MAPD 2027 plan HMO

Aetna Medicare Signature Legacy (HMO) H0523-022

Plan information effective January 1, 2027.

Aetna Medicare Plan ID H0523-022-000 Plan #22 MAPD

Plan costs & ratings

Monthly premium$10.00

Annual premium$120.00

Medical premium$0.00

Medical deductible$0

Drug premium$10.00

Drug deductible$700

Medical out-of-pocket limit (in network)$2,000

Part D annual out-of-pocket threshold$2,400

Availability

Available in 6 California counties

Kern County, CA, Los Angeles County, CA, Orange County, CA, Riverside County, CA, San Bernardino County, CA, San Diego County, CA

Available Cities

This plan is available in 269+ cities in California.

Benefits

Primary care In Network

In-Network $0

Inpatient hospital In Network

In-Network $150 per day, days 1-5; $0 per day, days 6-90

Skilled nursing In Network

In-Network $20 per day, days 1-20; $218 per day, days 21-100

Emergency care In Network

$150 If you are admitted to the hospital within 24 hours your cost share may be waived

Urgently needed care In Network

In-Network: $65 copay for Medicare-covered urgently-needed-care visits.

Ambulance In Network

In-Network $275

Dental In Network

In-Network Preventive dental services: $0 for oral exams $0 for cleanings $0 for x-rays Frequencies vary by covered dental service.

Vision In Network

In-Network Eye Exams: $0 for Medicare-covered eye exams $0 for non-Medicare covered routine eye exam Maximum one non-Medicare covered routine eye exam every calendar year with an EyeMed network provider Eyewear: $0 for Medicare-covered prescription eyewear $100 annual benefit amount (allowance) for non-Medicare covered prescription eyewear through an EyeMed network provider. $0 for Contacts $0 for Eyeglasses $0 for Eyeglass Frames $0 for Eyeglass Lenses $0 for Upgrades

Hearing In Network

In-Network Hearing Exams: $0 for Medicare-covered hearing exams $0 for non-Medicare covered hearing exams (Maximum one non-Medicare covered hearing exam every year) $0 for fitting/evaluation for hearing aids (Maximum one hearing aid fitting/evaluation every year) Hearing Aids: $0 for hearing aids $1,250 benefit amount (allowance) per ear, every year for hearing aids (Maximum two hearing aids every year)

Transportation In Network

In-Network: $275 copay

Fitness In Network

Fitness benefit that includes a basic membership to any SilverSneakers participating fitness facility. If you do not reside near a participating facility, or prefer to exercise at home, online classes and one at-home fitness kit per year are available through SilverSneakers at no additional cost to you.

Highlights

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Notes

Drug deductible details: $0 Deductible on Tier(s) 1, 2; $700 Deductible on Tier(s) 3, 4, 5
No

Plan Overview

CarrierAetna Medicare

Plan typeMAPD

PlanHMO

Marketing nameAetna Medicare

Drug coverageIncluded

Enrollment hours8 AM to 8 PM, local time, 7 days a week from 10/1 to 3/31; 8 AM to 8 PM, local time, Monday to Friday from 4/01 to 9/30

Provider searchOpen provider directory

Carrier websiteOpen website

Plan identifiers

Plan IDH0523-022-000

Plan number22

ContractH0523

Segment0

DRX ID1TL8405WZP

Carrier ID6

Formulary ID27013

Formulary versionversion 8<br/>(Formulary last updated 10/1/2026)

Carrier contact

Carrier phone8445096254

Enrollment phone8445096254

Enrollment TTY711

Carrier hours8 AM to 8 PM, local time, 7 days a week from 10/1 to 3/31; 8 AM to 8 PM, local time, Monday to Friday from 4/01 to 9/30

Network & documents

Preferred pharmacy networkYes

Preferred retail pharmacyYes

Preferred mail pharmacyYes

Mail drug benefitsYes

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