For those who have an Aetna Medicare Advantage plan, you may be wondering how to find Aetna Medicare providers or doctors who accept your plan. Actually, finding Aetna’s Medicare providers can be easier than you thought. Well, keep reading this entire article until you get the information you need.
Medicare Coverage in the Networks of Aetna Medicare
Need to know that Medicare Advantage plans from Aetna may have provider networks. If you have an Aetna Medicare Advantage plan, you may need to visit only Aetna doctors or risk paying more for your care. This is not unique to Aetna plans. It will be able to be true of Medicare Advantage plans from any medicare-approved insurance company.
Apparently, Medicare Advantage plans come in some different types. Several of the more common Medicare Advantage plans are PPOs (preferred provider organizations) and HMOs (health maintenance organizations). Usually, Aetna Medicare HMO plans need you to use in-network doctors, as HMO plans usually do. Generally, Aetna Medicare PPO plans have provider networks, but typically let you visit providers outside the Aetna provider network. And you may have to pay more to see out-of-network providers.
Therefore, it will be a good idea to discover an Aetna doctor before you sign up for an Aetna Medicare Advantage plan. That way you are able to select the Aetna doctor that you want and be ready from day one of your coverage under the plan.
Finding Aetna Doctor Near Me
Here is how to find a doctor near you who is in an Aetna Medicare Advantage plan network. You are able to get started right here.
- At the first step, you have to enter your ZIP code in the box on this page and click Enter.
- After that, you have to ensure the Medicare Advantage tab near the top of the page is selected. Just click this tab if it is not already selected.
- Now, you are able to compare the available Aetna Medicare Advantage plans. Or you are able to find the plan you are enrolled in.
Do not worry, no matter which Aetna Medicare Advantage plan you sign up for, you will be able to count on Aetna’s careful selection of doctors. Keep in mind that if you enroll in any Medicare Advantage plan, you have to keep paying your Medicare Part B premium, together with any premium your plan may charge.
Need to know that Aetna Medicare is a HMO and PPO plan with a Medicare contract. eHealth Medicare’s SNP has contracts with State Medicaid programs. Enrollment in their own plans depends on the contract renewal. Participating doctors/physicians, hospitals and other health care providers are independent contractors. And they are not agents or employees of Aetna. The availability of any particular provider will not be able to be guaranteed. While the provider network composition can change anytime. Just view Evidence of Coverage for a complete description of plan benefits, limitations, exclusions, and conditions of coverage. Plan features and availability will vary by service area.
Also, you have to know that non-contracted providers do not have an obligation to treat the members of Aetna, except in emergency conditions. You are able to call Aetna’s customer service number or check your Evidence of Coverage for more information, including the cost- sharing which applies to out-of-network services.
New to Aetna’s Medicare Plans? Here is What You Need to Know
Here are some information you need to know if you are new to Aetna’s Medicare Plans:
When does Aetna Medicare plan coverage begin?
This will depend on when you enrolled in your plan. Lots of people select Medicare plans from Aetna during the Initial Enrollment Period that begins three months before your 65th birthday month. If you sign up in the three months before your birthday, then your coverage begins on the first day of the month in which you turn 65 years old.
Do I need to select a primary care doctor with Medicare plans from Aetna?
Aetna will be able to offer both Medicare Advantage HMO and PPO plans. If you enrolled in one of the HMO Medicare plans from Aetna, usually you are going to select a primary care physician to oversee your health care. You will need to obtain all your routine care within your plan’s network. Also, you need to obtain a referral or prior authorization for specialist care.
You are able to choose your primary care physician when you enroll in a plan, or by calling the number on your ID card after you receive it. You will be able to change your primary care physician. Just check the website to know which doctors in your area participate in Medicare plans from Aetna. If you are enrolled in an Aetna Medicare Advantage PPO plan, usually you do not need to select a primary care physician or get your care from providers within the plan’s network. But, you may save money, if you use the plan’s preferred providers.
Do Medicare plans from Aetna cover the prescription drugs?
After you enroll in one of the Medicare plans from Aetna, usually you are going to receive your ID cards, an introductory letter, evidence of coverage documents, and your plan formulary. Actually, the formulary is a list of medications covered by your plan, and how much of a copayment or coinsurance you pay for each. If you have mail order pharmacy benefits, you also are going to get information on how to fill your prescriptions by using this service. Typically, these documents will arrive within the first two weeks after you enroll in a plan.
Can I utilize Medicare plans from Aetna anywhere in the United States?
If you enrolled in an Aetna Medicare Advantage HMO (health maintenance organization), usually you are only able to use your plan for emergency care outside your plan’s coverage area. If you enrolled in a PPO (preferred provider organization), usually you are able to use your plan anywhere where Medicare plans from Aetna are accepted, even though you pay more for your care.