Aetna Medicare Advantage Plans North Carolina 2025
Sorting through Medicare Advantage plans in North Carolina? Aetna offers a selection to match your lifestyle and health needs, including HMO and PPO options packed with benefits. Get to know the specifics of Aetna’s Medicare Advantage plans in North Carolina for 2025 and pick the plan that gives you peace of mind without the added fluff.
Key Takeaways
- Aetna Medicare Advantage Plans in North Carolina offer HMO, PPO, and PFFS options that cover at least the same benefits as Original Medicare Part A and B with extra benefits that include dental, vision, hearing coverage, and wellness programs.
- Beneficiaries can compare and enroll in Aetna’s plans online, by phone, or by mail, with a variety of plans available tailored to different health needs, prescription requirements, and $0-premium options to ensure accessible healthcare coverage.
- Aetna Medicare Advantage Plans provide comprehensive healthcare management including prescription drug coverage, a 24/7 nurse line, and support services that extend to non-medical forms of care, reflecting a commitment to extensive member resources and high CMS star ratings.
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Exploring Aetna Medicare Advantage Plans in North Carolina
North Carolina’s Medicare beneficiaries have a plethora of choices when it comes to selecting a Medicare Advantage plan, thanks to Aetna’s extensive offerings. From Health Maintenance Organization (HMO) to Preferred Provider Organization (PPO) and Private Fee-for-Service (PFFS) plans, Aetna strives to cater to the diverse healthcare needs of North Carolinians.
Each of these plans guarantees a minimum coverage equivalent to Original Medicare Part A and B, safeguarding enrollees’ access to vital healthcare services.
Understanding Medicare Advantage HMO and PPO Options
When it comes to Medicare Advantage plans, one size certainly does not fit all. That’s why Aetna offers both HMO and PPO plans, providing flexibility in choosing providers. Aetna’s PPO plans allow members the freedom to choose from any provider who accepts Medicare, providing flexibility in healthcare choices. While choosing in-network providers can result in lower costs, PPO members also have the option to seek care from out-of-network providers.
Contrastingly, Aetna’s HMO plans follow a more rigid structure, mandating that members use in-network providers for their healthcare needs, barring emergency situations. Many of these HMO plans require members to select a primary care provider (PCP) and obtain a referral to see specialists. This setup encourages coordinated care, where your healthcare providers work together to manage your overall health.
The Extra Benefits of Aetna’s Medicare Advantage Plans
In addition to offering comprehensive health coverage, Aetna’s Medicare Advantage plans come with a host of extra benefits that go beyond Original Medicare. Some of these benefits include:
- Coverage for oral exams, cleanings, and X-rays
- Vision coverage that includes annual eye exams and allowances for eyeglasses or contacts
- Hearing benefits that encompass an annual exam and hearing aid fitting
These additional benefits can provide you with the best coverage for your healthcare needs, ensuring more comprehensive protection.
The benefits extend beyond dental, vision, and hearing services. Aetna further enhances its offerings with access to fitness programs like the SilverSneakers membership. This program allows members to exercise and maintain their health at numerous facilities, providing a fun and effective way to stay fit.
Additionally, Aetna’s plans also include benefits like out-of-pocket limits on medical care, worldwide ER/urgent care coverage, and meals-at-home programs following inpatient hospitalizations, supporting healthcare management beyond hospital stays.
How to Access Aetna’s Secure Website for Plan Information
Aetna simplifies healthcare plan management through its user-friendly and secure website, which includes the Aetna Medicare website. To access this platform, both current and prospective members need to create an account to access their plan information. Once logged in, members can view details about their coverage, including the status of claims and plan benefits.
Designed with user-friendliness in mind, Aetna’s secure website offers the following features:
- Easy access to information related to your health plans
- Convenient management of mail-order prescriptions through the Aetna Pharmacy section
- A one-stop-shop for all your healthcare needs
Navigating Coverage Areas: Aetna’s Plans by ZIP Code
Recognizing that healthcare needs differ, Aetna offers coverage options that vary by ZIP code, enabling members to select a plan that aligns with their specific healthcare requirements and preferences. Beneficiaries in North Carolina have access to a variety of Aetna Medicare Advantage plans including HMO-POS, PPO, and Dual Special Needs Plans (D-SNP).
