What Medicare Plans Does Aetna Offer?

Aetna provides Medicare Advantage plans, as well as supplemental insurance (Medigap) plans and Part D prescription drug plans. With Medigap, members have to pay deductibles and coinsurance costs.


Medicare advantage plans

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 Medicare Advantage 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. To get one-on-one assistance with your Medicare needs, just call me or another licensed insurance agent TTY users 711; Monday through Friday, 9AM to 5PM ET.

* Out-of-network or 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 Aetna customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

Medicare Supplement Insurance Plans

Plans offering freedom and flexibility

Aetna offers a number of Medicare Supplement Insurance Plans. These plans offer coverage along with Original Medicare (Parts A and B). They can help limit your yearly out-of-pocket costs.

Call 1-800-345-6022 (TTY: 711), and a licensed insurance agent will help find a Medicare Supplement Insurance Plan that's right for you.


Medicare Supplement Insurance Plans cover basic benefits such as:

Medical costs-- Part B coinsurance (generally 20% of Medicare-approved costs) or copayments for hospital outpatient services

Hospitalization-- Per day coinsurance plus coverage for 365 additional days after Medicare benefits end

Blood-- First three pints of blood each year

Hospice-- Part A coinsurance

Moving? Your coverage can't be changed or canceled when you move anywhere within the United States, as long as you pay your premiums on time.

Traveling? You'll find plans that cover emergency care when you're out of the country.

Want to choose your doctor? You can see any doctor who accepts Medicare patients. There are no network restrictions.

Call Aetna at 1-800-345-6022 (TTY: 711), Monday to Friday, 8 a.m. to 8 p.m. ET


You can apply if you:

Live in a state where we offer the policy

Have Medicare Parts A and B (and continue to pay your Part B premium).

Is age 65 or over or, in some states, under age 65 due to disability or end-stage renal disease (ESRD).

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company. Blake Insurance Group LLC are not connected with or endorsed by the U.S. government or the federal Medicare program. The product and service descriptions, if any, provided on these Medicare.com Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, co-payments and restrictions may apply. Benefits, premiums and/or co-payments/co-insurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium.

Do I need to change plans for 2019?

People in a Medicare health or prescription drug plan should always review the materials their plans send them, like the “Evidence of Coverage” (EOC) and “Annual Notice of Change” (ANOC). If their plans are changing, they should make sure their plans will still meet their needs for the following year. If they’re satisfied that their current plans will meet their needs for next year and it’s still being offered, they don’t need to do anything.

 

When do I get information for 2019 Medicare plans?

Information for 2019 plans will be available beginning in October.

 

You can find Medicare plan information or compare plans

1-800-MEDICARE or Medicare.gov.

Medicare Insurance

Anyone who has gotten close to Medicare age knows you are literally inundated with information mailed to you. The most important information is sent from Medicare. This unbiased information gives you an overview of your options. Publications such as Medicare and You and Choosing a Medigap policy: A Guide to Health Insurance for People with Medicare include must-have information, but many people find the reading dry and boring.

Insurance companies will almost bury you with literature when you are about to turn 65. Just look at all the four-color brochures in your mailbox. Often, you get a high-level overview, but not what you really want, clear language and an idea of cost.

Comparing Medicare insurance plans

Many people don’t understand that a Medigap policy and a Medicare Advantage plan are two different types of insurance coverage.

Medigap

A Medigap policy (Medicare supplement) is the traditional type of plan that has been around since 1965. It’s called Medigap because it fills the gaps left by Medicare. Medicare Part A requires you to pay a hospital deductible and co-pays for extended stays and Part B requires that you pay 20% of all covered outpatient charges. A Medigap policy will, to varying degrees, fill these gaps.

Medigap insurance is available as one of several standardized plans. Plans will be the same from one company to the next. When you first become eligible for Medicare, you have an open enrollment period that lasts six months from the first day of the month that you become eligible. During this time an insurance company cannot refuse you the opportunity to purchase any policy that they sell, no matter what pre-existing medical conditions you may have.

If the Medigap policy is affordable, this is the best time to purchase. Compare rates with several companies, knowing that coverage will be the same no matter which company you look at. Standardization makes comparing Medigap insurance policies easy.

If you choose a Medigap policy you will also need to purchase a stand-alone Part D drug plan, because it is not included in this type of Medicare plan.

Medicare Advantage

Advantage plans are not Medicare supplements. But rather, you are receiving your benefits from an insurance company that is approved and contracted with CMS (The Centers for Medicare and Medicaid) to administer your Medicare. The idea behind this is that private insurance companies are more financially efficient than the federal government, and should be able to stretch the money allocated to give you more benefits.

Advantage plans do not fill the gaps, but rather give you set co-pays, co-insurance, and deductibles that may control costs and limit your out-of-pocket expenses compared to Medicare. Advantage plans also often include Part D drug coverage, as well as many additional benefits not included in Medicare, such as dental, vision and hearing. Many people choose an Advantage plan because it will often have lower monthly premiums or no premiums at all.

Advantage plans also have an open enrollment period when you become Medicare eligible. Plans also have an annual enrollment period because companies contract for one calendar year at a time, and can change or discontinue plans each year.

Shopping for Medicare insurance plans

One of the most efficient ways of comparing Medicare insurance plans is to do some research online. You can often shop for plans and get rates without having to leave your home. Another option would be to meet with a trusted insurance agent. If you choose to do this, make sure your agent represents several companies. Armed with some knowledge, you can avoid costly mistakes and compare the best Medicare insurance plans available.