Page 67 - Cover Letter and Evaluation for Mike Peaseley
P. 67
11/17/2017 Your Medicare Health Plan Comparison
Durable medical equipment (e.g., Durable medical equipment (e.g.,
Medical equipment/supplies wheelchairs, oxygen): In-Network: 20% wheelchairs, oxygen): In-Network: 20%
per item per item
Out-of-Network: 45% per item Out-of-Network: 40% per item
Prosthetics (e.g., braces, artificial limbs): In- Prosthetics (e.g., braces, artificial limbs): In-
Network: 20% per item Network: 20% per item
Out-of-Network: 45% per item Out-of-Network: 40% per item
Diabetes supplies: In-Network: 0-20% per Diabetes supplies: In-Network: 0-20% per
item item
Out-of-Network: 0-20% per item Out-of-Network: 0-20% per item
Covered Covered
Wellness programs (e.g., fitness,
nursing hotline)
Chemotherapy: In-Network: 20% Chemotherapy: In-Network: 20%
Medicare Part B drugs Out-of-Network: 45% Out-of-Network: 40%
Other Part B drugs: In-Network: 20% Other Part B drugs: In-Network: 20%
Out-of-Network: 45% Out-of-Network: 40%
View Less
Benefits Services
Hearing Aetna Medicare Choice Plan (PPO) Aetna Medicare Select Plan (PPO)
Hearing exam In-Network: $50 In-Network: $40
Out-of-Network: 45% Out-of-Network: 40%
Fitting/evaluation In-Network: $50 In-Network: $40
Out-of-Network: 45% Out-of-Network: 40%
There may be limits on how much the plan There may be limits on how much the plan
will provide. will provide.
Hearing aids - inner ear Not covered Not Available
Hearing aids - outer ear Not covered Not Available
Hearing aids - over the ear Not covered Not Available
Hearing aids Not Available In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan
will provide.
Preventive Dental Aetna Medicare Choice Plan (PPO) Aetna Medicare Select Plan (PPO)
Oral exam Not covered In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan
will provide.
Cleaning Not covered In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan
will provide.
Fluoride treatment Not covered In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan
will provide.
Dental x-ray(s) Not covered In-Network: $0 copay
Out-of-Network: $0 copay
There may be limits on how much the plan
will provide.
Comprehensive Dental Aetna Medicare Choice Plan (PPO) Aetna Medicare Select Plan (PPO)
Non-routine services Not covered Not covered
Diagnostic services Not covered Not covered
Restorative services Not covered Not covered
Endodontics Not covered Not covered
Periodontics Not covered Not covered
Extractions Not covered Not covered
Prosthodontics, other oral/maxillofacial Not covered Not covered
surgery, other services
https://www.medicare.gov/find-a-plan/results/planresults/plan-compare.aspx#plan_benefits 3/9
