How Can I Find Healthcare Providers that Accept Aetna’s Medicare Plans?
Last Updated : 10/21/20184 min read
How Can I Find Health-Care Providers that Accept Aetna’s Medicare Plans?
Aetna is a private company contracted with Medicare to provide benefits to beneficiaries under the Medicare Advantage program. Like many companies that offer Medicare plans, Aetna may require you to use certain providers to minimize your out-of-pocket health-care costs.
If you’re enrolled in an Aetna plan, this article will help you find Medicare providers in an Aetna network who may treat you.
Who are Aetna’s providers for Medicare Advantage plans?
If you are enrolled in a Medicare Advantage plan with Aetna, you may be required to get your health care from doctors and other providers who are in Aetna’s provider network and contracted with Aetna to treat their members. Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals.
Aetna’s network providers have agreed under contract to provide care for its members, usually at lower rates than they would otherwise charge you for the same services if you were not covered by Medicare Advantage plan through Aetna. These providers agree to accept your copayment or allowable coinsurance amount as payment in full for Medicare-covered services.
Depending on the plan you choose, you may be required to get all your care from providers in your Aetna Medicare Advantage plan network; you may have to pay in full (other than emergency treatment) for out-of-network care.
How do I find Aetna providers?
The easiest way to find contracted Aetna providers is to use Aetna’s online Medicare Advantage . You simply enter your location (zip code) and the type of medical provider you are looking for, and the tool lists Aetna’s Medicare providers in your area. You can also use Aetna’s provider search tool to find health-care facilities, pharmacists, and other professionals such as physical therapists. You can use the tool to search by health condition, as well.
Please note that even if you make an appointment with a provider listed in Aetna’s provider search tool, it’s important to confirm that he or she participates in your Medicare Advantage plan before you go to your appointment.
What happens if I don’t use Aetna’s providers?
If you’re enrolled in a Medicare Advantage plan through Aetna, and you choose to use a provider outside your plan’s provider network, one or more of the following things may happen:
- Your plan may pay less toward your care. Some plans do cover certain out-of-network services, while others pay nothing for non-emergency care outside the network.
- The fees for health services may be higher. This is because Aetna providers agree to accept a certain amount for your care. For example, if you usually pay 20% of the Medicare-approved cost for in-network care, you may be responsible for up to 50% of the cost for out-of-network care.
- Any amount you pay might not contribute to your plan deductible, if you have one.
- You may need preauthorization for any services you receive in order for any coverage to apply.
If you have any questions about your Aetna Medicare Advantage plan or how to find Aetna network providers, you can contact Aetna Customer Service at 1-800-282-5366 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days a week, from October 1 – February 14 and 8 a.m. to 8 p.m., local time, Monday – Friday, from February 15 – September 30.
*Aetna complies with applicable Federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. ATTENTION: If you speak a language other than English, free language assistance services are available. Visit our website at www.aetnamedicare.com or call the phone number listed in this material.
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