Aetna Medicare Advantage FAQ
Frequently asked questions
Learn more about our Medicare Advantage plans
We know you have questions about Medicare and our Medicare Advantage plans. Here we've answered some of the questions you ask most often. Simply click on the question below to see its answer.
- What types of Medicare coverage do you offer?
- I belong to another Medicare Advanage plan. Can I switch to your Medicare Advantage plan?
- Do you offer a plan in my area?
- When will my plan coverage become effective?
- Can I continue to go to my current doctors?
- How do I decide which plan is best for me?
- Can my plan voluntarily disenroll me?
- Are there things my plan doesn't cover?
- Is my choice of doctors limited with plans that have a network?
- What is a PCP and can I change my PCP once I'm enrolled?
- What if I need to see a specialist?
- What if I need to go to the hospital?
- What if I'm traveling, visiting or living out of town and need non-emergency care?
- What is a “medical emergency” and what should I do if I have one?
- Is fitness, vision, hearing and dental coverage provided?
- Will my Medicare Advantage plan premium decrease if the government is helping pay for part of my Medicare prescription drug plan costs?
- Does my Aetna Medicare Advantage plan cover hospice?
- Does Aetna have a quality improvement program?
- How much will I pay for my Medicare prescription drug plan?
- Do you offer preferred pharmacies that can lower my cost-share?
- How can I pay my monthly bill?
- Will I receive a bill for both your Medicare plan and Original Medicare?
- How can you 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 if I decide I no longer want my current coverage?
- Will I need to keep my Medigap policy if I join a Medicare Advantage plan?
- Do I need to re-enroll if I move out of my plan’s service area?
- What if I receive a survey about a move out of the service area and I haven’t moved?
What types of Medicare coverage do you offer?
- 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.
- Medicare Part D plans (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 too.
I belong to another Medicare Advanage plan. Can I switch to your Medicare Advantage plan?
Most people can only enroll in a new plan during certain tines of the year:
- Between October 15 – December 7 anyone can join, switch, or drop a Medicare plan.
- In certain situations, you may be able to join, switch, or drop a Medicare plan during a Special Enrollment Period. Examples include:
- If you move out of your plan’s service area.
- If you have Medicaid.
- If you qualify for Extra Help.
- If you live in an institution (like a nursing home).
Do you offer a plan in my area?
Use our online tool to find our Medicare plans in your area.back to top
When will my plan coverage become effective?
Generally, your coverage will begin on the first day of the month after we receive your completed enrollment form.back to top
Can I continue to go to my current doctors?
Verify if your current doctor is in our network. Generally, you must receive care from a network provider. Search for a Provider.back to top
How do I decide what plan is best for me?
Depending on where you live, several of our Medicare plans may be available. Use our online tool to find our Medicare plans in your area. If you need help selecting a plan, call our plan specialists toll free at 1-888-247-1028 (TTY: 711), 8 a.m. - 8 p.m., local time, 7 days a week, from October 1 - February 14, or 8 a.m. - 8 p.m., local time, Monday - Friday, from February 15 - September 30.back to top
Can my plan voluntarily disenroll me?
Yes. There are times when we are required to end your membership in our plan. Examples include:
- failure to pay premiums
- being outside our service area for more than 6 months
- loss of continuous Medicare Part A and Part B coverage
- if you become incarcerated
- fraud and/or disruptive behavior
Helpful Disenrollment Hints:
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- We must receive and process completed disenrollment forms by the end of the month for the disenrollment to be effective for the 1st of the following month. If you’re requesting a disenrollment after the 15th of the month, we suggest you call us or fax your form to ensure we receive and process it before the end of the month.
- If you want to disenroll, please call us or fax your form to ensure we receive and process it before the end of the month. Please do not stop paying your plan premiums and assume your disenrollment is in effect.
- You will receive an approval, denial or request for more information from your plan about your disenrollment/cancellation request.
- If you would like to cancel your recent enrollment prior to your effective date with your plan, you do not need to fill out a disenrollment form; you can verbally request a cancellation of your enrollment by calling your plan.
Are there things my plan doesn't cover?
