Aetna Medicare Plan (HMO)
Aetna Medicare Plan (HMO) is an Aetna Medicare Advantage plan HMO that gives you access to tens of thousands of network doctors nationwide. This generally allows you to get more benefits for less money than Original Medicare for most services
In many areas, our network is so large that it’s likely to include your current doctors and hospitals. To see a full list of doctors and hospitals in our network, click here or use “Easy Answers,” found on most pages of this site.
Other Aetna Medicare Advantage plan features include:
- Predictable out-of-pocket costs
- No referrals necessary for covered services with our Open Access HMO plans in select areas
- Coverage for most Part D prescription drugs when you choose an Aetna Medicare Advantage plan with prescription drug coverage (“MAPD” plan)
- A plan premium that can be hundreds of dollars less than a Medicare supplement plan
- $0 copays for preventive care, including routine physicals and annual screenings (Some group plans for retirees may have copays)
- Fitness center benefits, including a gym membership, at no extra cost (not offered in all plans)
- Allowances for hearing aids and eyewear (not offered in all plans)
You must be entitled to Medicare Part A and continue to pay your Part B premium and Part A, if applicable. For medical coverage, you must use network providers except for emergency 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 Medicare Plan (PPO)
The Aetna Medicare Plan (PPO) is an Aetna Medicare Advantage plan (PPO) that gives all the benefits of an HMO, plus the flexibility to visit doctors in or out of network for a low monthly plan premium, in addition to your Medicare Part B premium.
Other Aetna Medicare Advantage Plan features include:
- Predictable out-of-pocket costs
- Coverage for most Part D prescription drugs when you choose an Aetna Medicare Advantage plan with prescription drug coverage (“MAPD” plan)
- $0 copays for preventive care, including routine physicals and annual screenings (Some group plans for retirees may have copays)
- No referrals necessary to see doctors or specialists in or out of network for covered services
- You are not required to select a primary care physician (PCP), although you are encouraged to do so. You will pay the lower primary doctor copay only if you select a PCP and notify Aetna Medicare of your choice.
- Fitness benefits, including a gym membership, at no extra cost (available with some Aetna Medicare plans)
- Allowances for hearing aids and eyewear (available with some Aetna Medicare plans)
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 (Private Fee-for-Service - PFFS)
The Aetna Medicare OpenSM Plan (PFFS) is a private fee-for-service Aetna Medicare Advantage plan with no network. That gives you the freedom to visit any doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you, and accepts the Aetna Medicare OpenSM Plan terms and conditions.
Other plan features include:
- Freedom to access benefits nationwide
- Predictable out-of-pocket costs
- Coverage for most Part D prescription drugs when you choose an Aetna Medicare Advantage Plan with prescription drug coverage ("MAPD" plan)
- $0 copays for preventive care, including routine physicals and annual screenings (Some group plans for retirees may have copays)
- Allowances for hearing aids and eyewear
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.
Learn more about Medicare Advantage private-fee-for-service plans by reading the educational leaflet. The Centers for Medicare and Medicaid Services require 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 Dual Advantage Plan (Special Needs Plan - SNP)
The Aetna Medicare Dual Advantage Plan (SNP) is designed to meet the specific needs of Medicare beneficiaries who are dual eligible for federal Medicare and state Medicaid health insurance.
This Aetna Medicare Advantage Plan features include:
- Reduced or zero dollar plan premiums and copayments, with additional services and benefits
- Coverage for most Medicare Part D prescription drugs
- Requires you to live in a plan service area to enroll:
- New Jersey: Bergen County, Essex County, Hudson County, Middlesex County, Monmouth County, Ocean County, Passaic County, Sussex County, or Union County
- Texas: Bexar County or En Espanol (2 pages, 31 KB)
Welcome Texas Aetna Medicare Dual Advantage Plan (HMO) Members
Aetna, Medicare, and the Texas Health and Human Services Commission are working together to help you get the most from your Medicare and Medicaid benefits.
Contact the Texas Health and Human Services Commission (http://www.hhsc.state.tx.us) to get more information about the Medicaid Services available to you.
Get a printed list of Texas Medicaid participating doctors, clinics, hospitals and other providers available for your health care by calling the Enrollment Helpline 1-800-964-2777. You can also search for Texas Medicaid participating providers on the Texas Medicaid & Healthcare Partnership's (TMHP) website (http://www.tmhp.com).
If you have a disabling medical condition, the state of Texas may be able to help you with a program called Long-Term Services and Supports. The goal of this program is to help you remain as independent as you can. You can learn about these services from your STAR+PLUS health plan or the Texas Department of Aging and Disability Services (DADS).
If you are enrolled in a Star+PLUS Medicaid health plan, here is the information you need to contact them:
If you are not enrolled in a STAR+PLUS Medicaid health plan and need help, you can call DADS at 1-888-902-9990 or visit their website at http://www.dads.state.tx.us/services/index.cfm.
You can also get help with your Aetna Medicare benefits by contacting Aetna Member Services at 1-800-282-5366 (TTY/TDD 1-888-760-4748), Monday through Sunday from 8 a.m. to 8 p.m.
Coverage is provided through a Medicare Advantage organization with a Medicare contract. Health insurance plans are offered by Aetna Health Inc., Aetna Health of California Inc. and/or Aetna Life Insurance Company (Aetna). This material is for informational purposes only. See plan documents for a complete description of benefits, exclusions, limitations and conditions of coverage.
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