Aetna Medicare Advantra Gold HMO 2025
Choosing the right Medicare plan is critical, and with so many different Medicare Advantage plan choices it’s hard to know where to start.
The Aetna Medicare Advantra Gold HMO offers key benefits, such as an extensive provider network and robust prescription drug coverage, designed to give you peace of mind and health security.
This detailed guide will outline the plan’s features, help you understand your potential costs, and explain the enrollment process, arming you with the information you need to make an informed decision.
Key Takeaways
- Aetna Medicare Advantra Gold HMO offers a comprehensive range of benefits including prescription drug coverage, preventive care, hospitalization, specialist visits, emergency care, vision and dental coverage, fitness and wellness programs, and transportation services.
- The plan provides additional services like over-the-counter (OTC) benefits, fitness access through programs like SilverSneakers, and routine care coverage which significantly enhances its value beyond basic Medicare coverage.
- Enrollment is accessible during the annual period from January 1 through March 31, with additional opportunities during Special Enrollment Periods triggered by qualifying life events, and can be completed online, by phone, or through mail.
Compare Plans in One Step!
Enter Zip Code
Aetna Medicare Advantra Gold HMO: An Overview
Aetna Medicare Advantra Gold HMO stands out with its comprehensive coverage and wide network of healthcare providers. This health plan provides more than just basic coverage; it offers a plethora of benefits and services tailored to meet the diverse needs of its members.
Members gain access to a wide array of medical services when they choose an in-network primary care provider (PCP), thus ensuring their healthcare needs are well catered to.
Some of the benefits and services offered by Aetna Medicare Advantra Gold HMO include:
- Prescription drug coverage
- Preventive care services
- Hospitalization coverage
- Specialist visits
- Emergency care
- Vision and dental coverage
- Fitness and wellness programs
- Transportation services
With Aetna Medicare Advantra Gold HMO, members can have peace of mind knowing that their healthcare needs are covered, including the benefits offered by the Advantra Gold HMO POS plan.
Moreover, the Advantra Gold HMO goes the extra mile by covering routine foot care among its services. With a nominal copayment of $10, members can access podiatry services, which are crucial in maintaining overall foot health.
Indeed, this health plan extends beyond mere coverage; it provides peace of mind.
Plan Highlights
The Aetna Medicare Advantra Gold HMO boasts of high star ratings, a testament to its commitment to quality care and customer satisfaction. In fact, for the year 2024, the plan holds a star rating of 4 or higher, highlighting its stellar service. But the benefits don’t stop there.
The plan also encompasses an extensive array of fitness services, which are elaborately detailed in the evidence of coverage document available on the Aetna Medicare website. From cardio workouts to strength training, fitness services cater to various fitness levels, ensuring members can stay active and healthy.
Additionally, the Medicare plan offers a wide range of routine care services, making it a truly comprehensive health plan. As Medicare evaluates plans based on various factors, this plan stands out for its diverse offerings, making it one of the top Medicare plans.
Network Availability
A vital component of any health plan is its network of healthcare providers. The Aetna Medicare Advantra Gold HMO excels in this domain, providing coverage for a variety of healthcare services such as routine care, fitness benefits, and prescription medications.
This widespread network ensures members have access to quality healthcare whenever they need it.
The network providers under this plan provide high-quality medical care. They offer comprehensive coverage for a plethora of services, ensuring members receive the best care possible.
To find out about the medical specialists included in the network, members can refer to the detailed information available on the Aetna Medicare website.
Extra Benefits and Services
In addition to the essential coverage, the Aetna Medicare Advantra Gold HMO offers a host of extra benefits and services.
These include fitness access, over the counter (OTC) benefits, and routine care coverage for dental, vision, and hearing. These extra benefits add significant value to the plan, making it an excellent option for those seeking comprehensive coverage.
For fitness enthusiasts, the plan offers a range of services, from gym memberships to wellness programs.
It also provides a quarterly allowance for members to purchase approved health and wellness products such as pain relief medications and first aid supplies through the OTC benefit. On top of that, the plan covers dental, vision, and hearing benefits, providing holistic care for members.
Fitness Access
Recognizing the vital role fitness plays in overall health, the Aetna Medicare Advantra Gold HMO offers fitness access to its members.
This provision encompasses:
- SilverSneakers instructor-led group fitness classes
- The FLEX program, a network of senior fitness classes
- Customized workout programs tailored to individual fitness levels
These fitness benefits come at no additional cost for most members, making it a valuable addition to the plan. Members can utilize these benefits at any fitness facility, providing them with flexibility and convenience.
The fitness access provision encapsulates Aetna’s commitment to promoting a healthy lifestyle among its members.
Over the Counter (OTC) Benefit
The OTC benefit is another valuable provision of the Aetna Medicare Advantra Gold HMO.
This benefit provides a quarterly allowance for members to purchase approved health and wellness products, including pain relief medications, first aid supplies, as well as cold, allergy, and dental care items.
