Aetna Medicare Advantage FAQ

Frequently Asked Questions

• About
  Medicare
• About Aetna Medicare Advantage Plans
• About Aetna Medicare
  Rx^® Plans (PDP)

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 under the category you are interested in. The categories include: 

• General
• Aetna Medicare Open^SM Plan (PFFS)
• Aetna Medicare Advantage Special Needs Plan (SNP)

General

1. What types of Medicare coverage does Aetna offer?
2. Where are Aetna Medicare plans available?
3. How do I decide which plan is best for me?
4. Is my choice of doctors limited with plans that have a network?
5. What is a PCP?
6. What if I need to see a specialist?
7. What if I need to be hospitalized?
8. What if I'm out of town and I need emergency care?
9. What about fitness, vision, hearing and dental coverage?
10. Will my Medicare Advantage plan premium decrease if the government is helping pay for part of the Medicare prescription drug plan cost?

Aetna Medicare Open^SM Plan (PFFS)

1. What is the Aetna Medicare Open^SM Plan (PFFS)?
2. What is a Medicare Private Fee-for-Service (PFFS) plan?
3. What are the benefits of joining a Medicare Private Fee-for-Service plan?
4. Am I entitled to additional benefits as an Aetna Medicare Open^SM Plan (PFFS) member?
5. Is Medicare Part D/prescription drug coverage included in Aetna Medicare Private Fee-for-Service plans?
6. As a member of the Aetna Medicare Private Fee-for-Service plan, can I see health care professionals who are not considered “in network?”
7. What qualifications must a health care professional have to be eligible to deliver services to Medicare beneficiaries enrolled in the Aetna Medicare Open^SM Plan (PFFS)?
8. How does a provider know that I am enrolled in the Aetna Medicare Open^SM Plan (PFFS)?
9. How will I know if my health care professional is eligible to receive payment under Medicare?
10. What if a provider has been sanctioned or has opted out of Original Medicare?
11. What if a provider does not accept the Aetna Medicare Open^SM Plan (PFFS) ID card?
12. Can a provider bill me if Aetna does not pay for services provided?
13. If I receive a balance bill for the Medicare Limiting Charge from a provider that does not accept Medicare assignment, how will I know if the billed amount is accurate?
14. How do I obtain care when I am in the Aetna Medicare Open^SM Plan (PFFS)?
15. How will I know if a particular medical service is covered under the Aetna Medicare Open^SM Plan (PFFS)?
16. Am I required to use a primary care doctor?
17. Are prior authorization or referrals required for the Aetna Medicare Open^SM Plan (PFFS)?
18. Is my health care professional going to bill me for services I receive?
19. Will I need to submit claim forms to Aetna?
20. How do I receive emergency or urgent care?
21. Will I need to submit a claim form when I receive emergency care?
22. Will I receive Explanations of Benefits (EOBs) for Aetna Medicare Open^SM Plan (PFFS) services?
23. Do I need to continue to pay my Medicare Part B premium if I am enrolled in the Aetna Medicare Open^SM Plan (PFFS)?
24. What should I do if my PFFS plan will not pay for a service that I think I need?
25. What are my appeal rights under Medicare PFFS plans?
26. Should I worry about fraud and abuse with a PFFS plan? If yes, what should I look for?
27. What happens if my doctor is not familiar with the Aetna Medicare Open Plan (PFFS)?

Aetna Medicare Advantage Special Needs Plan (SNP)

1. What is the difference between Special Needs Plans (SNP) and other Medicare Advantage plans?
2. What types of Medicare Advantage Special Needs Plans (SNPs) does Aetna offer?
3. What are the unique enrollment and disenrollment rules that apply to Medicare Advantage Special Needs Plans (SNPs)?
4. What are the benefits of enrolling in a Special Needs Plan (SNP)?
5. Does enrolling in an Aetna Medicare Dual Advantage Plan (HMO) affect my Medicaid coverage and my Medicare Part D low income subsidy ("extra help")?
6. What ID cards should I bring with me when I have a doctor appointment?
7. What information do I need when I enroll?

