What Medicare Advantage Plans Does Aetna Offer?
This article was updated on: 05/28/2019
Aetna Medicare Advantage plans offer individuals eligible for Medicare coverage an alternative way to receive their Original Medicare benefits. By law, Aetna Medicare Advantage plans must cover everything included in Original Medicare (Part A and Part B), except for hospice care, which is still covered under Part A of the federal program; however, many plans offer additional benefits such as routine vision, dental, hearing care, and prescription drugs, with the convenience of having just one plan. Keep in mind that you’ll need to also keep paying your Part B premium.
There are many different Medicare Advantage plans, and Aetna, as a private insurance company approved by Medicare, can choose which plans to offer in each city or state. As such, not every plan will be offered in every location. In addition, specific plan benefits and monthly premiums may vary based on where you live.
What Aetna Medicare Advantage plans are available?
Depending on where you live, you may be able to enroll in one of the following types of Aetna Medicare Advantage plans:
Aetna Medicare Advantage HMO
Aetna Medicare Advantage HMO (Health Maintenance Organization) plans may have lower costs than other types of Medicare Advantage plans because they use a contracted provider network to keep health-care expenses low. Keep in mind the following details about Aetna Medicare Advantage HMO plans:
- You need to get all your health care in-network and follow your plan’s rules for specialist care, tests, and procedures carefully — or risk paying the full cost of your care. The exceptions are if you need emergency treatment or urgent care; in those cases, your Aetna MedicareAdvantage HMO will generally cover you even if you use a non-network provider.
- You’ll need to select a primary care doctor who will oversee all of your health care; your primary care doctor will give you a referral if you need to see a specialist.
- Most HMO plans cover prescription drugs (subject to the plan’s formulary, or approved prescription drug list). Keep in mind that formularies may change at any time; the Medicare plan will notify you if necessary.
Aetna Medicare Advantage HMO-POS
An HMO-POS (Point-of-Service) plan is a variation on the straight HMO model. In an Aetna Medicare Advantage HMO-POS plan, you may get certain approved services outside the plan’s provider network. Your out-of-pocket costs will be higher for these services, and you must still follow all other plan rules. You also need a primary care provider in this type of plan.
Aetna Medicare Advantage PPO
Aetna Medicare Advantage PPO (Preferred Provider Organization) plans* give you the flexibility to choose any doctor or hospital you like that accepts Medicare, but you save on your out-of-pocket costs if you use providers in the plan’s preferred provider network. Other features of an Aetna Medicare Advantage PPO include:
- There is no requirement to choose a primary care provider, and you don’t need a referral to see a specialist in most cases.
- Most Medicare Advantage PPOs cover prescription drugs.
- Similar to other types of Medicare Advantage plans, you may have more benefits than Original Medicare, including benefits that aren’t covered by the federal program, such as routine vision or dental.
Aetna Medicare Advantage SNP
A SNP (Special Needs Plan) is the most restrictive of the Aetna Medicare plans. SNPs limit enrollment to people with certain characteristics, including those with certain chronic or disabling diseases or conditions (such as diabetes or end-stage renal disease); those who live in institutions; or those with both Medicare and Medicaid coverage (also known as dual eligibles). You must meet the eligibility criteria that the SNP targets in order to enroll. Plan benefits, providers, and prescription drug coverage are designed around the needs of the people that the plan targets.
Other SNP features include:
- You’re generally required to have a primary care doctor or care coordinator to direct your overall health care; referrals are required for most specialist services.
- SNPs are required to cover prescription drugs.
- Membership is limited by Medicare rules to a) people who live in a nursing home or other institution or who need skilled nursing care at home, b) people who qualify for both Medicare and Medicaid, or c) people with qualifying chronic or disabling medical conditions. Aetna may choose to further limit membership in its SNPs.
As mentioned, Aetna Medicare Advantage plans may offer extra benefits not normally covered by Original Medicare, including prescription drug coverage and routine vision or dental benefits. If you’d like to learn more about Aetna Medicare plan options, visit the Aetna page to find coverage that may fit your needs.
* Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
**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.
ESPAÑOL (SPANISH): ATENCIÓN: Si usted habla español, se encuentran disponibles servicios gratuitos de asistencia de idiomas. Visite nuestro sitio web en www.aetnamedicare.com o llame al número de teléfono que se indica en este material.
繁體中文 (CHINESE): 請注意：如果您說中文，您可以獲得免費的語言協助服務。請造訪我們的網站www.aetnamedicare.com 或致電本材料中所列的電話號碼。