Aetna Medicare Advantage Plans and Benefits

Posted on

Medicare Advantage Plans are plans which are offered by Aetna Medicare. If you want to enroll in the plans, you have to know many things about the plans. Here, I have the information about Aetna Medicare Advantage plans for you according to the Aetna Medicare website.

As explained on the Aetna Medicare site, Aetna Medicare Advantage plans take a total approach to health and their Part C plans often include prescription drug coverage and extra benefits.

Medicare Advantage HMO Plans

If you choose Medicare Advantage HMO plans, you choose a main care physician who can help coordinate your care in a network of doctors and hospitals. It is Medicare coverage which is able to help you get the right care at the right time so that you are able to get your best health.

You may want to know how Medicare Advantage HMO plans work. A HMO or Health Maintenance Organization will give you access to a network of doctors and hospitals that you need to use in most cases. There are some HMO plans which require you to be able to get a referral from a main care physician for hospital care and specialist visits. It is also explained that there are typically limited out-of-network benefits with an HMO plan.

Medicare Advantage HMO-POS Plans

If you choose these plans, you are able to enjoy all the benefits of getting care through a network provider. Usually, you choose a primary care physician and most of the Aetna Medicare HMO-POS plans require you to use a participating provider for  medical care. Most HMO-POS in Aetna Medicare provide you with flexibility to go to licensed dental providers in or out of their network for routine dental care. When you go out of the network, you may pay more.

Medicare Advantage PPO Plans

If you choose these plans, you are able to visit Medicare-approved providers, in or out of Aetna’s provider network who accept plan terms of Aetna. This is Medicare coverage that gives you the freedom to choose.

PPO or Preferred Provider Organization plans allow you to choose any provider who can accept Medicare. You will not need a referral from a primary care physician for specialist or hospital visits. Note that if you use providers in your plan’s network, it may cost less.

Aetna Medicare Advantage at a Glance Including the Benefits

According to the Aetna Medicare site, here is the information about Aetna Medicare Advantage at a glance including the benefits.

Aetna Medicare HMO Plans Aetna Medicare HMO-POS Plans Aetna Medicare PPO Plans
Does it require you to use a provider network? Yes, unless it is an emergency Varies by plan. If you see out-of-network providers, generally it costs more. However, most permit non-network dental providers. No, but if you see out-of-network providers, it generally costs more.
Does it require you to have a primary care physician (PCP)? Yes, in many plans Yes, in many plans Usually no PCP required
Does it require a referral to see a specialist? Some plans Some plans No referral required
Monthly premiums Varies by plan. You can check your ZIP code for details. Varies by plan. You can check your ZIP code for details. Varies by plan. You can check your ZIP code for details.
Medical deductible Varies by plan. You can check your ZIP code for details. Varies by plan. You can check your ZIP code for details. Varies by plan. You can check your ZIP code for details.
Does it limit what you pay out-of-pocket for medical care each year? Yes Yes Yes
Does it include prescription drug (Rx) coverage Yes, in most plans Yes, in most plans Yes, in most plans
Does it include Rx mail-order benefit? Yes, if plan has Rx coverage Yes, if plan has Rx coverage Yes, if plan has Rx coverage
Does it include dental, vision and hearing coverage? Yes, in most plans Yes, in most plans Yes, in most plans
Do ER and urgent care coverage worldwide? Yes Yes Yes
Is there Fitness benefit? Yes, through SilverSneakers Yes, through SilverSneakers Yes, through SilverSneakers
Over-the-counter (OTC) benefit Yes, in many plans Yes, in many plans Yes, in many plans
Meals-at-home program (meals sent after an inpatient hospital or skilled nursing facility stay) Yes, in many plans Yes, in most plans Yes, in most plans

Medicare Advantage Dual Special Needs Plans (D-SNP)

Let’s say that you are eligible for Medicare and Medicaid. If so, you may be eligible for an Aetna Dual Special Needs Plan (D-SNP) and it includes a personal care team at low or even no cost. To check whether you are eligible or not, you are able to call 1-855-335-1407 (TTY:711). And the explanation about the benefits and resources is below.

Your personal care team is here to be able to give you help to get the most out of your benefits including the things below.

  • They learn your individual needs.
  • They help you to understand your medications.
  • They develop a care plan with your doctor.
  • They coordinate visits to the dentist, doctors and other health care providers.

A D-SNP also offers more than you can get from Original Medicare. Those offers are listed below.

  • Dental services
  • Permission for over-the-counter products
  • Prescription drugs
  • Eyeglasses and hearing aids

Note that benefits vary by plan.

There is a D-SNP education guide which will give you the information that you need to make an informed choice.

Let’s say that you have Medicare and Medicaid and you live in one of the states below. If so, you may qualify for a D-SNP.

California, Colorado, Connecticut, Delaware, Florida, Alabama, Arkansas, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Nebraska, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, Mississippi, Missouri, Texas, Virginia, West Virginia

Well, that’s the information that I can give to you about Aetna Medicare Advantage Plans and Benefits where the information was taken from the website of Aetna Medicare. So, if you want to get more information related to Aetna Medicare, it is better for you to access the official website of Aetna Medicare so that you will get the information completely.

Leave a Reply

Your email address will not be published.