AARP Medicare Advantage (HMO-POS) H4590-042 2022 Plan Details and Costs (2023)

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AARP Medicare Advantage (HMO-POS)

AARP Medicare Advantage (HMO-POS) H4590-042 Plan Details

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Basic Costs and Coverage

Roof	Cost
monthly deductible	$ 0
out-of-pocket maximum	On the network:$ 4500 Off the grid:N / D
Initial Coverage Limit	$ 4660
Catastrophic Coverage Limit	$ 7.400
Primary care doctor visit	On the network: Visit to the doctor's office: Primary care office visit copayment$ 0,00
Visit to the specialist doctor	On the network: Medical specialty consultation: Copay specialist doctor's office visit$ 35,00 Prior authorization is required for the visit to the specialist doctor prior authorization is required
hospital care	On the network: Acute hospital services: $ 295,00per day for days 1 to 5 $ 0,00per day for days 6 to 90 Prior authorization is required for acute hospital services prior authorization is required
Urgent Care	urgent care copayment$ 40,00 Worldwide coverage: Copayment for Worldwide Emergency Coverage$ 0,00
Visit to the emergency room	Emergency care copayment$ 90,00 Co-payment waiver for Medicare-covered emergency care if you are admitted to the hospital within 24 hours Worldwide coverage: Copayment for worldwide emergency coverage$ 0,00 Worldwide emergency transport copayment$ 0,00
ambulance transport	On the network: land ambulance: Co-payment for ground ambulance services$ 250,00 Air Ambulance: Copayment for air ambulance services$ 250,00 Section B - General 10a Note - PERMIT NOTE: Permit is required for ground and air ambulance transport not covered by Medicare. Emergency ambulance does not require authorization. See Proof of Coverage for prior authorization rules. prior authorization is required

Health services and medical supplies

AARP Medicare Advantage (HMO-POS) covers additional benefits and services, some of which may not be covered by Original Medicare (Medicare Part A and Part B).

Roof	Cost
chiropractic services	On the network: Co-payment for Medicare-covered chiropractic services$ 20,00 Prior authorization is required for chiropractic services prior authorization is required
Diabetes supplies, training, nutritional therapy and monitoring	On the network: Copay for Medicare-covered diabetic supplies$ 0,00 Coinsurance for footwear or therapeutic inserts for Medicare-covered diabetics20% Prior authorization required for diabetic services and supplies prior authorization is required
Durable medical equipment (DME)	On the network: Coinsurance for Medicare-covered durable medical equipment20% Prior authorization is required for durable medical equipment prior authorization is required
Diagnostic exams, laboratory services and radiology and X-rays	On the network: Outpatient Diagnosis Processes/Exams/Laboratory Services: Co-payment for Medicare-covered diagnostic procedures/tests$ 20,00 Copay for Medicare-covered lab services$ 0,00 Prior authorization is required for outpatient laboratory/test/diagnostic processing services Outpatient radiodiagnostic/therapeutic services: Co-payment for Medicare-covered diagnostic radiology services$ 0,00a$ 125,00 Copayment for Medicare-covered therapeutic radiology services$ 60,00 Copayment for Medicare-covered X-ray services$ 15,00 Prior authorization is required for outpatient diagnostic/therapeutic services prior authorization is required
health care at home	On the network: Copayment for Medicare-covered home health services$ 0,00 Prior authorization is required for home health services prior authorization is required
Mental health care for inpatients	On the network: Psychiatric Hospital Services: $ 295,00per day for days 1 to 5 $ 0,00per day for days 6 to 90 Prior authorization is required for psychiatric hospital services prior authorization is required
Outpatient mental health care	On the network: Copay for individual sessions covered by Medicare$ 25,00 Copay for Medicare-covered group sessions$ 15,00 Prior authorization is required for outpatient mental health services prior authorization is required
Ambulatory Services / Surgery	On the network: Outpatient Hospital Services: Copayment for Medicare-covered outpatient hospital services$ 0,00a$ 295,00 Prior authorization is required for outpatient hospital services Outpatient Observation Services: Copayment for Medicare-covered observation services: per day$ 295,00 Prior authorization is required for outpatient observation services Ambulatory Surgical Center Services: Copayment for outpatient surgical center services$ 0,00a$ 225,00 Prior authorization is required for outpatient OR services prior authorization is required
Outpatient Substance Abuse Treatment	On the network: Copay for individual sessions covered by Medicare$ 25,00 Copay for Medicare-covered group sessions$ 15,00 Prior authorization is required for outpatient substance abuse services prior authorization is required
Over-the-counter (OTC) items	On the network: Over-the-counter (OTC) items: Copay for over-the-counter (OTC) items$ 0,00 Maximum plan benefit$ 60,00every three months Nicotine replacement therapy (NRT) offered as an OTC Part C benefit
podiatry services	On the network: Copay for Medicare-covered podiatry services$ 35,00 Routine foot care copay$ 35,00 Maximum 6 visits per year Prior authorization is required for podiatry services prior authorization is required
Care in a specialized nursing unit	On the network: Skilled Nursing Facility Services: $ 0,00per day during days 1 to 20 $ 196,00per day during days 21 to 43 $ 0,00per day for days 44 to 100 Prior authorization is required for specialized services in nursing facilities prior authorization is required