General

1. What types of Medicare coverage does Aetna offer?

   Aetna Medicare offers Medicare Advantage plans (health maintenance organizations/HMOs, preferred provider organizations/PPOs, private fee-for-service/PFFS and special needs plans/SNPs) in key locations. The Medicare Advantage plans include options with Medicare prescription drug coverage. Aetna also offers the Aetna Medicare Rx^® Plan (PDP), as well as Medicare Supplement plans in some states. Plans are available to individuals and employer groups.

   back to top

2. Where are Aetna Medicare Advantage plans available?

   Please go to the Find Plans & Costs section to learn about plans available in your area.

   back to top

3. How do I decide what plan is best for me?

   Depending on where you live, several Aetna Medicare plans may be available. To find 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 1-888-760-4748), Monday through Sunday, 8 a.m. to 8 p.m.

   back to top

4. Is my choice of doctors limited with plans that have a network?

   For some of our plans, we coordinate your care through the provider network to help lower your costs. However, in many areas the network is so large that it's likely to include your current doctors and hospital. Plus, the Aetna Medicare Plan (PPO) allows you to choose any doctor or hospital outside of the network for a higher copay or coinsurance. The Aetna Medicare Open^SM Plan (PFFS) does not require the use of network doctors and hospitals. You can go to any licensed doctor or hospital eligible to receive payment from Medicare, who agrees to treat you for covered services and who accepts the Aetna Medicare Open Plan Terms and Conditions of Payment.

   back to top

5. 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 are not required to select a PCP for the Aetna Medicare Open Access Plan (HMO), the Aetna Medicare Plan (PPO) or the Aetna Medicare Open^SM Plan (PFFS). However, if you do choose a PCP with our PPO plan, you will pay a lower copay for office visits. 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. To find doctors for PFFS, visit www.medicare.gov and select "Find a Doctor" under Search tools. Aetna Medicare PFFS plan members can go to any licensed provider who is eligible to receive payment from Medicare, who agrees to provide covered services to the member and who accepts the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Payment.

   back to top

6. What if I need to see a specialist?

   With the Aetna Medicare Open Access Plan (HMO), the Aetna Medicare Plan (PPO) and the Aetna Medicare Open^SM Plan (PFFS), 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 write a referral 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

7. What if I need to be hospitalized?

   You’re covered for unlimited hospital days with any Aetna Medicare Advantage plan when you use network hospitals, or hospitals covered by our National Medicare Excellence Program^®, when medically necessary. With the Aetna Medicare Plan (PPO), you’re also covered for unlimited days at hospitals outside of the Aetna network. If you are a member of the Aetna Medicare Open Plan (PFFS), we encourage you to contact Aetna Member Services to inform us when you are admitted to a hospital.

   back to top

8. What if I'm out of town and I need emergency care?

   You are covered. With the Aetna Medicare Plan (PPO), you can get the same network benefits you receive at home when you travel to any plan-approved service area and use a doctor or hospital in the Aetna Medicare network. You can enjoy this same convenience with the Aetna Medicare Plan (HMO) when you enroll in our free U.S. Travel Advantage program. Our plans also cover you for urgent and emergency care 24 hours a day, 7 days a week, anywhere in the world. With the Aetna Medicare Open^SM Plan (PFFS), if you are traveling outside your home service area, you are still able to use any licensed provider who is eligible to receive payment under Medicare, is willing to provide covered services to you as a PFFS member and who accepts the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Payment. This plan also covers you for urgent and emergency care 24 hours a day, 7 days a week, anywhere in the world.

   back to top

9. What about fitness, vision, hearing and dental coverage?

   We have all four. Our 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. Most plans also include an allowance for eyewear and hearing aids. And some plans allow you to add dental coverage for an additional monthly plan premium.

   back to top

10. 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 may 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

Aetna Medicare Open Plan (PFFS)

1. What is the Aetna Medicare Open^SM Plan (PFFS)?

   The Aetna Medicare Open^SM Plan (PFFS) is Aetna's Medicare Private Fee-for-Service (PFFS) product, which is a Medicare Advantage (MA) plan without a provider network. Members can access any licensed provider who is eligible to receive payment from Medicare, who agrees to provide covered services to the Aetna Medicare PFFS member and who accepts the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Payment.

   back to top

2. What is a Medicare Private Fee-for-Service plan?

   A Medicare Private Fee-for-Service plan is a Medicare Advantage plan that provides coverage on a pay-per-visit basis. The per-visit payment amount is based on the Medicare allowable amount (a predetermined amount set by Medicare). A PFFS plan must provide coverage for all Medicare-covered benefits and may offer additional benefits not offered by Medicare. Aetna Medicare PFFS plan members can go to any licensed provider who is eligible to receive payment from Medicare, who agrees to provide covered services to the member and who accepts the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Payment.

