Search Aetna's Participating Provider Directory for federal employees. Start searching. Search by zip code and compare the plans that are available to you. Let us help you figure out the plan that's right for you. We're here to make. Aetna is extending all member cost-sharing and co-pay waivers for inpatient admissions for treatment of COVID-19 or health complications associated with COVID-19. Additionally, given the escalating mental health crisis resulting from or amplified by the pandemic, Aetna is extending all member cost-sharing waivers for in-network telemedicine.
Aetna, one of the nation’s largest insurers, purchased Coventry six years ago for more than $5 billion. Coventry offers plans in Pennsylvania through Health America. A wide range of Senior Medicare plans are offered, along with Medicaid Worker’s Compensation, and behavioral coverage.
Group coverage through small and large employers are also offered. Affordable monthly premiums are available with many flexible policy options. A large network helps provide physicians, specialists, medical facilities, and hospitals close to your home or work.
Advantra Insurance Medicare Plans In Pennsylvania
Advantra plans are issued through Coventry. Together, the two carriers offer managed care products, plans, and services to individuals, businesses, insurers, and government agencies. Although Advantra does not market Supplemental coverage, they do offer PPO and HMO Advantage plans. Shown below are the 2019 policy options:
Advantage Plans
Advantra Basic Medical – $0 monthly premium with $4,900 maximum out-of-pocket expenses. Primary care physician and specialist visit copays are $0 and $25. The in-hospital stay copay is $275 and the ER copay is $90. Lab services and diagnostic procedures have a $0 copay. X-rays have a $15 copay. $500 per ear hearing aid benefits are included.
Advantra Silver (PPO) – $27 monthly premium with $5,900 maximum out-of-pocket expenses and $750 deductible. Primary care physician and specialist visit copays are $5 and $35. The in-hospital stay copay is $275 and the ER copay is $90. Lab services and diagnostic procedures have $5 copays. X-rays have a $20 copay. $250 per year of preventative dental coverage is included. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), and $47 (Tier 3). Mail-order pharmacy copays are $0 (Tier 1), $0 (Tier 2), and $136 (Tier 3).
Advantra Silver (HMO) – $0 monthly premium with $6,700 maximum out-of-pocket expenses and $0 deductible. Primary care physician and specialist visit copays are $5 and $40. The in-hospital stay copay is $150 for 5 days and the ER copay is $90. Lab services and diagnostic procedures have $5 and $20 copays. X-rays have a $25 copay. $250 per year of preventative dental coverage is included. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), and $47 (Tier 3). Mail-order pharmacy copays are $0 (Tier 1), $0 (Tier 2), and $136 (Tier 3).
AdvantraOne – $0 monthly premium with $6,700 maximum out-of-pocket expenses and $1,500 deductible. Primary care physician and specialist visit copays are $35 and $50. The in-hospital stay copay is $275 and the ER copay is $90. Lab services and diagnostic procedures have $5 copays. X-rays have a $20 copay. $250 per year of preventative dental coverage is included. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), and $47 (Tier 3). Mail-order pharmacy copays are $0 (Tier 1), $0 (Tier 2), and $136 (Tier 3).
Advantra Choice Plan – $0 monthly premium with $6,700 maximum out-of-pocket expenses and $495 deductible. Primary care physician and specialist visit copays are $10 and $40. The in-hospital stay copay is $300 and the ER copay is $90. Lab services and diagnostic procedures have $5 and $15 copays. X-rays have a $35 copay. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), and $47 (Tier 3). Mail-order pharmacy copays are $0 (Tier 1), $0 (Tier 2), and $136 (Tier 3).
Advantra Gold (HMO) – $40 monthly premium with $4,900 maximum out-of-pocket expenses and $0 deductible. Primary care physician and specialist visit copays are $0 and $25. The in-hospital stay copay is $225 and the ER copay is $90. Lab services and diagnostic procedures have $0 copays. X-rays have a $10 copay. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), and $47 (Tier 3). Mail-order pharmacy copays are $0 (Tier 1), $0 (Tier 2), and $136 (Tier 3).
Advantra Gold (PPO) – $47 monthly premium with $5,900 maximum out-of-pocket expenses and $750 deductible. Primary care physician and specialist visit copays are $0 and $30. The in-hospital stay copay is $250 and the ER copay is $90. Lab services and diagnostic procedures have $0 copays. X-rays have a $15 copay. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), and $47 (Tier 3). Mail-order pharmacy copays are $0 (Tier 1), $0 (Tier 2), and $136 (Tier 3).
Covered By Coventry?
If you were covered by a Coventry Group policy through work, and that coverage ended, you may be eligible for a conversion to a personal policy and you would not have to qualify medically. Whether you are disabled or suffer from chronic disease, you may be automatically accepted. Typically, you have 31 days from receiving the notice and approximately 90 days from leaving your employer. Aetna healthcare plans in Pennsylvania, like Coventry, are not available on an individual basis to applicants under age 65.
