Aetna Medicare Advantage FAQ
Frequently Asked Questions
About Aetna Medicare Advantage Plans
Below are frequently asked questions about Medicare and Medicare coverage from Aetna Life Insurance Company. To see an answer to a question listed below, please click the question.
- What types of Medicare coverage does Aetna offer?
- Where are Aetna Medicare plans available?
- How do I decide which plan is best for me?
- Is my choice of doctors limited with plans that have a network?
- What is a PCP?
- What if I need to see a specialist?
- What if I need to be hospitalized?
- What if I'm out of town and I need emergency care?
- What is a “medical emergency” and what should you do if you have one?
- What about fitness, vision, hearing and dental coverage?
- Will my Medicare Advantage plan premium decrease if the government is helping pay for part of the Medicare prescription drug plan cost?
- Does my Aetna Medicare Advantage plan cover hospice?
- Does Aetna have a quality improvement program?
- How can I pay my monthly bill?
- Will I be billed for both my Aetna Medicare plan and Original Medicare?
- How can we offer a zero-dollar premium?
- What information do I need when I enroll?
- I currently have a Medicare Supplement plan. Can I enroll in a Medicare Advantage plan?
- Will I have to reapply every year?
What types of Medicare coverage does Aetna offer?
Aetna Medicare offers Medicare Advantage plans (health maintenance organizations/HMOs and preferred provider organizations/PPOs) in select service areas. Most Medicare Advantage plans include Medicare prescription drug coverage.back to top
Aetna also offers the Aetna Medicare Rx® Plan (standalone PDP) in all fifty states and the District of Columbia. Plans are available to individuals and employer groups. Individual Medicare Supplement plans are available in some states.
Where are Aetna Medicare Advantage plans available?
Please go to the Find Plans & Costs section to learn about individual Medicare plans available in your area.back to top
How do I decide what plan is best for me?
Depending on where you live, several Aetna Medicare plans may be available. To find individual Medicare plans available in your area, go to the Find Plans & Costs section of the website. If you need help selecting a plan, call our plan specialists toll free at 1-800-529-5586 (TTY/TDD: 711), Monday through Sunday, 8 a.m. to 8 p.m.back to top
Is my choice of doctors limited with plans that have a network?
For some of our plans, such as the Aetna Medicare Plan (HMO), we coordinate your care through our Aetna Medicare provider network to help lower your costs. If you go out of network, you may not be covered.
The Aetna Medicare Plan (PPO) allows you to receive covered services from any doctor or hospital inside or outside of the network. You may have to pay a higher copay or coinsurance for services outside our network. Providers must be eligible for Medicare payment and willing to accept the Aetna Medicare Plan (PPO).
Aetna's Medicare network includes over 200,000 doctors and over 1,900 hospitals. In many service areas our large network is likely to include your current doctors and hospital. Search for your doctor, hospital or pharmacy in our Provider Directory PDFs or use DocFind, our online provider search tool.back to top
What is a PCP?
A PCP is a “primary care physician” (doctor) you choose from the Aetna network to provide your routine and preventive care.
While you must select a PCP for the traditional Aetna Medicare Plan (HMO), you aren't required to select a PCP for the Aetna Medicare Open Access Plan (HMO) or the Aetna Medicare Plan (PPO). Our plan specialists can help you find a doctor who meets your needs. You can also use Find a Doctor or our provider directory to look for HMO or PPO doctors.back to top
What if I need to see a specialist?
With the Aetna Medicare Open Access Plan (HMO) and the Aetna Medicare Plan (PPO), you don't need referrals to see specialists. And with the traditional Aetna Medicare Plan (HMO), getting a referral is as easy as visiting your primary care doctor. If you have a condition your primary care doctor can't treat, your doctor can refer you to the network specialist of your choice. Plus, you never need referrals for emergency and urgent care, routine eye exams, flu and pneumonia shots, annual mammograms or Ob/Gyn care.back to top
What if I need to be hospitalized?
You're covered for unlimited hospital days with any Aetna Medicare Advantage plan when medically necessary. See plan documents for specific hospital benefit details.back to top
What if I'm traveling, visiting or living out of town and need non-emergency care?
You’re covered. The Aetna Medicare Plan (PPO) allows you to get the same network benefits you receive at home for covered non-emergency medical care from network providers or from out-of-network providers anywhere in the United States who accept Original Medicare.. back to top
With the Aetna Medicare Plan (HMO), if you will be staying out of your home service area for an extended period of time and traveling within the U.S., you can enroll in our free U.S. Travel Advantage program and select a participating PCP to access your plan’s covered medical benefits. Your enrollment in the U.S. Travel Advantage program will allow you to receive access to the same medical services you receive at home when using Aetna Medicare network providers. Contact Member Services at the phone number on the back of your ID card to enroll in the U.S. Travel Advantage program. .