   back to top

3. What are the benefits of joining a Medicare Private Fee-for-Service plan?

   Generally:

   • A Medicare Private Fee-for-Service plan is typically less costly than the combination of Original Medicare and a Medigap policy. PFFS plans cover all of the services under Medicare Parts A and B, and typically provide coverage for additional services such as preventive care. PFFS plans can also include Medicare prescription drug coverage.
   • Unlike many Medicare Advantage HMO plans, members are not restricted by provider networks — they can go to any licensed health care provider who is eligible to accept payment under Original Medicare, agrees to provide covered services to the member and accepts the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Payment. You are not locked into a provider network with a PFFS plan.

   With the Aetna Medicare Open^SM Plan (PFFS), you receive benefits and services that Original Medicare does not cover:

   • Most plans offer reimbursements for eyewear and hearing aids.
   • Disease management and care management programs are integrated into the plan.
   • All plans provide Aetna Extras^SM — discounts toward vision care products and services, special rates on vitamins and more — for no additional cost.*
   • No referrals are required.
   • Unlimited hospitalization for covered services and full coverage for preventive services are included.

   *Dental discounts and the GlobalFit™ fitness center discounts are not available with the PFFS plans at this time.

   back to top

4. Am I entitled to additional benefits as an Aetna Medicare Open^SM Plan (PFFS) member?

   Yes. Members of the Aetna Medicare Open^SM Plan (PFFS) receive access to “Aetna Extras^SM.” These are Aetna’s value-added benefits and services, which provide you with access to discounts on vision services and products, and discounts on vitamins — all for no additional cost. For more information on Aetna Extras^SM, refer to your plan documents, visit the website section Wellness Programs or call Member Services at the number on your ID card.

   back to top

5. Is Medicare Part D prescription drug coverage included in the Aetna Medicare Private Fee-for-Service plans?

   It depends on your plan. If you enrolled through your former employer or plan sponsor, you may or may not have Part D prescription drug coverage as part of your plan. Check your plan documents to determine if prescription drug coverage is included.

   back to top

6. As a member of the Aetna Medicare Private Fee-for-Service plan, can I see providers who are not considered “in network?”

   Since PFFS is not network-based, providers do not have to be contracted with Aetna to provide services to an Aetna Medicare Open^SM Plan (PFFS) member. You can go to any licensed provider who is eligible to receive payment from Medicare, who agrees to provide covered services to the member and who accepts the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Payment. If you wish to see a provider who does not accept Medicare assignment, you may do so. However, the provider can balance bill you up to the Medicare limiting charge (up to 15% of the Medicare allowable charge).

   If a provider has “opted out” of Medicare, or is no longer eligible for payment under Medicare, then services will not be covered by the Aetna Medicare Open^SM Plan (PFFS).

   back to top

7. What qualifications must a provider have to be eligible to deliver services to Medicare beneficiaries enrolled in the Aetna Medicare Open^SM Plan (PFFS)?

   A provider must be eligible to receive payment under Original Medicare, be willing to provide covered services to a PFFS member and accept Aetna’s Terms and Conditions of Payment. Physicians and facilities must be state licensed and have a Medicare billing number or be eligible to obtain one. Institutional providers treating PFFS members, such as hospitals and skilled nursing facilities, must be Medicare certified.

   back to top

8. How does a provider know that I am enrolled in the Aetna Medicare Open^SM Plan (PFFS)?

   You need to inform your provider that you are enrolled in a PFFS plan before obtaining any service. Your Aetna Medicare Open^SM Plan (PFFS) ID card will indicate that you have a PFFS plan. The card will include a Web address and a phone number where providers can call to obtain the Aetna Medicare Open^SM Plan (PFFS) Terms and Conditions of Payment.

   back to top

9. How will I know if my provider is eligible to receive payment under Medicare?

   You are encouraged to ask your health care professionals if they are eligible for Medicare payment and if they will accept the Aetna Medicare Open^SM Plan (PFFS) prior to receiving services. You can also find the listing of health care professionals who are eligible to receive payment under Medicare (or who accept assignment with Medicare) at the Medicare website: www.medicare.gov. Or, you can call Member Services at the number on your ID card for assistance.

   back to top

10. What if a provider has been sanctioned or has opted out of Original Medicare?

    Aetna Medicare PFFS members cannot receive items or services from providers who have been sanctioned or opted out of Original Medicare, and these providers may not treat PFFS members. Claims for services received from providers who have “opted out” of Medicare or have been sanctioned, will not be covered by the Aetna Medicare Open Plan.

    back to top

11. What if a provider does not accept the Aetna Medicare Open^SM Plan (PFFS) ID card?

    If the provider will not accept the Aetna Medicare Open^SM Plan, then you must seek covered services from another provider, unless you are seeking emergency or urgently needed services. Providers are not required to accept the Aetna Medicare Open^SM Plan (PFFS).

