Medicare Plans
Learn more about plans that may be offered by your former employer or union. Look at the plans below and see if they have the important benefits you need.
Aetna MedicareSM Plan (HMO)
The Aetna MedicareSM Plan (HMO) is a Health Maintenance Organization (HMO)Medicare Advantage plan. Your care is coordinated through a network of doctors and hospitals, allowing you to get more benefits than the Original Medicare Plan and many Medicare supplement plans. You must continue to pay your Medicare Part B premium and Part A, if appropriate.
Other plan features of the Aetna Medicare Plan (HMO) include:
- A wide network of doctors and hospitals
- Your health care is coordinated through the Aetna Medicare network of health care providers, which helps to lower your costs.
- You can choose a primary care physician (PCP) from the network of doctors.
- In many areas Aetna Medicare’s health care provider network is so large that it's likely to include your current doctors and hospital. To see a full list of doctors and hospitals in the Aetna Medicare network, click Find a Doctor to see if your doctor is in the network.
- Wellness Programs and Tools
- Motivational Coaching Benefit — Free telephone access to professionals and advice on wellness programs to help you stop smoking and lose weight. For more information and to find out if you're eligible, call 1-800-650-2747.
- Fitness Option — Your plan may include a benefit for a free membership at a participating fitness center or spa nationwide, and more. Call 1-877-243-3004 to find out if you're eligible and to learn more. Or, find fitness centers in your area.
- Personal Health Record — A private, secure online tool for you and your doctor to use that keeps your health information in one place. It is automatically updated with your most recent health results, diagnoses, and prescriptions. Already a member? Login in now at http://www.aetnanavigator.com.
- No referrals necessary for certain health services, known as direct-access services, listed below
- You do not need referrals for:
- Emergency and urgent care
- Routine eye exams
- Flu and pneumonia shots
- Annual mammogram
- Annual ob/gyn services
- You do not need referrals for:
- Easy specialist referrals
- If you have a health condition your primary care doctor can’t treat, and it’s not a direct-access service (see list above), your PCP can give you a referral to the network specialist of your choice.
- Coverage for prescription drugs
- Some Aetna Medicare Advantage Plans may include Medicare prescription drug coverage.
- This type of plan includes a wide selection of prescription drugs used by Medicare beneficiaries.
- Nationwide, more than 60,000 pharmacies participate in the Aetna Medicare network.
- For a complete listing of all covered prescription drugs for 2010, view and/or print our 2010 Aetna Medicare Formulary (prescription drug list).
2010 Aetna Medicare Open Formulary (124 pages, 427 kb) - 2010 Aetna Medicare Standard Formulary (104 pages, 401 kb)
- For a complete listing of all covered prescription drugs for 2009, view and/or print our 2009 Aetna Medicare Formulary (prescription drug list).
- 2009 Aetna Medicare Open Formulary (116 pages, 539 kb)
- 2009 Aetna Medicare Closed Formulary (72 pages, 1,305 kb)
- Preventive care services that are covered include:
- Routine eye and hearing exams
- Flu and pneumonia shots
- Annual mammograms
- Annual ob/gyn services
- Bone mass measurement
- Prostate and colorectal cancer screenings
- Travel coverage
- If you travel to plan-approved service areas and use a doctor or hospital in the Aetna Medicare network, the U.S. Travel Advantage® program gives you access to the same benefits you receive at home for up to 12 months. Please contact Member Services to register.
- You’re also covered for urgent and emergency care 24 hours a day, 7 days a week, anywhere in the world.
- Aetna ExtrasSM are available to you at no extra cost. They include discounts for a variety of products and services, such as:
- Vision care
- Fitness
- Vitamins
- Alternative therapies
- Weight management
- In certain service areas dental discounts and allowances for eyewear and hearing aids are available.
For detailed plan information, check your Benefits Summary or the enrollment package you received from your former employer.
View and/or print the Aetna Medicare Plan (HMO) brochure (12 pages, 187kb)
The Grievance Process
We understand the importance of having the coverage you need. If you have a coverage issue or problem, Member Services can help you to resolve it. If you feel that Aetna Medicare should pay for benefits and services that are not covered, you have the right to appeal any decision. You have two options:
- Appeal to have a decision made by Aetna Medicare on the benefits you feel you are entitled to receive
- File a grievance to address your coverage issues, complaints and problems if Member Services cannot resolve your issue.