Each plan is different, so it’s important to refer to your plan’s Evidence of Coverage (EOC). The EOC provides specific information on benefits and coverage. It’s the legal contract between us (as member and plan). Below is a partial list of the most common exclusions:
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- Services and equipment that aren’t reasonable or medically necessary to treat an illness
- Plastic or cosmetic surgery, unless medically necessary
- Personal convenience items or services
- Meals delivered to the home
- Immunizations for travel or employment
- Special duty nurses, unless medically necessary
- Private hospital room, unless medically necessary and approved by your plan in advance
- Custodial care
- Benefits and services not covered by Medicare unless specifically described as a covered service in your plan materials
Is my choice of doctors limited with plans that have a network?
HMO plans generally require you to receive care from a network provider for coverage and to receive the lowest costs.
PPO plans allow you to receive covered services from any doctor or hospital inside or outside 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 our Medicare PPO plan.
Our Medicare network includes more than 400,000 doctors and hospitals nationwide. Search for your doctor or hospital using our online provider search tool.back to top
What is a PCP and can I change my PCP once I am enrolled??
A PCP is a “primary care physician” (doctor) you choose from our network to provide your routine and preventive care. You can change your PCP after you've enrolled. Please refer to our online provider search tool for help finding a PCP.
Another option is to contact us for help finding a doctor who meets your needs.back to top
What if I need to see a specialist?
Most of our plans don’t require a referral to see a specialist. Getting a referral with our traditional HMO plans is as easy as visiting your primary care doctor. If you have a condition your primary care doctor is unable to treat, your doctor can refer you to the network specialist of your choice. Remember 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 go to the hospital?
Our Medicare Advantage plans cover you for unlimited hospital days 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 may be covered. Some of our plans allow you to get the same network benefits you receive at home for covered non-emergency medical care from network providers. Other plans offer coverage from out-of-network providers anywhere in the United States if they accept Original Medicare.
With some of our HMO plans, we offer a U.S. Travel Advantage program. Your enrollment in this program allows you access to the same medical services you receive at home when using our 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.back to top
What is a “medical emergency” and what should I do if I have one?
When you have a “medical emergency,” you believe 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 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 don't need to get approval or a referral first from your primary care doctor.
- As soon as possible, make sure you tell us about your emergency because we need to follow up on your emergency care. Usually within 48 hours, you or someone else should call Member Services at the number on the back of your ID card to report your emergency care.
Is fitness, vision, hearing and dental coverage provided?
Yes. Many of our plans include fitness, vision, hearing and dental coverage depending on the plan. Please refer to your plan documents for coverage details.back to top
Will my Medicare Advantage plan premium decrease if the government is helping pay for part of my Medicare prescription drug plan costs?
It depends on whether or not your Medicare Advantage (MA) plan includes Medicare prescription drug coverage. If you have an MA plan without Medicare prescription drug coverage, you won’t receive financial help paying for your plan. If you have an MA plan that includes Medicare prescription drug coverage, you may be able to get financial help that affects your premiums, copayments or both.back to top
Does my Medicare Advantage plan cover hospice?
You may receive care from any Medicare-certified hospice program. Original Medicare 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’ll remain our plan member and your care that’s unrelated to your terminal condition will be covered through our 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
- One hospice consultation service 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 much will I pay for my Medicare prescription drug plan?
The amount you pay depends on several factors including your plan, which tier your drug is in, the pharmacy you use, if you get Extra Help, and the phase of coverage you're in. Use our online search tool to estimate costs for your drugs. If you have limited income, you may be able to get Extra Help paying for your plan.back to top
Do you offer preferred pharmacies that can lower my cost-share?
Yes. Our PDP and most MAPD plans offer a robust network of more than 60,000 pharmacies. More than 30,000 are preferred pharmacies, which can lower your prescription cost-share.back to top
How can I pay my monthly bill?
You can pay your monthly bill in a number of ways:
- 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. If your Medicare premium payments aren’t taken out of your SSA check for two or three months, you could owe more than the $200 limit. If you owe more than the $200 limit, you'll receive a bill from us.back to top
Will I be receive a bill for both my Medicare Advantage plan and Original Medicare?