    If your provider will not accept the Aetna PFFS plan, you can encourage your provider to seek additional information on the Aetna Medicare Open^SM Plan (PFFS) through the Aetna website at www.aetna.com or by contacting Aetna directly through the Provider Service Line phone number on your ID Card.

    back to top

12. Can a provider bill me if Aetna does not pay for services provided?

    If a Plan member has agreed in advance in writing to receive non-covered services from a provider, the provider may collect payment for these non-covered services from the member. For example, if the Aetna Medicare Open^SM Plan (PFFS) does not cover hearing aids, but a plan member agrees in writing to receive a hearing aid from a hearing services provider, the provider may collect payment for the hearing aid from the member. Neither Aetna nor Original Medicare will pay for non-covered services.

    back to top

13. If I receive a balance bill for the Medicare Limiting Charge from a provider that does not accept Medicare assignment, how will I know if the billed amount is accurate?

    If you obtain services from a provider that does not accept Medicare assignment, the provider may balance bill you up to the Medicare Limiting Charge (15% of the Medicare allowable charge). You can always contact Member Services at the number on your ID card for help confirming that the amount of the balance bill is accurate based upon the service rendered.

    back to top

14. How do I obtain care when I am in the Aetna Medicare Open^SM Plan (PFFS)?

    When you go to a provider, you must inform the provider that you are enrolled in the Aetna Medicare Open Plan (PFFS) Private Fee-for-Service plan, and show them your ID card. The ID card will indicate that you are enrolled in a PFFS plan and will give providers directions about whom to contact to obtain additional information on the PFFS Plan, including the Plan's Terms and Conditions of Payment.

    Your provider can decide if he or she will treat you as a member of the Aetna Medicare Open^SM Plan (PFFS). If the provider decides to treat you, you are required to pay the cost-sharing amount allowed by your plan. The provider will bill Aetna for the rest of the fee. If the treating provider does not accept Medicare assignment, you may be balance billed up to the Medicare limiting charge (up to 15% of the Medicare allowable charge).

    back to top

15. How will I know if a particular medical service is covered under the Aetna Medicare Open^SM Plan (PPFS)?

    Like all Medicare Advantage plans, the Aetna Medicare Open^SM Plan (PFFS) must provide those benefits covered under Original Medicare and must use Medicare coverage rules to determine which services are medically necessary. If you have a question whether the Aetna Medicare Open^SM Plan (PFFS) will pay for a service, including inpatient hospital services, you have the right to request a written advance coverage determination to ensure the service requested will be covered. Initial organization coverage determinations for medical services would be requested through the Aetna Patient Management Department. Coverage determinations related to Medicare prescription drugs being offered under a PFFS plan would be requested through the Aetna Pharmacy Management Precertification Department. Contact the number on your ID card for more information.

    If Aetna has denied or will not pay for a service that you feel is medically necessary or would be covered under Original Medicare, you may file a Medicare Appeal with Aetna. Please consult your plan documents or contact Member Services at the number on the back of your ID card for more details on the Aetna Medicare Appeals process.

    back to top

16. Am I required to use a primary care doctor?

    No. Under Medicare PFFS plans, you can access care from any licensed provider who is eligible to accept payment under Original Medicare, is willing to provide covered services to you as an Aetna Medicare Open Plan (PFFS) member, and who accepts Aetna's Medicare Open^SM Plan (PFFS) Terms and Conditions of Payment. This includes specialists who are willing to accept the Aetna Medicare Open^SM Plan (PFFS) Terms and Conditions.

    back to top

17. Are prior authorization or referrals required for the Aetna Medicare Open^SM Plan (PFFS)?

    PFFS plans cannot require members to obtain prior authorization or referrals prior to receiving covered services. We do encourage prior notification for certain services, including inpatient care, skilled nursing, home health and some DME. To provide prior notification on behalf of a PFFS member, the provider should contact our Aetna Patient Management Department. Aetna Medicare Open^SM Plan (PFFS) members are not required to select a PCP, and there are no referrals required.

    back to top

18. Is my health care professional going to bill me for services I receive?

    If your provider agrees to accept the Aetna Medicare Open Plan (PFFS) Terms and Conditions of Paryment and is licensed and eligible to accept payment under Original Medicare, then the provider is only allowed to collect your specified cost sharing at the time the covered services are provided. They must submit a claim to Aetna for the remaining balance.

