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What Medicare Advantage Plans does Aetna have?


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You may have heard that Medicare Advantage plans are an alternative way to get your Medicare benefits from a private insurance company. As the name suggests, Medicare Advantage plans may have some “advantages” that Original Medicare doesn’t have, including additional benefits and coverage. You also never have to worry that your Medicare Advantage coverage will be inferior to Original Medicare. Medicare Advantage plans are required to cover at least everything that Original Medicare covers, with the exception of hospice care, which is still covered by Medicare Part A.

How are Aetna Medicare Advantage plans different from Original Medicare?

Aetna Medicare Advantage plans can be different from Original Medicare in terms of benefits and costs.

Aetna Medicare Advantage plans may include coverage for things that Original Medicare generally doesn’t cover, such as routine vision, routine dental, routine hearing care, and prescription drugs you take at home.

Medicare Advantage plans out of pocket costs could be lower than Original Medicare out of pocket costs, depending on what you pay for premiums, deductibles, and copayments or coinsurance when you receive care. Some Aetna Medicare Advantage plans may have no premium, although you generally still have to pay your Medicare Part B premium. Your costs for your Medicare Advantage plan could also depend if you follow the plan rules, like using network providers.

What are the different types of Aetna Medicare Advantage plans?

You may be familiar with various types of Aetna Medicare Advantage plans including HMOs (Health Maintenance Organizations) and PPOs (Preferred Provider Organization). You may have a selection of plans in your area, but keep in mind that not every plan may be available in every location.

Aetna Medicare Advantage HMOs  

HMO stands for “Health Maintenance Organization.” If you have an Aetna Medicare Advantage HMO, you generally choose a primary care physician to help coordinate your care within a network of other doctors and hospitals. You may need a referral from your primary care doctor in order to see a specialist, like a dermatologist or an oncologist. The network means you may be limited on the providers your plan will pay for, with the exception of emergency care, out-of-area urgent care, and out-of-area dialysis. If you go out of the Aetna Medicare Advantage plans’ network, you may have to pay the full cost for the services provided to you.

In most cases, your Aetna Medicare Advantage HMO will cover prescription drugs you take at home.

Aetna Medicare Advantage PPOs  

PPO stands for “Preferred Provider Organization.” Aetna Medicare Advantage PPOs, like HMOs, also have networks. However if you visit a doctor, specialist, or hospital that isn’t on the plan’s list, you may still be covered but just to have to pay more. With an Aetna Medicare Advantage PPO, you generally don’t need to choose a primary care doctor and you can see a specialist without getting a referral. Aetna Medicare Advantage PPOs typically cover prescription drugs you take at home, which are not generally covered by Original Medicare.

Aetna Medicare Advantage SNPs and DSNPs

SNP stands for “Special Needs Plan” and are generally limited to people with specific diseases (like diabetes) or other characteristics. Medicare Advantage SNP plans may orient their offerings including benefits and covered prescription drugs, to specifically meet the needs of the special group they serve. An Aetna Medicare Advantage plan called “DSNP” is a “Dual Special Needs Plan” or “Dual-Eligible Special Needs Plan” and is generally only available to people who have both Medicare and Medicaid.

Aetna Medicare Advantage HMO-POS

“POS” stands for “point of service.” With an Aetna Medicare Advantage HMO-POS plan you have more choice of providers than a traditional HMO plan. This generally means that you can see out-of-network providers but you may pay more. Like a traditional HMO, you generally must select a primary care provider.

To look for Aetna Medicare Advantage plans in your area, enter your ZIP code on this page.

Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. 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.

Out-of-network/non- contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call Aetna’s customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.

 

NR_0001_17095_C  09/2019

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