Pa Exchange Options
Preventative coverage is included with no out of pocket costs or waiting period. Some of the included preventative coverage includes gynecological exams, adult physicals, routine mammograms, well-child visits and routine pediatric immunizations. There are many additional preventive benefits that can be found in a policy spec sheet.
Each year the Department of Health and Human Services reviews existing free services and often adds additional options. This should continue beyond 2019, regardless of which political party holds office. Some of the most recent additions are mandatory maternity benefits and breast-feeding counseling and information. These changes are part of the Affordable Care Act legislation.
Summary
HealthAmerica is one of many large reputable companies including United Healthcare, Highmark Blue Cross Blue Shield, UPMC, Capital Blue Cross, Independence Blue Cross and Aetna. Advantra Medicare Advantage plans continue to provide popular choices for Seniors.
To compare Pa Health America options, we have provided a free quote section on the top of the page. You’ll be able to review plans along with other reputable carriers and apply for a policy. We give you more than three decades of experience and the quickest methods to purchase the benefits you need.
Original Medicare is a federal health insurance program for seniors and people with certain disabilities. When a Medicare recipient requires emergency care, Medicare does cover emergency room visits for the most part, and the recipient pays a copayment.
Read on to learn more about emergency room costs and how a Medicare Supplement Insurance plan can help reduce what you pay out of pocket for Medicare emergency room coverage.
Your Benefits Resources Aetna Retiree
What is the Copay for Medicare Emergency Room Coverage?
A copay is the fixed amount that you pay for covered health services after your deductible is met. In most cases, a copay is required for doctor’s visits, hospital outpatient visits, doctor’s and hospital outpatients services, and prescription drugs. Medicare copays differ from coinsurance in that they're usually a specific amount, rather than a percentage of the total cost of your care.
Medicare does cover emergency room visits. You'll pay a Medicare emergency room copay for the visit itself and a copay for each hospital service. It is important to remember, however, that your actual Medicare urgent care copay amount can vary widely, depending on the services you require and where you receive care.
If you are admitted for inpatient hospital services after an emergency room visit, Medicare Part A does help cover costs for your hospital stay. Medicare Part A does not cover emergency room visits that don't result in admission for an inpatient hospital stay.
What Does Medicare Pay for Emergency Room Visits?
Medicare Part A emergency room coverage is specifically for inpatient hospital stays. If your emergency room visit requires you to be admitted for inpatient care, your Medicare Part A benefits would kick in but are subject to the Part A deductible and coinsurance.
Aetna Er Copay
Most ER services are considered hospital outpatient services, which are covered by Medicare Part B.They include, but are not limited to:
- Emergency and observation services, including overnight stays in a hospital
- Diagnostic and laboratory tests
- X-rays and other radiology services
- Some medically necessary surgical procedures
- Medical supplies and equipment, like splints, crutches and casts
- Preventive and screening services
- Certain drugs that you wouldn't administer yourself
NOTE: There's an important distinction to be made between inpatient and outpatient hospital statuses. Your hospital status affects how much you pay for services. Unless your doctor has written an order to admit you as an inpatient, you're an outpatient, even if you spend the night in the hospital.
How Medicare Part B Pays For Outpatient Services
Medicare Part B pays for outpatient services like the ones listed above, under the Outpatient Prospective Payment System (OPPS). The OPPSpays hospitals a set amount of money (or payment rate) for the services they provide to Medicare beneficiaries.
The payment rate varies from hospital to hospital based on the costs associated with providing services in that area, and are adjusted for geographic wage variations.
Other Medicare Costs
Aside from Medicare ER copays, there are other outpatient hospital costs that you should be aware of when visiting the emergency room, such as deductibles and coinsurance. In most cases, if you receive care in a hospital emergency department and are covered by Medicare Part B, you'll also be responsible for:
Aetna Copay Assistance
- An annual Part B deductible of $203 (in 2021).
- A coinsurance payment of 20% of the Medicare-approved amount for most doctor’s services and medical equipment.
Aetna Ppo Er Copay
How You Pay For Outpatient Services
In order for your Medicare Part B coverage to kick in, you must pay the yearly Part B deductible. Once your deductible is met, Medicare pays its share and you pay yours in the form of a copay or coinsurance.
Get Help Covering Your Emergency Room Copay
If you're worried about a trip to the emergency room adding expensive and unpredictable costs to your health care budget, consider joining a Medicare Supplement Insurance (or Medigap) Plan. Medigap is private health insurance that Medicare beneficiaries can buy to cover costs that Medicare doesn't, including some copays. All Medigap plans cover at least a percentage of your Medicare Part B coinsurance or ER copay costs.
To find a Medigap plan in your area, call 1-800-995-4219 to connect with a licensed insurance agent.
Does Medicare Part A cover emergency room visits?
If you opted out of Medicare Part B, and only have Part A, you may be wondering if you can get coverage for an emergency room visit. Medicare Part A is designed for hospital insurance, meaning that it's benefits are generally used once admitted to the hospital.
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