS) (2023)PFFS$-$360
4
Aetna Medicare Advantra Silver (PPO) (2023)Local PPO$7,550$0
5
Humana Gold Choice H8145-055 (PFFS) (2023)PFFS *$-$-
4
HumanaChoice R0923-002 (Regional PPO) (2023)Regional PPO$6,700$0
3
HumanaChoice H5216-120 (PPO) (2023)Local PPO$6,700$0
4
Aetna Medicare Advantra Silver Plus (PPO) (2023)Local PPO$7,550$0
5
Humana Honor (PPO) (2023)Local PPO *$6,700$-
4
UPMC for Life PPO High Deductible with Rx (PPO) (2023)Local PPO$7,550$0
3
Security Blue HMO-POS Deluxe (HMO-POS) (2023)Local HMO$4,500$0
4
Geisinger Gold Classic Essential Rx (HMO) (2023)Local HMO$7,550$0
4
Community Blue Medicare HMO Signature (HMO) (2023)Local HMO$7,550$0
4
HumanaChoice H5216-116 (PPO) (2023)Local PPO *$3,900$-
4
Geisinger Gold Classic Advantage (HMO) (2023)Local HMO *$3,450$-
4
Humana Value Plus H5216-117 (PPO) (2023)Local PPO$6,700$420
4
Aetna Medicare Advantra Gold (HMO) (2023)Local HMO$7,550$0
5
Security Blue HMO-POS Basic (HMO-POS) (2023)Local HMO *$5,900$-
4
Geisinger Gold Classic Advantage Rx (HMO) (2023)Local HMO$3,450$0
4
Security Blue HMO-POS ValueRx (HMO-POS) (2023)Local HMO$5,500$0
4
Freedom Blue PPO ValueRx (PPO) (2023)Local PPO$5,500$0
4
Aetna Medicare Advantra Premier (HMO) (2023)Local HMO$7,550$0
5
Aetna Medicare Advantra Eagle (HMO) (2023)Local HMO *$4,000$-
5
UPMC for Life HMO Rx Enhanced (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Preferred Advantage Rx (PPO) (2023)Local PPO$4,000$0
3
Security Blue HMO-POS Standard (HMO-POS) (2023)Local HMO$5,000$0
4
Freedom Blue PPO Classic (PPO) (2023)Local PPO$4,500$0
4
AARP Medicare Advantage Patriot (HMO) (2023)Local HMO *$5,500$-
5
UPMC for Life HMO Rx (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Classic Complete Rx (HMO) (2023)Local HMO$4,900$0
4
Allwell Medicare Boost (HMO) (2023)Local HMO$7,550$0
4
Geisinger Gold Preferred Complete Rx (PPO) (2023)Local PPO$6,700$0
3
Complete Blue PPO Distinct (PPO) (2023)Local PPO$6,500$0
4
UPMC for Life HMO Deductible with Rx (HMO) (2023)Local HMO$7,550$0
4
Lasso Healthcare Growth (MSA) (2023)MSA *$-$-
4
Allwell Medicare (HMO) (2023)Local HMO$6,700$0
4
AARP Medicare Advantage Choice (PPO) (2023)Local PPO$4,900$0
New plan - not yet rated.
Geisinger Gold Preferred Enhanced Rx (PPO) (2023)Local PPO$6,700$0
3
UPMC for Life HMO Rx Choice (HMO) (2023)Local HMO$7,550$0
4
Lasso Healthcare Growth Plus (MSA) (2023)MSA *$-$-
4
Allwell Medicare Simple (HMO) (2023)Local HMO *$3,450$-
4
UPMC for Life HMO No Rx (HMO) (2023)Local HMO *$7,550$-
4
Aetna Medicare Silver (HMO) (2023)Local HMO$7,550$0
5
Freedom Blue PPO Select (PPO) (2023)Local PPO$5,000$0
4
AARP Medicare Advantage Plan 1 (HMO) (2023)Local HMO$6,700$0
5
Allwell Medicare Complement (HMO) (2023)Local HMO$7,550$445
4
AARP Medicare Advantage Plan 2 (HMO) (2023)Local HMO$5,500$0
5
Medicare Advantage Plans by Aetna Medicare
Aetna Medicare Advantra Credit Value (PPO) (2023)Local PPO$7,550$250
5
Aetna Medicare Value (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare Advantra Premier Plus (PPO) (2023)Local PPO$4,900$0
5
Aetna Medicare Advantra Silver (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare Advantra Silver Plus (PPO) (2023)Local PPO$7,550$0
5
Aetna Medicare Advantra Gold (HMO) (2023)Local HMO$7,550$0
5
Aetna Medicare Advantra Premier (HMO) (2023)Local HMO$7,550$0
5
Aetna Medicare Advantra Eagle (HMO) (2023)Local HMO *$4,000$-
5
Aetna Medicare Silver (HMO) (2023)Local HMO$7,550$0
5

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