Aetna Medicare Choices
Low Income Subsidy
Aetna Medicare Plan (PPO) —
2011 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 for Extra Help to pay for your prescription drug costs. If eligible, Medicare could pay for up to one-hundred (100) percent of drug costs including monthly prescription drug premiums, annual deductibles, and coinsurance. Additionally, those who qualify will not be subject to the coverage gap or a late enrollment penalty. Many people are eligible for these savings and don't know it.
See if you qualify for Extra Help 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 (PPO) Plan Name |
Premium Without Extra Help |
Aetna Medicare Premium for Your Level of Extra Help | |||
| 100% | 75% | 50% | 25% | |||
| Colorado | ||||||
| Adams | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Arapahoe | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Boulder | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Broomfield | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Denver | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Douglas | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Jefferson | Aetna Medicare Select Plan (PPO) | $60.00 | $35.50 | $41.60 | $47.70 | $53.90 |
| Connecticut | ||||||
| Fairfield | Aetna Medicare Standard Plan (PPO) | $87.00 | $66.10 | $71.30 | $76.50 | $81.80 |
| Hartford | Aetna Medicare Standard Plan (PPO) | $87.00 | $66.10 | $71.30 | $76.50 | $81.80 |
| Litchfield | Aetna Medicare Standard Plan (PPO) | $87.00 | $66.10 | $71.30 | $76.50 | $81.80 |
| New Haven | Aetna Medicare Standard Plan (PPO) | $87.00 | $66.10 | $71.30 | $76.50 | $81.80 |
| Delaware | ||||||
| New Castle | Aetna Medicare Premier Plan (PPO) | $151.00 | $116.70 | $125.30 | $133.90 | $142.40 |
| District of Columbia | ||||||
| District of Columbia | Aetna Medicare Premier Plan (PPO) | $120.00 | $109.50 | $112.10 | $114.70 | $117.40 |
| Florida | ||||||
| Broward | Aetna Medicare Standard Plan (PPO) | $109.00 | $83.60 | $89.90 | $96.30 | $102.60 |
| Charlotte | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Duval | Aetna Medicare Premier Plan (PPO) | $119.00 | $93.60 | $99.90 | $106.30 | $112.60 |
| Aetna Medicare Standard Plan (PPO) | $79.00 | $57.40 | $62.80 | $68.20 | $73.60 | |
| Hillsborough | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Lee | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Manatee | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Miami-Dade | Aetna Medicare Standard Plan (PPO) | $109.00 | $83.60 | $89.90 | $96.30 | $102.60 |
| Palm Beach | Aetna Medicare Standard Plan (PPO) | $109.00 | $83.60 | $89.90 | $96.30 | $102.60 |
| Pasco | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Pinellas | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Saint Johns | Aetna Medicare Premier Plan (PPO) | $119.00 | $93.60 | $99.90 | $106.30 | $112.60 |
| Aetna Medicare Standard Plan (PPO) | $79.00 | $57.40 | $62.80 | $68.20 | $73.60 | |
| Sarasota | Aetna Medicare Standard Plan (PPO) | $129.00 | $103.60 | $109.90 | $116.30 | $122.60 |
| Georgia | ||||||
| DeKalb | Aetna Medicare Standard Plan (PPO) | $94.00 | $61.20 | $69.40 | $77.60 | $85.80 |
| Forsyth | Aetna Medicare Standard Plan (PPO) | $94.00 | $61.20 | $69.40 | $77.60 | $85.80 |
| Fulton | Aetna Medicare Standard Plan (PPO) | $94.00 | $61.20 | $69.40 | $77.60 | $85.80 |
| Gwinett | Aetna Medicare Standard Plan (PPO) | $94.00 | $61.20 | $69.40 | $77.60 | $85.80 |
| Illinois | ||||||
| Cook | Aetna Medicare Standard Plan (PPO) | $79.00 | $54.90 | $60.90 | $66.90 | $73.00 |
| Maryland | ||||||
| Anne Arundel | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Baltimore | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Baltimore City | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Calvert | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Carroll | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Cecil | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Charles | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Frederick | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Harford | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Howard | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Montgomery | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Prince Georges | Aetna Medicare Standard Plan (PPO) | $148.00 | $116.30 | $124.20 | $132.10 | $140.10 |
| Nevada | ||||||
| Clark | Aetna Medicare Select Plan (PPO) | $67.00 | $45.70 | $51.00 | $56.30 | $61.70 |
| New Jersey | ||||||
| Essex | Aetna Medicare Premier Plan (PPO) | $156.00 | $120.30 | $129.20 | $138.10 | $147.10 |
| Aetna Medicare Standard Plan (PPO) | $96.00 | $60.30 | $69.20 | $78.10 | $87.10 | |
| Hudson | Aetna Medicare Premier Plan (PPO) | $156.00 | $120.30 | $129.20 | $138.10 | $147.10 |
| Aetna Medicare Standard Plan (PPO) | $96.00 | $60.30 | $69.20 | $78.10 | $87.10 | |
