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.

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 is a “medical emergency” and what should you do if you have one?
10. What about fitness, vision, hearing and dental coverage?
11. Will my Medicare Advantage plan premium decrease if the government is helping pay for part of the Medicare prescription drug plan cost?
12. Does my Aetna Medicare Advantage plan cover hospice?
13. Does Aetna have a quality improvement program? 

General

1. 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.
   
   The Medicare Advantage plans include options with Medicare prescription drug coverage. 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.

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2. 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.

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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 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 1-888-760-4748), Monday through Sunday, 8 a.m. to 8 p.m.

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4. 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 outside of the network for a higher copay or coinsurance. Providers must be eligible for Medicare payment and willing to accept the Aetna Medicare Plan (PPO).

   Aetna's Medicare network includes over 225,000 doctors and over 1,700 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.

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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) 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.

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6. 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 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.

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7. What if I need to be hospitalized?

   You're covered for unlimited hospital days with any Aetna Medicare Advantage plan when medically necessary. Refer to the plan documents for specific hospital benefit details.

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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 medical care 24 hours a day, 7 days a week, anywhere in the world.

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

    We have all four. 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. Most 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.
    
    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.

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11. 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.

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12. 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.
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13. 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.

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