To determine the specific plan availability in your area, Aetna has made it easy with their online tool. Simply follow these steps:
- Input your ZIP code into the tool.
- The tool will display relevant plan information.
- Use this information to explore your options and make an informed decision.
Find Your Fit: Matching Plans to Your Health Needs
Selecting a Medicare Advantage plan is a significant decision, particularly when considering personal health needs and prescription drug requirements. That’s where SilverScript Part D plans come in. Offered by Aetna, these plans provide a range of formulary options, allowing individuals to tailor their plan to their specific prescription drug needs.
With varying monthly premiums, deductibles, copays, and additional gap coverage, members can find a plan that fits their health needs like a glove.
Enrolling in an Aetna Medicare Advantage Plan
After exploring Aetna’s Medicare Advantage plans and identifying the most suitable one, the subsequent step involves enrollment. To be eligible for a Medicare Advantage (Part C) plan, individuals must first be enrolled in Original Medicare Parts A and B. What’s more, Aetna ensures that all Medicare-eligible individuals in North Carolina have access to a $0-premium Medicare Advantage plan, making healthcare coverage accessible to everyone.
Aetna has made the enrollment process as seamless as possible. Individuals can enroll in Aetna Medicare Advantage plans through the following methods:
- Online: You can shop, compare coverage, and prices, and enroll directly on the Aetna website.
- Phone: If you prefer a more personal touch, you can complete the enrollment process over the phone by calling a licensed agent.
- Mail: If you request an enrollment kit, you can complete the enrollment process by mail. And, if you have any questions about the enrollment process, you can request a call from a licensed Aetna Medicare agent for answers. Rest assured, Aetna’s commitment to providing excellent customer service means help is always just a phone call away, seven days a week.
Prescription Drug Coverage with Aetna Medicare Plans
Prescription drug coverage is an integral part of any healthcare plan. Aetna Medicare Advantage plans include a comprehensive formulary that lists all covered prescription drugs, complete with details such as drug tiers, requirements or limits if any, and mail-order availability.
This ensures that members can manage their prescription costs effectively by ensuring their new prescriptions are on their plan’s drug formulary, considering a smaller initial supply, and regularly reviewing their medications with healthcare professionals for necessity and redundancy.
For those who qualify, the Patient Access Network (PAN) Foundation provides financial assistance to cover medication costs. And, if you’re not eligible for this program, don’t worry. Aetna offers alternative resources to help manage your prescription costs, such as:
- Prescription discount programs
- Generic drug options
- Mail-order pharmacy services
- Medication therapy management programs
These resources can help make your medications more affordable and accessible.
Understanding Part D and Its Integration with Medicare Advantage
Aetna’s commitment to providing comprehensive healthcare coverage is evident in its Medicare Advantage plans that include prescription drug coverage, also known as MAPD plans. This integration of Part D prescription drug coverage into Medicare Advantage ensures that members have access to the prescription drugs they need, all under one convenient plan.
Managing Prescriptions: Aetna’s Mail-Order Service
Given the demands of our fast-paced lives, Aetna provides a mail-order prescription service via CVS Caremark® Mail Service Pharmacy for convenience. This service allows Aetna’s Medicare Advantage plan members to manage their prescriptions securely online, saving them time and effort.
Aside from convenience, this mail-order service also provides cost savings. By ordering a 90-day supply of medications, members can reduce their costs. With the SilverScript Plus plan, members can enjoy:
- $0 copays for Tier 1 and Tier 2 drugs, potentially eliminating the need to pay base pharmacy charges
- Mail-order prescriptions typically arrive within 10 days
- Options for alternate delivery addresses or expedited shipping for an extra cost
And while returns on mail-order prescriptions are generally not accepted, Aetna can provide exceptions in certain cases, ensuring that members are always supported in managing their prescriptions.