| Middlesex | Aetna Medicare Premier Plan (PPO) | $156.00 | $120.30 | $129.20 | $138.10 | $147.10 |
| Aetna Medicare Standard Plan (PPO) | $96.00 | $60.30 | $69.20 | $78.10 | $87.10 | |
| Morris | Aetna Medicare Premier Plan (PPO) | $156.00 | $120.30 | $129.20 | $138.10 | $147.10 |
| Aetna Medicare Standard Plan (PPO) | $96.00 | $60.30 | $69.20 | $78.10 | $87.10 | |
| Ocean | Aetna Medicare Premier Plan (PPO) | $156.00 | $120.30 | $129.20 | $138.10 | $147.10 |
| Aetna Medicare Standard Plan (PPO) | $96.00 | $60.30 | $69.20 | $78.10 | $87.10 | |
| Passaic | Aetna Medicare Premier Plan (PPO) | $156.00 | $120.30 | $129.20 | $138.10 | $147.10 |
| Aetna Medicare Standard Plan (PPO) | $96.00 | $60.30 | $69.20 | $78.10 | $87.10 | |
| New York | ||||||
| Broome | Aetna Medicare Standard Plan (PPO) | $48.00 | $13.10 | $21.80 | $30.50 | $39.30 |
| Cayuga | Aetna Medicare Standard Plan (PPO) | $48.00 | $13.10 | $21.80 | $30.50 | $39.30 |
| New York | Aetna Medicare Standard Plan (PPO) | $71.00 | $35.60 | $44.40 | $53.30 | $62.10 |
| Onondaga | Aetna Medicare Standard Plan (PPO) | $48.00 | $13.10 | $21.80 | $30.50 | $39.30 |
| Oswego | Aetna Medicare Standard Plan (PPO) | $48.00 | $13.10 | $21.80 | $30.50 | $39.30 |
| Queens | Aetna Medicare Standard Plan (PPO) | $71.00 | $35.60 | $44.40 | $53.30 | $62.10 |
| Richmond | Aetna Medicare Standard Plan (PPO) | $71.00 | $35.60 | $44.40 | $53.30 | $62.10 |
| Tioga | Aetna Medicare Standard Plan (PPO) | $48.00 | $13.10 | $21.80 | $30.50 | $39.30 |
| Ohio | ||||||
| Cuyahoga | Aetna Medicare Standard Plan (PPO) | $54.00 | $26.90 | $33.70 | $40.40 | $47.20 |
| Delaware | Aetna Medicare Standard Plan (PPO) | $54.00 | $26.90 | $33.70 | $40.40 | $47.20 |
| Franklin | Aetna Medicare Standard Plan (PPO) | $54.00 | $26.90 | $33.70 | $40.40 | $47.20 |
| Hamilton | Aetna Medicare Standard Plan (PPO) | $54.00 | $26.90 | $33.70 | $40.40 | $47.20 |
| Lucas | Aetna Medicare Standard Plan (PPO) | $54.00 | $26.90 | $33.70 | $40.40 | $47.20 |
| Summit | Aetna Medicare Standard Plan (PPO) | $54.00 | $26.90 | $33.70 | $40.40 | $47.20 |
| Pennsylvania | ||||||
| Berks | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Carbon | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Lancaster | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Lebanon | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Lehigh | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Monroe | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Northampton | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Schuylkill | Aetna Medicare Premier Plan (PPO) | $120.00 | $87.30 | $95.50 | $103.60 | $111.80 |
| Texas | ||||||
| Bexar | Aetna Medicare Value Plan (PPO) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Collin | Aetna Medicare Value Plan (PPO) | $56.00 | $25.50 | $33.10 | $40.80 | $48.40 |
| Comal County | Aetna Medicare Value Plan (PPO) | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Dallas | Aetna Medicare Value Plan (PPO) | $56.00 | $25.50 | $33.10 | $40.80 | $48.40 |
| Denton | Aetna Medicare Value Plan (PPO) | $56.00 | $25.50 | $33.10 | $40.80 | $48.40 |
| Harris | Aetna Medicare Value Plan (PPO) | $58.00 | $27.50 | $35.10 | $42.80 | $50.40 |
| Montgomery | Aetna Medicare Value Plan (PPO) | $58.00 | $27.50 | $35.10 | $42.80 | $50.40 |
| Tarrant | Aetna Medicare Value Plan (PPO) | $56.00 | $25.50 | $33.10 | $40.80 | $48.40 |
| Virginia | ||||||
| Alexandria City | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Arlington | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Fairfax | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Fairfax City | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Falls Church City | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Loudoun | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Manassas City | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Manassas Park City | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
| Prince William | Aetna Medicare Standard Plan (PPO) | $140.00 | $106.70 | $115.10 | $123.40 | $131.70 |
For the Aetna Medicare Plan (PPO): It may cost more to get care from out-of-network providers, except in an emergency. Precertification, or prior approval of coverage, is requested for certain services. Providers must be licensed and eligible to receive payment under the federal Medicare program.
A Medicare Advantage organization with a Medicare contract. A Medicare-approved Part D sponsor. You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. Benefits, limitations, service areas and premiums are subject to change on January 1, 2012.
In general, beneficiaries must use network pharmacies to access their prescription drug benefit, except in non-routine circumstances. Pharmacy clinical programs such as prior authorization, step therapy, and quantity limits may apply to your prescription drug coverage.
