Aetna Medicare Advantage Plan Benefits

What Do Aetna Medicare Advantage Plans Offer

Aetna Medicare Advantage plans vary based on your location, but many plans offer opportunities to make access to your day-to-day necessities as simple as possible.

Generally, Medicare Advantage plans offer private health insurance through Medicare and provide common benefits that original Medicare does not. Aetna is one of the most popular Medicare Advantage providers, with a clear focus on your overall well-being.

Costs Of Medicare Advantage From Aetna

Ideally, the cost of Medicare Advantage plans will vary with what your present situation is. The cost of the plan for a person who is taking cover from the provider within the network may vary from the person whos taking coverage outside the network.

Apart from the plans cost, the copayments, coinsurance, and even the deductibles changes from plan to plan. You can find plans from Aetna asking for a $0 premium. However, youll have to pay for the premium of your Part B if you want to pay a $0 premium.

You should know that theres an annual out-of-pocket amount or maximum for Aetnas Advantage plans similar to other Advantage plans. This way you will always know the maximum amount which is to be paid in a year.

With every Advantage plan from Aetna, youll also get a document stating all the information regarding the benefits and costs. This Evidence of Coverage document can help you refer to detailed information in case of some confusion.

Hmo Point Of Service Plans

Aetnas Medicare Advantage HMO Point of Service plans also offer the benefits of coordinated care through a primary care physician.

Members have the flexibility to choose out-of-network providers for some services, though this is likely to be at a higher cost.

Aetna HMO-POS plans do not require a person to use in-network health services. In some plans, members will need to select a primary care physician.

Aetna HMO-POS plan benefits include:

• prescription drug coverage and mail-order benefits
• dental, vision, and hearing cover
• worldwide emergency care cover

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Advantage Plans By Aetna

The majority of health maintenance organizations require members to have a primary care physician who assists in the coordination of care and serves as a gatekeeper to other healthcare options. Aetna facilitates its members in this regard. If members of Aetnas Medicare Advantage HMO need to see a specialist, it is possible that they will be required to obtain a referral.

The use of Aetnas HMO plans, with the exception of emergency care, requires members to access health care through a predetermined network of providers. Many of these plans are reasonably priced, in addition to providing pharmacy benefits and other extra benefits.

In the majority of cases, advantage plans have HMO or PPO networks with stringent rules. Members of an HMO network are required to select a primary care physician who will coordinate a referral to a specialist if the need for one arises.

The majority of Medicare HMO networks treat patients only through network providers, with the exception of emergencies. This contrasts with the majority of Medicare PPO networks, which allow patients to see doctors from outside the network. PPO networks, on the other hand, require you to pay a higher out-of-pocket expense.

Aetna Medicare Advantage Plans

Aetna Medicare Advantage plans provide your Medicare coverage and other optional benefits in one simple plan.

Plans include the same benefits as Original Medicare and may include prescription drug coverage. You may get even more benefits and services not covered by Original Medicare. Some examples include routine dental care, vision, wellness programs and a 24/7 nurse hotline.

Over 2.6 million people were enrolled in an Aetna Medicare Advantage plan in 2020.1

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D Prescriber Enrollment Requirement

Any health care professional who prescribes drugs to patients with Part D plans must now enroll in the Medicare program or opt out. If you do not enroll or opt out, Medicare Part D may no longer cover these drugs as of February 1, 2017. Please try to enroll or opt out by November 1, 2016. This will allow time for application processing and ensure that patients get their prescriptions without disruption.

Find what you need to know about submitting a dispute or appealing a decision.

Learn More About Medicare Part D

Medicare Part D is prescription drug coverage, which can be combined with other Medicare health insurance. Part D plans are offered by health insurance companies which are approved by the federal government.

It is optional to add a Part D plan to Original Medicare Part A and B, Medicare Supplement Insurance plans, or Part C – Medicare Advantage plans .

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Rcbp With Medicare And Aetna Medicare Advantage For Rcbp Benefit Comparison

The first column is a summary of the RCBP High Option when Medicare Parts A and B are your primary coverage. RCBP waives your calendar year deductible and most copayments and coinsurance, except for prescription drugs, and pays Medicares deductible and coinsurance for services covered by both Medicare and RCBP. Do not rely on this chart alone. All benefits are fully described in the official Plan Brochure .

Aetna is the brand name used for products and services provided by one or more of the Aetna group of subsidiary companies, including Aetna Life Insurance Company and its affiliates . Aetna Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice.

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Aetna Medicare Advantage Plans Review

Is an Aetna Medicare Advantage Plan a good fit for you?

• V.

Quick Aetna Medicare Advantage Plans Review

Aetna, an award-winning health insurance company, was founded in 1853 in Hartford, Connecticut, and is a subsidiary of CVS Health Corporation. Its the third-largest health insurance provider in the nation, with approximately 22.1 million members. It offers affordable monthly premiums and low copays, and it has consistently positive customer feedback. By reviewing Aetnas available plans and assessing its benefits and drawbacks, you can determine whether Aetna is right for you.

