Aetna Medicare Choices
Low Income Subsidy
Aetna Medicare Open Plan (PFFS) —
2010 Monthly Plan Premium for People who get Extra Help from Medicare to Help Pay for Their Prescription Drug Costs
If you get extra help from Medicare to help pay for your Medicare prescription drug plan costs, your monthly plan premium will be lower than what it would be if you did not get extra help from Medicare. The amount of extra help you get will determine your total monthly plan premium as a member of our Plan.
If you aren’t getting extra help, you can see if you qualify by calling:
- 1-800-Medicare (TTY/TDD users call 1-877-486-2048) - 24 hours a day/7 days a week,
- Your State Medicaid Office, or
- The Social Security Administration at 1-800-772-1213. TTY/TDD users should call 1-800-325-0778 between 7 a.m. and 7 p.m., Monday through Friday.
If you have any questions, please call our representatives at 1-800-529-5586, (TTY/TDD: 1-888-760-4748), Monday to Sunday, 8 a.m. to 8 p.m.
The table below tells how much you will pay for a monthly premium if you receive extra help. (This does not include any Medicare Part B premium you may have to pay.)
| Your State and County |
Aetna Medicare Open (PFFS) Plan Name |
Premium Without Extra Help |
Aetna Medicare Premium for Your Level of Extra Help | |||
| 100% | 75% | 50% | 25% | |||
| California | ||||||
| San Diego | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Illinois | ||||||
| Boone | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Henry | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Madison | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Ogle | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Peoria | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Rock Island | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Stephenson | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Tazewell | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Winnebago | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Ohio | ||||||
| Adams | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Allen | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Ashland | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Ashtabula | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Athens | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Auglaize | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Belmont | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Brown | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Butler | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Carroll | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Champaign | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Clark | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Clermont | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Clinton | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Columbiana | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Coshocton | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Crawford | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Cuyahoga | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Darke | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Defiance | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Delaware | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Erie | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Fairfield | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Fayette | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Franklin | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Fulton | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Gallia | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Geauga | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Greene | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Guernsey | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Hamilton | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Hancock | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Hardin | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Harrison | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Henry | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Highland | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Hocking | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Holmes | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Huron | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Jackson | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Jefferson | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Knox | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Lake | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Lawrence | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Licking | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Logan | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Lorain | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Lucas | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Madison | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Mahoning | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Marion | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Medina | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Meigs | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Mercer | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Miami | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Monroe | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Montgomery | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Morgan | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Morrow | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Muskingum | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Noble | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Ottawa | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Paulding | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Perry | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Pickaway | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Pike | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Portage | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Preble | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Putnam | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Richland | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Ross | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Sandusky | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Scioto | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Seneca | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Shelby | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Stark | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Summit | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Trumbull | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Tuscarawas | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Union | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Van Wert | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Vinton | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Warren | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Washington | Open Value Plan w/Rx | $44.00 | $23.90 | $28.90 | $33.90 | $39.00 |
| Wayne | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Williams | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Wood | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Wyandot | Open Value Plan w/Rx | $78.00 | $52.30 | $58.70 | $65.10 | $71.60 |
| Pennsylvania | ||||||
| Adams | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Cumberland | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Dauphin | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Lackawanna | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Luzerne | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| York | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Virginia | ||||||
| Bedford | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Bedford City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Botetourt | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Chesapeake City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Chesterfield | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Craig | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Franklin | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Hanover | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Henrico | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| King William | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Newport News City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Norfolk City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Richmond City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Roanoke | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Roanoke City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Salem City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
| Virginia Beach City | Open Value Plan w/Rx | $24.00 | $23.90 | $23.90 | $23.90 | $24.00 |
For the Aetna Medicare Open Plan (PFFS): You can receive covered services from any licensed doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the Aetna Medicare Open Plan private fee-for-service terms and conditions of payment. This product does not require a contracted network and providers are not required to accept Medicare Private Fee-for-Service plans.
Coverage is provided through a Medicare Advantage organization or a Medicare prescription drug plan sponsor with a Medicare contract. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year.