    Providers who do not accept Medicare assignment, but agree to provide covered services and accept Aetna’s Terms and Conditions of Payment, can balance bill you up to the Medicare Limiting Charge. This amount is typically 15% above the Medicare allowable rate.

    back to top

19. Will I need to submit claim forms to Aetna?

    If your provider agrees to the Aetna Medicare Open^SM Plan (PFFS) Terms and Conditions of Payment, he or she will collect your share of the cost and bill Aetna for the remainder.

    In certain situations — for example, if you require emergency or urgently needed care, you are not required to see providers who have agreed to Aetna’s Terms and Conditions — you may be asked to pay the bill in full. In these situations, you can complete a claim form or send the bill to Aetna for reimbursement, minus any applicable cost share. Please be sure to include your name and member ID on the bill. You can send claim forms to the address on the back of your ID card.

    back to top

20. How do I receive emergency or urgent care?

    You have the right to receive emergency and urgent care when and where you need it without prior approval. If you are seeking emergency or urgently needed services, you do not need to access care from a provider who accepts the Aetna Medicare Open^SM Plan (PFFS). However, if the provider does not accept Medicare assignment, he or she may also balance bill PFFS members up to the Medicare Limiting Charge for emergency or urgently needed services.

    back to top

21. Will I need to submit a claim form when I receive emergency care?

    Aetna asks providers to bill Aetna directly for covered services and charge PFFS members only their share of the cost. However, if a member is asked to pay for covered services, the member can submit the claim to Aetna, and Aetna will reimburse the member, minus any applicable cost sharing. If the provider does not accept Medicare assignment, then the provider may also balance bill the member up to the Medicare Limiting Charge for emergency or urgently needed services.

    back to top

22. Will I receive Explanations of Benefits (EOBs) for Aetna Medicare Open^SM Plan (PFFS) services?

    Yes. An Explanation of Benefits (EOB) is created for every processed Aetna Medicare Open^SM Plan (PFFS) claim, even if no member cost-sharing applies.

    back to top

23. Do I need to continue to pay my Medicare Part B Premium if I am enrolled in the Aetna Medicare Open^SM Plan (PFFS)?

    Yes. You must continue to pay your Part B premium to remain enrolled in any Medicare Advantage Private Fee-for-Service plan.

    back to top

24. What should I do if my PFFS plan will not pay for a service that I think I need?

    You have the right to ask for an initial organization coverage decision for a service or payment of services received that you feel is both medically necessary and should be covered by the Medicare PFFS plan. If the request is denied, Aetna must send you a written denial and your appeal rights.

    back to top

25. What are my appeal rights under Medicare PFFS plans?

    You can file an appeal if your PFFS plan will not cover a service that you think should be covered. If you believe that waiting for a decision about a service could seriously harm your health, ask, or have your doctor ask, the PFFS plan for an expedited decision. If your appeal request qualifies for an expedited decision, Aetna must make a decision and notify you of its decision within 72 hours. Appeal requests that do not qualify for expedited processing will be processed under the Medicare Appeals guidelines and timeframes. See your membership materials for details about your Medicare appeal and grievance rights or visit the Medicare Advantage — Appeals and Grievances section of the website.

    back to top

26. Should I worry about fraud and abuse with a PFFS plan? If yes, what should I look for?

    In general, you want to make sure that you do not pay a provider any more than your Aetna Medicare Open^SM Plan (PFFS) requires. You should also be certain that your provider only bills Aetna for services that you received. If you believe that fraud has occurred, call the Inspector General's hotline at 1-800-447-8477 to report Medicare fraud. Your name will not be used if you request that it not be used.