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Preferred Provider Organization Plans

Aetnas Medicare Preferred Provider Organization plans allow members to visit any provider without a referral. When someone uses in-network services, they need not make a claim, and the cost is lower.

With some Aetna PPO plans, the member can choose a primary care physician. This can save on costs.

Aetna PPO plans do not require a person to use in-network health services or select a primary care physician.

Aetna PPO plan benefits include:

• prescription drug coverage and mail-order benefits
• dental, vision, and hearing cover
• worldwide emergency care cover

Aetna recently expanded their plan options. They now offer individual MAPD plans in 45 states, plus Washington, D.C.

Other new plans include:

• Prescription Drug Plan: There are two new individual plans, called SilverScript Choice and SilverScript Plus. Both plans have $0 tier 1 copay at select pharmacies. Standard tier 1 copay is $15.
• Dual Eligible Special Needs Plan : A total of 14 states now offer DSNP plans for people who qualify for Medicare and Medicaid benefits.
• Medicare supplement: Aetna now offer options for Medicare supplement plans in 45 states. These plans allow people to customize their plans to suit their health needs.
• Group Medicare: This is available to businesses in all 50 states. It includes virtual behavioral healthcare via phone and video chat.

Most Aetna Medical Advantage plans offer a range of benefits, though these can vary by plan.

Benefits include:

Browse Advantage Plans From Aetna

You can simply click to the right, or call us today to browse Aetna Medicare advantage plans. Just click the View Plans button to access our plan finder, and itll help you with the rest. Also, theres an option where you can input the prescription drugs.

You can even apply online!

It will help you find the Advantage plans that cover those prescription drugs.

You can think of Aetnas plans as a PPO or HMO plan having a Medicare contract. Aetnas SNP plans to have contracts with the Medicaid programs of the state. And the enrollment usually depends on the renewal of the contract.

However, you should know that all the hospitals, healthcare workers, physicians involved in the coverage are independent/private contractors. So, Aetna never guarantees the availability of the providers.

The provider network can also change from time to time.

Therefore, you should always consider the Evidence of coverage to determine all the plan benefits, limitations, conditions, and inclusions. The availability of plans and benefits it offers may vary with locations.

Another important thing to note is that the non-contracted or providers that are outside the network are never obligated to treat the enrollees of Aetna. Emergency situations are an exception here, though.

Or just call us today to get the help you need!

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Find Your Aetna Medicare Advantage Plan

• TTY: 711, 24/7

Aetna-MedicareAdvantage.com is owned and operated by TZ Insurance Solutions LLC, a licensed insurance agency.

1. Kaiser Family Foundation A Dozen Facts About Medicare Advantage in 2020 Published Jan. 13, 2021

$0 premium plans may not be available in all areas

Aetna Medicare is an HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov. This information is available for free in other languages.

Not all plans or products are available in all markets. Additional plans may be available in your service area.

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Medical Benefits On Aetna Medicare Advantage

Aetna Medicare Advantage plans include Health Maintenance Organization Plans , Preferred Provider Organization Plans , Special Needs Plans , Dual-Eligible Special Needs Plans , and Health Maintenance Organization-Point Of Service Plans .

While original Medicare does not cover vision and hearing care, many of Aetnaâs Medicare Advantage plans do. Several of Aetnaâs plans also include routine dental care and Medicare Part D prescription drug coverage. Some plans even include prescription home delivery, 24/7 access to Aetnaâs âAsk a Nurseâ phone hotline, and a flu shot benefit.

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Learn More About Medicare Supplement Insurance Plans In Colorado

Medicare Supplement Insurance Plans cover costs not included in Original Medicare Part A and Part B, including deductibles, copays, and coinsurance. Medicare Supplement Insurance Plans are also known as Medigap, because they cover the gaps in Part A and B. Although Original Medicare is administered by the federal government, Medigap plans are offered by health insurance companies approved by the federal government.

Get Advice & Sign Up Help

Speak with a Licensed Insurance Agent

No obligation to enroll. Find your plan online or speak with a licensed insurance agent to get help signing up for the right plan for you! Plan availability depends on your location. Licensed agents may not be able to provide assistance for all plans shown on this site.

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Healthplanradar.com is for research purposes only. Information and figures shown on Healthplanradar.com are based on publicly available information from healthcare.gov and medicare.gov. By using Healthplanradar.com you agree to our Terms of Service and Privacy Policy.

Healthplanradar.com is owned and operated by a private company, Amabo LLC, and is not affiliated with the federal government health insurance marketplace healthcare.gov or state-based marketplaces. Healthplanradar.com is not connected with or endorsed by the United States federal government or the federal Medicare program. For official federal government information, please visit Healthcare.gov or Medicare.gov .

Applied Behavior Analysis Medical Necessity Guide

The Applied Behavior Analysis Medical Necessity Guide helps determine appropriate levels and types of care for patients in need of evaluation and treatment for behavioral health conditions. The ABA Medical Necessity Guide does not constitute medical advice. Treating providers are solely responsible for medical advice and treatment of members. Members should discuss any matters related to their coverage or condition with their treating provider.