For more complete information about the appeal and grievance processes, download this Appeals and Grievances information (5 pages, 139kb).
- CMS Appointment of Representative form CMS-1696 (2 pages, 71kb)
- Aetna Medicare Plans Complaint and Appeal form (5 pages, 63kb)
You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. You must use network providers except for emergeny care or out-of-area urgent care/renal dialysis. Coverage is provided through a Medicare Advantage organization with a Medicare contract. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year.
Aetna MedicareSM Plan (PPO)
The Aetna MedicareSM Plan (PPO) is a Preferred Provider Organization (PPO) Medicare Advantage plan. It offers all the benefits of an HMO plan, but also lets you choose doctors and hospitals outside of the Aetna network (no referrals needed). You must still continue to pay your Medicare Part B premium.
Other plan features for Aetna Medicare Plan (PPO) include:
- A wide network of doctors and hospitals
- You are NOT required to select a primary care physician (PCP). However, by choosing a PCP in the Aetna network, you can lower your cost sharing.
- You can go directly to a doctor in the Aetna network. Your health care is coordinated through a network of health care providers, which helps to lower your costs.
- You have coverage for any licensed doctor or hospital that is eligible for payment from Original Medicare outside the Aetna network for a higher copay or coinsurance.
To see a full list of doctors and hospitals in the Aetna network, click click here.
- Wellness Programs and Tools
- Motivational Coaching Benefit — Free telephone access to professionals and advice on wellness programs to help you stop smoking and lose weight. For more information and to find out if you're eligible, call 1-800-650-2747.
- Fitness Option — Your plan may include a benefit for a free membership at a participating fitness center or spa nationwide, and more. Call 1-877-243-3004 to find out if you're eligible and to learn more. Or, find fitness centers in your area.
- Personal Health Record — A private, secure online tool for you and your doctor to use that keeps your health information in one place. It is automatically updated with your most recent health results, diagnoses, and prescriptions. Already a member? Login in now at http://www.aetnanavigator.com.
- No referrals
- You do not need referrals for covered services. To see a full list of doctors and hospitals in the Aetna network, check Find a Doctor.
- Preventive care services that are covered include:
- Routine eye and hearing exams
- Flu and pneumonia shots
- Annual mammograms
- Certain ob/gyn services
- Some cancer screenings
- Some plans cover more.
- Coverage for prescription drugs
- Some Aetna Medicare Advantage Plans may include Medicare prescription drug coverage.
- This type of plan includes a wide selection of prescription drugs used by Medicare beneficiaries.
- Nationwide, more than 60,000 pharmacies participate in the Aetna network.
- For a complete listing of all covered prescription drugs for 2010, view and/or print our 2010 Aetna Medicare Formulary (prescription drug list).
- 2010 Aetna Medicare Open Formulary (124 pages, 427 kb)
- 2010 Aetna Medicare Standard Formulary (104 pages, 401 kb)
- For a complete listing of all covered prescription drugs for 2009, view and/or print our 2009 Aetna Medicare Formulary (prescription drug list).
- 2009 Aetna Medicare Open Formulary (116 pages, 539kb)
- 2009 Aetna Medicare Closed Formulary (72 pages, 1,305kb)
- Aetna ExtrasSM are available at no extra cost to you. They include discounts for a variety of products and services, such as:
- Vision care
- Fitness
- Vitamins
- Alternative therapies
- Weight management
- In certain service areas dental and hearing aids are available.
For detailed plan information, check your Benefits Summary or the enrollment package you received from your former employer.
View and/or print the Aetna Medicare Plan (PPO brochure (12 pages, 186kb).
The Grievance Process
We understand the importance of having the coverage you need. If you have a coverage issue or problem, Member Services can help you to resolve it. If you feel that Aetna Medicare should pay for benefits and services that are not covered, you have the right to appeal any decision. You have two options:
- Appeal to have a decision made by Aetna Medicare on the benefits you feel you are entitled to receive
- File a grievance to address your coverage issues, complaints and problems if Member Services cannot resolve your issue.
For more complete information about the appeal and grievance processes, download this Appeals and Grievances information (5 pages, 139kb).