Member Resources and Support Services
Membership in Aetna’s Medicare Advantage plans grants access to a range of resources and support services tailored to enhance your healthcare journey. From the Aetna HealthSM mobile app, which allows you to manage your plan information at your fingertips, to educational resources available through Medicare.gov and CMS’s website, Aetna ensures you have all the information you need to make informed healthcare decisions.
One particularly helpful resource is Aetna’s Medicare glossary. With this tool, you can easily navigate the often complex healthcare terminology, aiding in informed decision-making. What’s more, Aetna’s commitment to excellence in healthcare coverage is reflected in its ratings. Approximately 87 percent of its Medicare Advantage members are enrolled in plans rated 4 stars or higher by CMS for 2024, demonstrating the high quality of care Aetna provides.
24/7 Access to Healthcare Professionals
Understanding that healthcare concerns can arise anytime, Aetna provides a 24/7 nurse line, ensuring uninterrupted access to healthcare advice and support for members. This service, known as the Informed Health Line®, allows Aetna Medicare Advantage plan members to speak with a registered nurse anytime, ensuring that help is always just a phone call away.
Whether you need to learn more about a health condition, understand medical tests or procedures, or prepare for a doctor’s visit, the Informed Health Line® is there to assist you. This nurse advice service is available 24 hours a day, 365 days a year, providing peace of mind that you can always access medical guidance when you need it most.
Utilizing Aetna’s Resources For Living® Program
Healthcare goes beyond doctor’s visits and prescription medications. It involves all aspects of living a healthy, balanced life. Aetna recognizes this, which is why it offers the Resources For Living® program to Medicare Advantage plan members. This program provides fast referrals to community services and support, along with a concierge service to help members find local resources.
The Resources For Living program offers a wide range of services to support independent living and provide caregiver support. These services include:
- Essential services such as food and meal services, cleaning, senior living options, pet care, and home modifications
- Caregiver support through consultations, backup care, care planning, in-home care, and support groups
- Social connections through classes, transportation, and other community activities
To access these valuable resources, members simply need to contact a dedicated phone line available during specific weekday hours for tab feedback.
Comparing Aetna to Other Providers in North Carolina
The decision to select a Medicare Advantage plan is momentous, warranting careful evaluation of all available options. In North Carolina, Aetna is one of many providers offering Medicare Advantage plans. While Aetna’s plans have a CMS Star Rating of 3.98 out of 5, which is above average, it’s slightly lower than Humana’s leading 4.34 star rating but higher than UnitedHealthcare’s 3.87 star rating.
Other top providers in the state include Blue Cross Blue Shield, Cigna, and Anthem, along with Aetna, UnitedHealthcare, and the market-leading Humana.
Evaluating Plan Options: Aetna vs. Competitors
Aetna advocates for a thorough comparison of options when deciding on a Medicare Advantage plan. By utilizing comparison tools and worksheets, you can evaluate Aetna’s Medicare Advantage plans against competitors to ensure alignment with your individual health goals. For instance, UnitedHealthcare boasts the largest network size among Medicare Advantage providers, offering a significant point of comparison to Aetna’s network in the state.
Blue Cross Blue Shield offers robust local support to its Medicare Advantage members in North Carolina, another important contrast to consider when comparing with Aetna’s offerings. While Humana is recognized for its low-cost plan options and high overall CMS Star Rating, Aetna encourages out-of-network physicians to engage with their Member Services to possibly join their network.
Feedback and Ratings: What Members Say About Aetna
Member feedback and ratings serve as valuable indicators of a Medicare Advantage plan’s quality. Aetna’s Medicare Advantage plans in North Carolina have an above-average member experience rating, with a score of 3.79 out of 5, indicating a high level of satisfaction among members. However, it’s worth noting that no Aetna Medicare Advantage plans in North Carolina currently hold a 5-star rating by CMS.
