Aetna Cont.

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

* Aetna US Healthcare chart reproduced from www.thehealthinsurance.com

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