Yes. You'll get a monthly bill for your Aetna Medicare plan. You'll also need to keep paying your Part B premium and/or Part A premium, if you have one.back to top
How can you offer a zero-dollar premium?
We have a contract with the federal government to offer Medicare Advantage plans. As a result, some areas offer both medical and prescription drug coverage for a zero-dollar premium. Just remember you still have to pay for your Medicare Part B premium and doctor office copays.
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 would have to pay for both plan premiums and you wouldn’t benefit from your supplemental plan. Medicare Supplement plans 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.
What if I decide I no longer want my current coverage?
There are only certain times during the year when you may voluntarily end your membership in our plan. The key time to make changes is the Medicare fall open enrollment period (also known as the “Annual Election Period”). This period occurs every year from October 15 through December 7. It’s the time to review your health care and drug coverage for the following year and make changes if you need to. Any changes you make during this time will be effective January 1.
You can leave your plan and switch to Original Medicare between January 1–February 14 if you’re in a Medicare Advantage plan,. If you switch to Original Medicare during this period, you’ll have until February 14 to join a Medicare prescription erug plan to add drug coverage.
Certain people, such as those with Medicaid, those who get extra help, or those who move in/out of a plan’s service area, can make changes at other times.
You can also disenroll from our plan if you’re eligible for a Special Enrollment Period. Examples that qualify you for a special enrollment include:
- You move in or out of a plan’s service area
- You have Medicaid
- You’re eligible for extra help with Medicare prescriptions
- You live in an institution (such as a nursing home)
Generally, your disenrollment will be effective the first day of the next month following receipt of your disenrollment request. You may use any of the following ways to disenroll from our Medicare Advantage plans:
- Write a letter or fill out a disenrollment form.
- Please fax the form to 1-888-554-7668.
- Mail it to our Enrollment Department at: PO Box 7770, London KY 40742-7770.
- Note: the member or the member’s legal representative must sign all disenrollment requests before we process them.
- Call Member Services – please use the number on the back of your member ID card to request a disenrollment form.
- Call 1-800-MEDICARE (1-800-633-4227) (TTY/TDD users should call 1-877-486-2048) 24 hours a day, seven days a week.
Will I need to keep my Medigap policy if I join a Medicare Advantage plan?
You can’t be sold or use a Medicare Supplement Insurance (Medigap) policy while you’re enrolled in a Medicare Advantage plan. If you already have a Medigap policy and join a Medicare Advantage Plan, you’ll probably want to cancel your Medigap policy. If you cancel your Medigap policy, you may not be able to get it back. Consult a licensed plan representative, your licensed agent, an agent who specializes in Medicare, or your local SHIP office before giving up your Medigap policy.
Do I need to re-enroll if I move out of my plan’s service area?
You must live in our service area to remain a member of our plan. Please let us know immediately if you move. If you move outside of a plan’s service area, your disenrollment date will be the 1st of the following month.
To continue coverage with us, you’ll have to enroll in a plan that offers coverage in your new service area. Submit a new enrollment application for the plan you chose – we can’t transfer you from one plan to another automatically.
Things to expect if you decide to continue coverage with us:
- You need to complete an enrollment application for a plan in your new service area. Call us if you need help completing your enrollment application. The call will take about 10-15 minutes. Have your red, white, and blue Medicare card available when placing this call.
- Please let us know you’re requesting enrollment in a new plan because you moved in or out of a service area.
- You’ll receive a confirmation of disenrollment letter from the plan in your previous service area AND a confirmation of enrollment letter from the plan in your new service area. This information confirms that you were disenrolled from your old plan and are now enrolled in your new plan.
What if I receive a survey about a move out of the service area and I haven’t moved?
Please complete and return the form to help us make sure our records are as accurate as possible. We don’t want interruption to your coverage. You may also respond to our request for information by calling us.
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.
The Formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location.
This information is available for free in other languages. Please call our customer service number at 1-888-247-1028 (TTY: 711), Monday through Sunday, 8 a.m. to 8 p.m. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-800-282-5366 (TTY: 711). Horario de atención: de 8 a.m. a 8 p.m., los siete días de la semana.