Each benefit plan defines which services are covered, which are excluded, and which are subject to dollar caps or other limits. Members and their providers will need to consult the member’s benefit plan to determine if there are any exclusions or other benefit limitations applicable to this service or supply.

The conclusion that a particular service or supply is medically necessary does not constitute a representation or warranty that this service or supply is covered for a particular member. The member’s benefit plan determines coverage. Some plans exclude coverage for services or supplies that Aetna considers medically necessary.

Please note also that the ABA Medical Necessity Guide may be updated and are, therefore, subject to change.

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Why Get Aetna Medicare Advantage Plans

HMO and PPO plans are available through Aetna Medicare for their members. They have also negotiated contracts with state Medicare programs and are in effect. Contract renewal is a requirement for enrollment in their programs. SilverScript is a Medicare-approved Prescription Drug Plan marketed by Aetna Medicare. Contract renewal is also a factor in SilverScript enrollment. An additional perk of signing up for the Aetna Medicare plan is that it includes extra benefits for retired individuals.

Their retiree benefits have resulted in the following fascinating facts about Aetna medicare advantage plans:

1- A 73% decrease in the occurrence of life-threatening diabetic complications

2- Spending on inpatient hospital services is reduced by 7 percent with the Aetna medicare program for retirees

3- Reduced use of emergency rooms by 33 percent

4- Members with a 90% or higher satisfaction rating

5- A 29 percent decrease in hospitalizations due to the Aetna medicare advantage program

Transition Of Coverage For Part D

Members who are taking Part D drugs that are not on the plan’s formulary, or that are subject to utilization management requirements, can get a transition supply of their drug under certain circumstances. They can work with you to complete a successful transition and avoid disruption in treatment.

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Aetna Medicare Advantage 2022 Review

Many or all of the products featured here are from our partners who compensate us. This may influence which products we write about and where and how the product appears on a page. However, this does not influence our evaluations. Our opinions are our own. Here is a list ofour partnersandhere’s how we make money.

Aetna was the fourth-largest provider of Medicare Advantage plans in 2021

Although the company’s offerings are notable, Aetna Medicare Advantage plans score in the average range for member satisfaction and quality of care. Heres what you should know about Aetna Medicare Advantage.

Medicare Plans Offered By Aetna: Types Of Medicare Advantage Plans

Advantage plans offered by Aetna comprise a range of plans which cater to different requirements or needs. However, these plans vary with locations. Here are some plan types for your reference:

HMO plans: Such plans usually need you to stay within the provider network to enjoy the coverage. However, there are certain exceptions like:

• Out-of-region Dialysis

HMO-POS plans: you can think of this plan as a blend of two Advantage plans from Aetna. Such plans function like the HMO plans. But you get the freedom to use certain out-of-network services at higher prices.

PPO plans: If you use this plan type and use providers within your network, you can save good money. Also, you can move outside the provider network in this plan type. However, this means higher coinsurance and copayments. Also, you do not need a reference for availing of specialist care.

SNP: These plans are apt for people who have special needs. For example, if youre suffering from any chronic disorder and are living in an institution or are registered with Medicare and Medicaid, you can benefit from this plan.

Such plans are also known as dual-eligibles as theyre meant for people whore enrolled with both Medicaid and Medicare. These plans offer a better coordination provider network and services using which you can manage the benefits of health care.

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Additional Aetna Medicare Advantage Ppo Plan Benefits

Aetna Medicare Advantage PPO plans give you the freedom to choose providers. And many of these plans offer a variety of benefits that go beyond what Original Medicare covers.

Many Aetna Medicare Advantage PPO plans also include:

• Prescription drug coverage
• Non-emergency transportation for visits to the doctors office or trips to the pharmacy
• Home meal delivery services after a hospital stay
• An allowance for certain over-the-counter benefit that allows you to get items like vitamins and cold medicine
• Prescription home delivery for plans that include prescription drug coverage
• 24/7 nurse hotline

Important: Annual Medicare Compliance Program Requirements

New and existing participating providers in our Medicare Advantage , Medicare-Medicaid , Dual Eligible or Fully Integrated Special Needs Plans are required to meet the Centers for Medicare & Medicaid Services compliance program requirements for first-tier, downstream and related entities as identified in the and/or training.

Additional Compliance Information

• MA/MMP: Providers who participate only in our MA/MMP plans do not need to complete an annual FDR Attestation.

• MA/ D-SNP/FIDE: Providers who are in states/regions that offer MA/D-SNP/FIDE plans are required to complete an Annual and attestation.

• Delegated Entities: Provider attestation collection for the FDR compliance requirements continue to be required for Delegated Entities.

Annual notification regarding requirements will be sent to providers via Adobe Acrobat Sign email or postcard. Providers continue to be notified via OfficeLink Newsletters during the summer months. You can access the training and attestation at the link below. Our Compliance Department completes random audits to ensure compliance on an annual basis.

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