dental benefits

The following dental services are covered by in-network providers.

Roof	Cost
Dental care	On the network: Preventive dentistry: Copay for oral exams$ 0,00 Maximum 2 visits per year Copay for Prophylaxis (Cleaning)$ 0,00 Maximum 3 visits per year Co-payment of fluoride treatment$ 0,00 Maximum 2 visits per year Copayment for dental x-rays$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) Maximum plan benefit$ 1.000,00each year for preventive services and services not covered by Medicare combined Comprehensive Dentistry: Coinsurance for Medicare-covered benefits20% Copay for non-routine services$ 0,00 Co-payment of diagnostic services$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) Copayment for Restorative Services$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) root canal copayment$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) Copay for Periodontics$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) Copayment for Extractions$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) Copay for dental prosthesis, other oral and maxillofacial surgeries, other services$ 0,00 Maximum 1 visit (see Evidence of Coverage for details) Maximum plan benefit$ 1.000,00each year for preventive services and services not covered by Medicare combined Prior authorization is required for comprehensive dental services prior authorization is required POS (off-network): Dental services not covered by Medicare: Copayment for preventive dental services not covered by Medicare$ 0,00 Co-payment for comprehensive dental services not covered by Medicare$ 0,00

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Cost

Dental care

On the network:

Preventive dentistry:
Copay for oral exams$ 0,00

Maximum 2 visits per year

Copay for Prophylaxis (Cleaning)$ 0,00

Maximum 3 visits per year

Co-payment of fluoride treatment$ 0,00

Maximum 2 visits per year

Copayment for dental x-rays$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

Maximum plan benefit$ 1.000,00each year for preventive services and services not covered by Medicare combined

Comprehensive Dentistry:
Coinsurance for Medicare-covered benefits20%
Copay for non-routine services$ 0,00
Co-payment of diagnostic services$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

Copayment for Restorative Services$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

root canal copayment$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

Copay for Periodontics$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

Copayment for Extractions$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

Copay for dental prosthesis, other oral and maxillofacial surgeries, other services$ 0,00

Maximum 1 visit (see Evidence of Coverage for details)

Maximum plan benefit$ 1.000,00each year for preventive services and services not covered by Medicare combined
Prior authorization is required for comprehensive dental services
prior authorization is required

POS (off-network):

Dental services not covered by Medicare:
Copayment for preventive dental services not covered by Medicare$ 0,00
Co-payment for comprehensive dental services not covered by Medicare$ 0,00

vision benefits

The following vision services are covered by network providers.

