Tuesday, November 30, 2010

review of aetna US heathcare - Medicare HMO plan

Aetna US Healthcare (Medicare HMO)


For more information regarding Aetna US Healthcare's Medicare services, consult the chart below.

Benefits
Golden Medicare Plan
Golden Choice Plan (out-of-network benefit)
Doctor and Hospital Choice
You must go to network doctors, specialists, and hospitals.
You need a referral to go to network hospitals and certain doctors, including specialists forcertain services.
You do not need a referral to go to network doctors, specialists and hospitals.
You can go to doctors, specialists, and hospitals in orout of the network. Higher costs apply for out-of-network services.
Monthly Premium
$0-$25
$95-$130
Inpatient Hospital Care
$100-$150/day for days 1-5, $0 days 6-90
$350 for each Medicare-covered stay in a network hospital, no copayment for additional days in a network hospital, covered for unlimited days each benefit period
Skilled Nursing Facility
$20-$25/day for days 1-100 for Medicare-covered stay
No copayment, covered for 100 days each benefit period
Home Health Care
$20 for Medicare-covered visits
No copayment
Doctor Office Visits
$10-$30 for each primary care doctor office visit; $15-$35 for each specialist visit
$10-$20 for each primary care doctor office visit, $20 for each specialist visit
Prescription Drugs
You pay 100% for most prescription drugs; some plans offer $10 for each prescription or refill of generic drugs up to a 30-day supply and $20 for mail order generic drugs up to a 90-day supply
For each prescription or refill, $15 for generic drugs up to a 30-day supply, $30 for mail order generic drugs up to a 90-day supply
Routine Physical Exam
$10-$20 for each exam, covered for 1 exam every year
$20 for each exam, covered for 1 exam every year



For more information regarding Aetna US Healthcare, visit the company website at www.Aetna.com.

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Medicare physician fee schedule - Quick overview

Medicare Part B pays for physician services based on the PFS, which lists the more than 7,400 unique
covered services and their payment rates. Physicians’ services include the following:

* Office visits;
* Surgical procedures;
* Anesthesia services; and
* A range of other diagnostic and therapeutic services.


Medicare Physician Fee Schedule Payment Rates

Payment rates for an individual service are based on
three components:
1) Relative Value Units (RVU)
2) Conversion Factor (CF)
3) Geographic Practice Cost Indices (GPCI)


Medicare Physician Fee Schedule Payment Rates Formula


The Medicare PFS payment rates formula is shown below:

[(Work RVU x Work GPCI) + (PE RVU x PE GPCI) +
(MP RVU x MP GPCI)] x CF

Medicare fee schedule download