The rating scale used by CMS for rating Medicare Advantage and Part D plans ranges from one to five stars, providing a benchmark for comparing plan quality. When considering a plan, it’s important to look at the CMS Star Rating but also to review member feedback and new tab feedback to get a comprehensive understanding of the plan’s quality.
Maximizing Your Medicare Advantage Plan
After selecting a Medicare Advantage plan, the subsequent step involves leveraging its benefits to the fullest. Whether you’re managing healthcare costs or staying in-network for care, understanding your plan’s coverage and benefits can help you make the most out of your plan.
Keeping Healthcare Costs in Check
Grasping the coverage and costs associated with Aetna Medicare Advantage plans is key to effective healthcare expense management. Aetna’s secure website enables members to view detailed information on their healthcare costs, the extent of coverage provided by the plan, deductible status, and out-of-pocket maximums.
Furthermore, it’s worth noting that the average monthly premium for a Medicare Advantage plan in North Carolina has risen to $17.10 in 2024, which is an increase from the previous year’s average of $14.81.
Medicare Advantage Plans cover all Medicare services, providing comprehensive medicare coverage, including Part A and Part B benefits, as well as additional benefits that may arise from new laws or Medicare policy decisions. They can also offer coverage for things Original Medicare does not cover, such as fitness programs, vision, hearing, and dental services, transportation to doctor visits, and over-the-counter drugs.
In fact, some Medicare Advantage Plans can tailor their benefit packages to offer additional benefits specifically for chronically ill enrollees, with benefits customized to treat specific conditions.
Staying In-Network: Finding Doctors and Hospitals
Opting for in-network providers serves as another effective strategy to derive maximum benefit from your Medicare Advantage plan. Aetna’s online directory makes it easy for members to find in-network:
- doctors
- hospitals
- urgent care centers
- pharmacies
For the most accurate provider search results, members should access the directory through their secure member account, which tailors search results to their plan type.
Members can also:
- Change their primary care physician anytime through their secure online account or by contacting Aetna directly
- If a primary care physician departs from the Aetna network, members are prompted to select a new in-network physician
- Staying in-network generally leads to lower out-of-pocket costs and a more coordinated healthcare experience, as in-network providers can easily share medical records and communicate with each other.
Summary
Navigating the world of Medicare Advantage plans can be complex, but with Aetna, members in North Carolina can enjoy a variety of plans designed to cater to their diverse healthcare needs. From HMO to PPO and PFFS plans, Aetna offers comprehensive coverage, additional benefits, and the flexibility to choose providers that best fit your healthcare preferences.
Choosing a healthcare plan is a significant decision, and Aetna provides the resources and support services you need to make an informed choice. With a 24/7 nurse line, a secure website for managing your plan, and the Resources For Living® program, Aetna goes above and beyond to ensure members have everything they need to maximize their health and wellness.
Frequently Asked Questions
→ What is the difference between Aetna Medicare and Aetna Medicare Advantage?
Aetna Medicare Advantage plans, also known as Part C plans, are offered by private insurance companies like Aetna Medicare and can include extra benefits that Original Medicare does not offer.
→ Why are people leaving Medicare Advantage plans?
People are leaving Medicare Advantage plans due to excessive prior authorization denial rates and slow payments from insurers. These issues are contributing to dissatisfaction among plan members.
→ What types of Medicare Advantage plans does Aetna offer in North Carolina?
Aetna offers Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), and Private Fee-for-Service (PFFS) Medicare Advantage plans in North Carolina, providing a range of options for beneficiaries.
→ How can I enroll in an Aetna Medicare Advantage plan?
You can enroll in an Aetna Medicare Advantage plan by completing the enrollment process online, by phone, or by mail. To be eligible, you must first be enrolled in Original Medicare Parts A and B.
→ What prescription drug coverage does Aetna offer?
Aetna Medicare Advantage plans provide comprehensive prescription drug coverage through a formulary that includes details about drug tiers, requirements, and mail-order availability.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.