Roof	Cost
vision benefits	On the network: Eye exams: Copayment for Medicare-covered benefits$ 0,00 Copay for routine eye exams$ 0,00 Maximum of 1 routine eye examination per year Prior authorization is required for eye exams Cups: Copayment for Medicare-covered benefits$ 0,00 contact lens co-payment$ 0,00 Glasses co-payment (lenses and frames)$ 0,00 Maximum 1 pair per year Maximum plan benefit$ 200,00every year for all eyeglasses not covered by Medicare prior authorization is required

Roof

Cost

vision benefits

On the network:

Eye exams:
Copayment for Medicare-covered benefits$ 0,00
Copay for routine eye exams$ 0,00

Maximum of 1 routine eye examination per year

Prior authorization is required for eye exams

Cups:
Copayment for Medicare-covered benefits$ 0,00
contact lens co-payment$ 0,00
Glasses co-payment (lenses and frames)$ 0,00

Maximum 1 pair per year

Maximum plan benefit$ 200,00every year for all eyeglasses not covered by Medicare
prior authorization is required

auditory benefits

The following hearing services are covered by network providers.

Roof	Cost
auditory benefits	On the network: Hearing Tests: Copayment for Medicare-covered benefits$ 0,00 Copay for routine hearing tests$ 0,00 Maximum 1 visit per year Prior authorization required to perform hearing tests Headphones: hearing aid copayment$ 175,00a$ 1.225,00 Maximum 2 hearing aids per year Prior authorization is required for hearing aids Section B - General 18b Note - COST SHARING NOTE: Co-payments range from a minimum co-payment of$ 175to a maximum of$ 1.225 based on features and style. NOTE ON COMBINED COVERAGE FOR HEARING AID BENEFITS: A member may purchase a total of two hearing aids per year. prior authorization is required

Roof

Cost

auditory benefits

On the network:

Hearing Tests:
Copayment for Medicare-covered benefits$ 0,00
Copay for routine hearing tests$ 0,00

Maximum 1 visit per year

Prior authorization required to perform hearing tests

Headphones:
hearing aid copayment$ 175,00a$ 1.225,00

Maximum 2 hearing aids per year

Prior authorization is required for hearing aids
Section B - General 18b Note - COST SHARING NOTE: Co-payments range from a minimum co-payment of$ 175to a maximum of$ 1.225 based on features and style. NOTE ON COMBINED COVERAGE FOR HEARING AID BENEFITS: A member may purchase a total of two hearing aids per year.
prior authorization is required

Preventive services and health/wellness education programs

The following services are covered by in-network providers.

Roof	Cost
Preventive services and health/wellness education programs	On the network: $ 0,00copayment for preventive services covered by Medicare: Abdominal aortic aneurysm screening Counseling and Screening for Alcohol Abuse Bone mass measurements (bone density) Cardiovascular disease screening Cardiovascular disease (behavioral therapy) Cervical and vaginal cancer screening Colorectal Cancer Tests depression exams diabetes exams Diabetes self-management training glaucoma tests Screening for hepatitis B infection (HBV) Hepatitis C screening HIV screening lung cancer screening Mammograms (screening) Nutritional therapy services. Obesity screening and counseling Welcome to the Medicare Single Preventive Visit Prostate cancer screening tests (PSA) Screening and counseling in sexually transmitted infections Shots: vaccines for covid-19 flu shots Hepatitis B vaccines pneumococcal vaccines Cessation of tobacco use Visita anual "Wellness"

Roof

Cost

Preventive services and health/wellness education programs

On the network:
$ 0,00copayment for preventive services covered by Medicare:

Abdominal aortic aneurysm screening
Counseling and Screening for Alcohol Abuse
Bone mass measurements (bone density)
Cardiovascular disease screening
Cardiovascular disease (behavioral therapy)
Cervical and vaginal cancer screening
Colorectal Cancer Tests
depression exams
diabetes exams
Diabetes self-management training
glaucoma tests
Screening for hepatitis B infection (HBV)
Hepatitis C screening
HIV screening
lung cancer screening
Mammograms (screening)
Nutritional therapy services.
Obesity screening and counseling
Welcome to the Medicare Single Preventive Visit
Prostate cancer screening tests (PSA)
Screening and counseling in sexually transmitted infections
Shots:

vaccines for covid-19

flu shots

Hepatitis B vaccines

pneumococcal vaccines

Cessation of tobacco use
Visita anual "Wellness"

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