Page 5 - Summary of Benefits_MA_RPPO_7444-004
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AARP® MedicareComplete Choice® Essential (Regional
PPO)
dummy spacing In-Network Out-of-Network
Benefits
Inpatient Hospital $395 copay per day: for 40% coinsurance per
days 1-4 stay
$0 copay per day: for
days 5 and beyond
Our plan covers an unlimited number of days for an
inpatient hospital stay.
Outpatient Hospital 20% coinsurance 40% coinsurance
Cost sharing for Cost sharing for
additional plan covered additional plan covered
services will apply. services will apply.
Outpatient Hospital Observation 20% coinsurance 40% coinsurance
Services
Doctor Visits Primary $15 copay $45 copay
Specialists $50 copay $70 copay
Preventive Care Medicare-covered $0 copay $0 copay - 40%
coinsurance (depending
on the service)
Abdominal aortic aneurysm screening
Alcohol misuse counseling
Annual “Wellness” visit
Bone mass measurement
Breast cancer screening (mammogram)
Cardiovascular disease (behavioral therapy)
Cardiovascular screening
Cervical and vaginal cancer screening
Colorectal cancer screenings (colonoscopy, fecal
occult blood test, flexible sigmoidoscopy)
Depression screening
Diabetes screenings and monitoring
Hepatitis C screening
HIV screening
Lung cancer with low dose computed tomography
(LDCT) screening
Medical nutrition therapy services
Medicare Diabetes Prevention Program (MDPP)
PPO)
dummy spacing In-Network Out-of-Network
Benefits
Inpatient Hospital $395 copay per day: for 40% coinsurance per
days 1-4 stay
$0 copay per day: for
days 5 and beyond
Our plan covers an unlimited number of days for an
inpatient hospital stay.
Outpatient Hospital 20% coinsurance 40% coinsurance
Cost sharing for Cost sharing for
additional plan covered additional plan covered
services will apply. services will apply.
Outpatient Hospital Observation 20% coinsurance 40% coinsurance
Services
Doctor Visits Primary $15 copay $45 copay
Specialists $50 copay $70 copay
Preventive Care Medicare-covered $0 copay $0 copay - 40%
coinsurance (depending
on the service)
Abdominal aortic aneurysm screening
Alcohol misuse counseling
Annual “Wellness” visit
Bone mass measurement
Breast cancer screening (mammogram)
Cardiovascular disease (behavioral therapy)
Cardiovascular screening
Cervical and vaginal cancer screening
Colorectal cancer screenings (colonoscopy, fecal
occult blood test, flexible sigmoidoscopy)
Depression screening
Diabetes screenings and monitoring
Hepatitis C screening
HIV screening
Lung cancer with low dose computed tomography
(LDCT) screening
Medical nutrition therapy services
Medicare Diabetes Prevention Program (MDPP)