    You can also report fraud using Aetna’s Fraud Hot Line. Aetna has a toll-free fraud hot line for our customers — plan sponsors, members and providers — for questions, information or to report potential fraud-related problems. The phone number is 1-800-338-6361. The line is staffed by the Special Investigations Unit and is available 7 days a week, 24 hours a day. Callers can remain anonymous. You can also fax the Fraud Hot Line at: 1-860-636-2400, or send an e-mail to: aetnasiu@aetna.com.

    back to top

27. What happens if my doctor is not familiar with the Aetna Medicare Open^SM Plan (PFFS)?

    Ask your doctor to visit the website at www.aetna.com and look under the "Health Care Professionals" section for more information about Medicare PFFS, including the Terms and Conditions of the plan. Providers can also call our Provider Line at 1-800-624-0756. (This website and phone number are also on the back of your ID card.)

    back to top

Aetna Medicare Advantage Special Needs Plan (SNP)

1. What is the difference between Special Needs Plans (SNP) and other Medicare Advantage plans?

   Special Needs Plans provide benefits and services specifically designed for certain groups of the Medicare population. Enrollment is restricted to those groups, which include:

   • Institutional (that is, a person living in a long-term care facility)
   • Dual Eligible (that is, a person with both Medicare and state Medicaid health insurance)
   • Chronic and disabling condition (that is, a person who has a certain condition, such as end-stage renal disease (ESRD), diabetes, or congestive heart failure (CHF)).
   back to top

2. What types of Medicare Advantage Special Needs Plans (SNPs) does Aetna offer?

   Aetna offers Dual Eligible SNPs, which are called Aetna Medicare Dual Advantage Plans (HMO). These plans are available in Bexar County, Texas, and some New Jersey counties (Bergen, Essex, Hudson, Middlesex, Monmouth, Ocean, Passaic, Sussex, and Union).

   back to top

3. What are the unique enrollment and disenrollment rules that apply to Medicare Advantage Special Needs Plans (SNPs)?

   Enrollment rules:

   • Aetna must verify your Medicaid status before you can enroll in the Aetna Medicare Dual Advantage Plan (HMO).
   • You will be disenrolled from your Aetna Medicare Plan if you lose your Medicaid coverage (Aetna Medicare Dual Advantage Plan (HMO)) or
   • Members will be given a six-month grace period in which to re-establish SNP eligibility prior to disenrollment.
   back to top

4. What are the benefits of enrolling in a Special Needs Plan (SNP)?

   Aetna Medicare Dual Advantage Plan (HMO), a Dual Eligible SNP, provides special benefits and services, including reimbursement allowances for eyewear and hearing aids. This plan also covers, at no cost to you, 50 one-way visits to and from provider offices. Your monthly premium will be $0 if you receive the full Medicare Part D Low Income Subsidy (“extra help”).

   back to top

5. Does enrolling in an Aetna Medicare Dual Advantage Plan (HMO) affect my Medicaid coverage and my Medicare Part D low income subsidy ("extra help")?

   Enrolling in an Aetna Medicare Dual Advantage Plan (HMO) DOES NOT affect your coverage for Medicaid and Medicare Part D Low Income Subsidy. You keep your state Medicaid coverage and extra help with your prescription drugs.

   If you receive the full Medicare Part D Low Income Subsidy, your monthly plan premium will be $0. Your Medicaid coverage will continue to pay your Medicare Part B premium.

   If your state Medicaid coverage pays for your Medicare deductibles, coinsurance and copays, your health care professional should continue to bill the state Medicaid program for those items. Your coverage may change if the status of your Medicaid eligibility or the status of your extra help changes. However, you MAY BE RESPONSIBLE for paying the copays through extra help for Medicare Part D prescription drugs, unless the state Medicaid program separately pays for those copays.

   back to top

6. What ID cards should I bring with me when I have a doctor appointment?

   Aetna Medicare Dual Advantage Plan (HMO) members should always show both their Aetna Medicare ID card and state Medicaid card.

   Before your visit, check with your doctor’s office to verify that they accept both Aetna Medicare and state Medicaid. Not all Aetna Medicare providers accept state Medicaid.

   If you visit a doctor who does not accept state Medicaid, they should inform you of the extra cost you will need to pay for his/her services.

   back to top

7. What information do I need when I enroll?

   1. Your original Medicare card. This will have the effective dates of your Part A and/or Part B coverage.
   2. Your state Medicaid number or Social Security number if you are enrolling in the Aetna Medicare Dual Advantage Plan (HMO).
   back to top