- CMS Appointment of Representative form CMS-1696 (2 pages, 71kb)
- Aetna Medicare Plans Complaint and Appeal form (5 pages, 63kb)
You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. Higher costs apply for out-of-network services. Precertification, or prior approval of coverage, is requested for certain services. Providers must be licensed and eligible to receive payment under the federal Medicare program. Coverage is provided through a Medicare Advantage organization with a Medicare contract. Benefits, limitations, service areas and premiums are subject to change on January 1 of each year.
Aetna Medicare OpenSM Plan (PFFS) Private Fee-for-Service
The Aetna Medicare Open Plan is a Medicare Advantage private fee-for-service (PFFS) Medicare Advantage plan. It offers all benefits of the Original Medicare plan and more. You can receive covered services from any licensed doctor or hospital that is eligible to receive payment under Medicare, agrees to treat them and accepts the Aetna Medicare Open Plan private fee-for-service terms and conditions of payment.
Other plan features include:
- Easy-to-use coverage
- NO special networks or health care providers needed.
- You can visit any doctor or hospital that is eligible to receive payment from Medicare and accepts the Aetna Medicare Open Plan terms and conditions.
- Show your Aetna member ID card before you receive medical care. No referrals required for covered services.
To find a health care provider in your area that accepts the Aetna Medicare Open Plan, contact us at 1-800-307-4830 (TTY/TDD: 1-888-760-4748), Monday through Friday, 8 a.m. – 6 p.m. Remember, be sure to ask your provider if they accept the Aetna Medicare Open Plan before receiving care. You may also want to review the following:
- Educational Leaflet - The Centers for Medicare and Medicaid Services requires this educational leaflet to help ensure beneficiaries and their providers are provided with a complete description of Private Fee-For-Service plan rules and guidelines.
- Aetna Medicare Open Plan Disclosure
- Wellness Programs and Tools
- Motivational Coaching Benefit — Free telephone access to professionals and advice on wellness programs to help you stop smoking and lose weight. For more information and to find out if you're eligible, call 1-800-650-2747.
- Fitness Option — Your plan may include a benefit for a free membership at a participating fitness center or spa nationwide, and more. Call 1-877-243-3004 to find out if you're eligible and to learn more. Or, find fitness centers in your area.
- Personal Health Record — A private, secure online tool for you and your doctor to use that keeps your health information in one place. It is automatically updated with your most recent health results, diagnoses, and prescriptions. Already a member? Login in now at http://www.aetnanavigator.com.
- Coverage for prescription drugs
- Some Aetna Medicare Advantage plans may include Medicare prescription drug coverage.
- This type of plan includes a wide selection of prescription drugs used by Medicare beneficiaries.
- Nationwide, more than 60,000 pharmacies participate in the Aetna network.
- For a complete listing of all covered prescription drugs for 2010, view and/or print our 2010 Aetna Medicare Formulary (prescription drug list).
- 2010 Aetna Medicare Open Formulary (124 pages, 427 kb)
- 2010 Aetna Medicare Standard Formulary (104 pages, 401 kb)
- For a complete listing of all covered prescription drugs, view and/or print our 2009 Aetna Medicare Formulary (prescription drug list).
- 2009 Aetna Medicare Open Formulary (116 pages 539kb)
- 2009 Aetna Medicare Closed Formulary (72 pages, 1,305kb)
- Preventive care services that are covered include:
- Routine eye and hearing exams
- Flu and pneumonia shots
- Annual mammograms
- Anual ob/gyn services
- Prostate and colorectal cancer screenings
- Some plans cover more.
- Aetna ExtrasSM are available to you at no extra cost. They include discounts for a variety of products and services, such as:
- Vision care
- Fitness
- Vitamins
- Alternative therapies
- Weight management
- In certain service areas dental discounts and allowances for eyewear and hearing aids are available.
- For detailed plan information, check your Benefits Summary or the enrollment package you received from your former employer.
View and/or print the Aetna Medicare Open Plan (PFFS) brochure (12 pages, 692kb)
The Grievance Process
We understand the importance of having the coverage you need. If you have a coverage issue or problem, Member Services can help you to resolve it. If you feel that Aetna Medicare should pay for benefits and services that are not covered, you have the right to appeal any decision. You have two options:
- Appeal to have a decision made by Aetna Medicare on the benefits you feel you are entitled to receive
- File a grievance to address your coverage issues, complaints and problems if Member Services cannot resolve your issue.
For more complete information about the appeal and grievance processes, download this Appeals and Grievances information (5 pages, 139kb).
