Aetna Medicare is a managed health care company which offers people with health care insurance and related services. In Aetna Medicare, there are Medicare Advantage, Dual Eligible Special Needs Plans (D-SNP), Prescription Drug Plans (PDPs) and Medicare Supplement Insurance. You may want to know the plans at Aetna Medicare Advantage. If so, you are able to read them below according to the Aetna Medicare site.
Medicare Advantage HMO Plans
If you choose Medicare Advantage HMO plans, usually you will choose a primary care physician who helps coordinate your care within a network of doctors and hospitals. As a result, you can get your best health.
HMO or Health Maintenance Organization will give you access to a network of doctors and hospitals that you need to use in most cases. Some HMO plans ask you to get a referral from a primary care physician for hospital care and specialist visits. With this plan, usually there are limited out-of-network benefits.
Here are some points about Aetna Medicare HMO plans.
- It requires you to use a provider network, unless it is an emergency.
- In many plans, it requires you to have a primary care physician (PCP).
- In some plans, it requires referral to see a specialist.
- Monthly premiums vary by plan, so that you have to check your ZIP code for details.
- Medical deductible varies by plan.
- It limits what you pay out-of-pocket for medical care each year.
- It includes prescription drug (Rx) coverage in most plans.
- It includes Rx mail-order benefit if plan has Rx coverage.
- There is dental, vision, and hearing coverage in most plans.
- It provides ER and urgent care coverage worldwide.
- It provides fitness benefit through SilverSneakers.
- It provides over-the-counter (OTC) benefit in many plans.
- It provides meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay) in many plans.
Medicare Advantage HMO-POS Plans
Medicare Advantage HMO-POS plans offer all benefits of receiving care through a network provider. A primary care physician is usually chosen by you and most of Aetna Medicare HMO-POS plans require you to be able to use a participating provider for medical care. Most Aetna Medicare HMO-POS plans provide you with flexibility to go to licensed dental providers in or out of Aetna Medicare network for routine dental care. If you go out of the network, you may have to pay more.
Here are some points about HMO-POS plans.
- Whether it requires you to use a provider network or not, it varies by plan. Usually, seeing out-of-network providers costs more, but most permit non-network dental providers.
- In many plans, it requires you to have a primary care physician (PCP).
- In some plans, it requires referral to see a specialist.
- Monthly premiums vary by plan.
- Medical deductible also varies by plan.
- It limits what you pay out-of-pocket for medical care each year.
- In most plans, it includes prescription drug (Rx) coverage.
- If plan has Rx coverage, it includes Rx mail-order benefit.
- In most plans, it provides dental, vision and hearing coverage.
- It provides ER and urgent care coverage worldwide.
- Through SilverSneakers, it provides fitness benefit.
- In many plans, it provides over-the-counter (OTC) benefit.
- In most plans, it provides meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay).
Medicare Advantage PPO Plans
Medicare Advantage PPO plans allow you to be able to visit Medicare-approved providers, in or out of Aetna’s provider network, who accept Aetna’s plan terms. A referral from a primary care physician is not needed by you for specialist or hospital visits. Let’s say that you use providers in your plan’s network. If so, it may cost less.
Here are some points about PPO plans.
- It does not require you to use a provider network, but if you see out-of-network providers, usually it will cost more.
- Usually, it does not require you to have a PCP or Primary Care Physician.
- It does not require referral if you want to see a specialist.
- Monthly premiums vary by plan.
- Medical deductible varies by plan.
- It limits what you pay out-of-pocket for medical care each year.
- In most plans, it includes prescription drug (Rx) coverage.
- If plan has Rx coverage, it includes Rx mail-order benefit.
- In most plans, vision, dental and hearing coverage are provided.
- ER and urgent care coverage worldwide are provided.
- Fitness benefit is provided through SilverSneakers.
- In a lot of plans, over-the-counter (OTC) benefit is provided.
- In most plans, meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay) is provided.
Medicare Advantage Dual Special Needs Plans (D-SNP)
You may wonder what Dual-Eligible Special Needs Plan is. It is a type of Medicare Advantage plan that offers extra benefits and it is available to anyone who has both Medicare and Medicaid. If you want to know whether you qualify or not, you are able to call 1-833-223-0614 (TTY:711).
If you are eligible for this, your personal care team will be here to help you to get the most out of your benefits as you can read below.
- They will learn your individual needs.
- They will help you understand your medications.
- They will develop a care plan with your doctor.
- They will coordinate visits to doctors, dentists and other health care providers.
With a D-SNP, you are offered more than you would get from Original Medicare such as allowance for over-the-counter products, routine dental services, prescription drugs, and eyeglasses and hearing aids. However, it is important for you to note that benefits may vary by plan.
D-SNP is available in 27 states including Alabama, Delaware, Florida, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Nebraska, North Carolina, Arkansas, California, Colorado, Connecticut, Nevada, New Jersey, Texas, Virginia, West Virginia New York, Ohio, and Pennsylvania.
So, if you have Medicare and Medicaid and you live in one of the states mentioned earlier, you may qualify for a D-SNP.
If you need more information about Dual Eligible Special Needs Plans (D-SNP), you are able to read the guidebook at here. On that guidebook, you will get all information about D-SNP.