Be sure to refer to your Evidence of Coverage for the details of your specific plan.
Individual members should visit our Evidence of Coverage Page
Employer or union group members should visit our secure member website, then select the Coverage & Benefits menu
What is a “medical emergency” and what should you do if you have one?
When you have a “medical emergency,” you believe that your health is in serious danger. A medical emergency can include severe pain, a bad injury, a sudden illness, or a medical condition that is quickly getting much worse. If you have a medical emergency:
- Get help as quickly as possible. Call 911 for help or go to the nearest emergency room, hospital, or urgent care center. Call for an ambulance if you need it. You do not need to get approval or a referral first from your PCP.
- As soon as possible, make sure you tell us about your emergency. We need to follow up on your emergency care. You or someone else should call to tell us about your emergency care, usually within 48 hours. Please call Member Services at the number on your ID card.
What about fitness, vision, hearing and dental coverage?
We have all four. Many of our individual plans include additional benefits at no extra cost to you. Depending on the plan, these additional benefits include routine vision and hearing exams, and may include a fitness center benefit. Many plans also include an allowance for eyewear and hearing aids. And some plans allow you to add optional supplemental benefits coverage. With these optional supplemental benefits, you can receive covered dental services plus eyewear allowances and/or hearing aid allowances for an additional monthly plan premium.back to top
If your plan coverage is through a former employer, many employers have also elected to offer these additional benefits to you with your Aetna Medicare Plan. Please refer to your plan documents for coverage details.
Will my Medicare Advantage plan premium decrease if the government is helping pay for part of the Medicare prescription drug plan cost?
If you have a Medicare Advantage plan without Medicare prescription drug coverage, the government financial help with Medicare prescription drug costs will not have an impact on your plan. If you have a Medicare Advantage plan with Medicare prescription drug coverage, the government financial help with Medicare prescription drug costs may affect your premiums, copayments or both.back to top
Does my Aetna Medicare Advantage plan cover hospice?
You may receive care from any Medicare-certified hospice program. Original Medicare (rather than your Aetna Medicare Plan) will pay the hospice provider for the services you receive. Your hospice doctor can be a network provider or an out-of-network provider. You will still be a plan member and will continue to get the rest of your care that is unrelated to your terminal condition through your Aetna Medicare Plan. Covered services include:
- Drugs for symptom control and pain relief, short-term respite care, and other services not otherwise covered by Original Medicare,
- Home care
- Our Plan covers hospice consultation services (one time only) for a terminally ill person who hasn’t elected the hospice benefit.
Does Aetna have a quality improvement program?
Yes. We approach quality measurement and improvement with a member-centric focus on everything we do. Our programs are designed to enhance the quality of care our members receive. We use clinical data and industry-accepted, evidence-based guidelines to better inform members. And we support transparency by providing credible clinical information and tools to help doctors and members make informed decisions.back to top
How can I pay my monthly bill?
You can pay your monthly bill in a number of ways:
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- Pay online using your credit card.
- Use electronic funds transfer (EFT) to have the amount deducted from your checking or savings account.
- Call Customer Service, and they'll take your payment information.
- Have the premium taken out of your Social Security check.
Note: Social Security Administration (SSA) systems have a $200 “harm limit” for deductions from SSA checks. Your Aetna Medicare premium may not be taken out of your SSA check for two or three months. If that happens, the premium owed could be more than the $200 limit. Then you'll receive a bill from us.
Will I be billed for both my Aetna Medicare plan and Original Medicare?
Yes. You'll get a monthly bill for your Aetna Medicare plan. You'll also keep paying your Part B premium and/or Part A premium, if you have one.
How can we offer a zero-dollar premium?
We have a contract with the federal government to offer Medicare Advantage plans. As a result, in some areas, you may find a plan with both medical and prescription drug coverage for a zero-dollar premium. Just remember that you still have to pay for things like doctor office copays, as well as your Medicare Part B premium.
What information do I need when I enroll?
You'll need to have one of the following items with you when you enroll:
- Medicare card
- Letter from the Social Security Administration
- Letter from the Railroad Retirement Board
You may also want to have your bank account or credit card number handy. You’ll need it if you choose to pay from your bank account or by credit card.
I currently have a Medicare Supplement plan. Can I enroll in a Medicare Advantage plan?
Yes, but there's no need to have both. You’d have to pay for both plan premiums and you wouldn’t benefit from your supplemental plan. Medicare Supplement can't pay any deductibles, copayments or coinsurance for a Medicare Advantage plan.
Will I have to reapply every year?
No. Your current Medicare Advantage plan continues if you do nothing.