- CMS Appointment of Representative form CMS-1696 (2 pages, 71kb)
- Aetna Medicare Plans Complaint and Appeal form (5 pages, 63kb)
You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. You can receive covered services from any licensed doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the Aetna Medicare Open Plan Private Fee-for-Service terms and conditions of payment. This product does not require a contracted network and providers are not required to accept Medicare Private Fee-for-Service plans.
A Medicare Advantage Private Fee-for-Service plan works differently than a Medicare supplement plan. Your doctor or hospital must agree to accept the plan’s terms and conditions prior to providing healthcare services to you, with the exception of emergencies. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide healthcare services to you, except in emergencies. Providers can find the plan’s terms and conditions on our website at: www.aetna.com. You can receive covered services from any licensed doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the Aetna Medicare Open Plan private fee-for-service terms and conditions of payment. This product does not require a contracted network. You must be enrolled in Medicare Part B and continue to pay your Part B premium.
Aetna Medicare Rx® (PDP)
You can receive Medicare prescription drug coverage (Part D) by joining a Medicare prescription drug plan, such as an Aetna Medicare Rx (PDP) plan.
Here are some benefits of having the Aetna Medicare Rx (PDP) plan:
- For most plans, you simply pay a copay/coinsurance to get your covered prescriptions filled
- Nationwide, more than 60,000 pharmacies participate in the Aetna network.
- This type of plan includes a wide selection of prescription drugs used by Medicare beneficiaries.
- We want to provide you with the best customer service and answer your questions, so we have specially trained Aetna Medicare representatives dedicated to help you.
- You can depend on Aetna. We are a company with 40 years of Medicare experience.
- Get Aetna ExtrasSM which includes discounts for a variety of products and services such as vision care, vitamins, alternative therapies, weight management and more, plus allowances for eyewear and hearing aids (in select service areas).
Find information on the Medicare prescription drug plan offered through your former employer — estimate costs and search for covered medications and participating pharmacies.
- For a complete listing of all covered prescription drugs for 2010, view and/or print our 2010 Aetna Medicare Formulary (prescription drug list).
- 2010 Aetna Medicare Open Formulary (124 pages, 427 kb)
- 2010 Aetna Medicare Standard Formulary (104 pages, 401 kb)
- For a complete listing of all covered prescription drugs for 2009, view and/or print our 2009 Aetna Medicare Formulary (prescription drug list).
- 2009 Aetna Medicare Open Formulary (116 pages, 539kb)
- 2009 Aetna Medicare Closed Formulary (72 pages, 1,305kb)
- Vision care
- Fitness
- Vitamins
- Alternative therapies
- Weight management
- In certain service areas dental and hearing aids are available.
View the Aetna Medicare Rx Plan brochure (12 pages, 203kb)
The Grievance Process
We understand the importance of having the coverage you need - and that includes your prescription drugs. If you're taking a medication that's not currently covered by Aetna Medicare Rx (PDP) plans, you have several options:
- Request an exception for nonformulary Part D drugs and for plans with tiered cost sharing.
- Appeal to have Aetna Medicare make a decision on the benefits you feel you are entitled to receive.
- File a grievance to address your coverage issues, complaints and problems, if Member Services is unable to resolve your issue.
For more complete information about the appeal and grievance processes, download this Exceptions, Appeals, and Grievances Information (10 pages, 160.6kb).
- CMS Appointment of Representative form CMS-1696 (2 pages, 71kb)
- Aetna Medicare Plans Complaint and Appeal form (5 pages, 63kb)
You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable, if not otherwise paid for under Medicaid or by another third-party. You must reside in the Aetna Medicare Prescription Drug Plan service area.
Enrollees must use network pharmacies to receive plan benefits except under emergency circumstances. Covered Part D drugs are available at out-of-network pharmacies in special circumstances, including illness while traveling within the United States but outside of the plan's service area where there is no network pharmacy. An additional cost may be incurred for drugs received at an out-of-network pharmacy.
You may be enrolled in only one Medicare Prescription Drug Plan at a time. If you are enrolled in a Medicare Advantage (MA) Plan, you may not enroll in a Medicare Prescription Drug Plan, unless you are a member of a Private Fee-for-Service MA Plan (PFFS), a Medical Savings Account MA Plan (MSA), or a 1876 Cost Plan.
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Page Last Updated: October 5, 2009