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Plan benefits & forms

Medicare plans have many different details and forms, so we’ve organized everything together into one convenient place.

 

Questions? Call ${groupPhoneNumber} ${tty}, ${memberhours}.

Aetna plan benefits & Star Ratings

We’re offering you a choice of four plans. All plans include — medical, prescription, hearing and vision benefit coverage. You can also see any provider (in network or out of network) who’s eligible to receive Medicare payment and willing to accept your plan at no extra cost.

 

Compare your plan options below. See a word or term you don't know? Check our glossary.

 

 

Premium

Premium

Mid-range

Value

Monthly premium

$275.52

$215.37

$131.02

$68.90

Pharmacy plan

Custom

Standard

Standard

Standard

Coinsurance

0%

0%

10%

20%

Deductible

$0

$0

$0

$0

Out of pocket maximum

$0

$0

$3000

$3400

Plan details

Premium

Monthly premium

$275.52

Pharmacy plan

Custom

Coinsurance

0%

Deductible

$0

Out of pocket maximum

$0

Plan details

Premium

Monthly premium

$215.37

Pharmacy plan

Standard

Coinsurance

0%

Deductible

$0

Out of pocket maximum

$0

Plan details

Mid-range

Monthly premium

$131.02

Pharmacy plan

Standard

Coinsurance

10%

Deductible

$0

Out of pocket maximum

$3000

Plan details

Value

Monthly premium

$68.90

Pharmacy plan

Standard

Coinsurance

20%

Deductible

$0

Out of pocket maximum

$3400

Plan details

Evidence of coverage, Star Ratings & Formulary

 

Review your Evidence of Coverage (EOC) to learn about comprehensive plan details, and your rights and responsibilities. You can request a copy of your Evidence of Coverage if you need one.

 

2021 Star Ratings – English (PDF)

 

Formulary – English (PDF)

Find Medicare forms

 

See below for helpful resources for managing your plan and how to get started with common requests.

 

 

File claims & reimbursement requests

Give someone permission to manage your care

Manage your medications

Exceptions, appeals & grievances

Additional information