Members can easily utilize their OTC benefit to acquire various products, including:
- Pain relievers
- Dental care items
- Cold and allergy medicine
- First aid supplies
- Vitamins and supplements
- Eye and ear care products
- Skin care items
- Feminine hygiene products
Although there are no explicit restrictions on the items that can be purchased, some items may be subject to specific limits, and returns or exchanges are not permitted.
The quarterly allowance varies depending on the benefit plan, so members are advised to review their plan documents or reach out to customer service for further details.
Routine Care Coverage
Routine care coverage is a significant part of the Aetna Medicare Advantra Gold HMO. This coverage includes essential services such as dental, vision, and hearing benefits, aimed at providing comprehensive preventive care and other health care services to members.
While Original Medicare does not cover routine dental care, the Aetna Medicare Advantra Gold HMO steps in to cover specific dental services like cleanings, X-rays, and fillings.
However, there may be a benefit maximum for these services. The plan also includes an annual routine hearing exam and hearing aid fitting covered at 100 percent, along with potential assistance with hearing aid purchases.
This routine care coverage ensures members receive the essential care they need.
Prescription Drug Coverage
Prescription drug coverage is an integral part of the Aetna Medicare Advantra Gold HMO. This coverage includes a comprehensive formulary, mail-order options, and a cost-sharing arrangement that helps members manage their prescription costs effectively.
Upon reaching the coverage gap phase, members are obligated to cover 25% of the cost for both generic and brand-name prescription drugs.
Furthermore, the out-of-pocket threshold for prescription drug costs is set at $6,350. After this threshold is surpassed, there are substantial cost reductions on subsequent drug purchases, thanks to the Catastrophic Coverage Phase.
Formulary
The Aetna Medicare Advantra Gold HMO formulary is a comprehensive list of drugs covered by the plan. This formulary covers a diverse range of medications, ensuring that members have access to the drugs they need.
The selection of medications for the formulary is based on a comprehensive list of drugs covered by the plan, aiming to meet the medication needs of its members.
While there may be exclusions in the formulary, members can consult the specific plan’s formulary or reach out to Aetna directly for comprehensive information on any exclusions.
Mail Order Options
Aetna Medicare Advantra Gold HMO also offers the convenience of mail-order options for prescription drugs. The plan utilizes CVS Caremark® Mail Service Pharmacy as the mail-order pharmacy option.
Members can access and refill their mail-order prescriptions through CVS Caremark® Mail Service Pharmacy by calling the number on their ID card or signing up for automated mail-order delivery.
To utilize this service, members should ensure their medication is available via mail order and have their doctor e-prescribe to CVS Caremark. Utilizing the mail-order pharmacy service can result in cost savings for members.
Drug Pricing and Cost Share
Grasping the nuances of drug pricing and cost share is key to effectively managing prescription costs.
The cost-sharing arrangement for prescription medications within the Aetna Medicare Advantra Gold HMO includes $2 copays for Tier 1 drugs and a $0 monthly plan premium. Eligible members may access reduced cost-sharing rates through the Extra Help program.
The pricing of drugs under the plan is established by tier-based cost-sharing. Members can access comprehensive details regarding medication coverage and specific copay amounts by utilizing the tools available on the Aetna member website.
Furthermore, members have access to various cost-saving strategies, such as:
- Obtaining a larger supply of drugs
- Opting for generic alternatives
- Utilizing in-network pharmacies
- Comparing prices
- Making use of preferred pharmacy pricing if provided by their plan.
Navigating Costs and Coverage
While navigating costs and coverage may pose a challenge, Aetna Medicare Advantra Gold HMO offers transparent information to aid members in managing their healthcare expenses.
Understanding inpatient hospital and skilled nursing facility coverage, durable medical equipment and supplies, and coinsurance, copayments, and deductibles is crucial for managing out-of-pocket expenses.
The plan includes:
- A fee of $350 for each inpatient hospital stay
- Skilled nursing facility coverage with no cost for the first 20 days, followed by a charge of $203 per day from the 21st day onwards
- Coverage for durable medical equipment for its members, with a coinsurance ranging from 0% to 20%
- A higher cost-share may be applicable for non-OneTouch diabetic supplies.
Inpatient Hospital and Skilled Nursing Facility Coverage
Inpatient hospital and skilled nursing facility coverage are essential components of the Aetna Medicare Advantra Gold HMO. The coverage for inpatient hospital stays under the plan is $250 per stay.
The coverage for a skilled nursing facility includes $0 per day for days 1 through 20, and $203 per day for days 21 through 100.
Upon reaching the 100th day in a skilled nursing facility, the Medicare coverage ceases, necessitating the exploration of alternative options.
Aetna provides in-network coverage at no cost for days 1-20, and charges $203 per day for days 21-100. However, there is no out-of-network coverage available.
Durable Medical Equipment and Supplies
Durable medical equipment and supplies are another important aspect of the Aetna Medicare Advantra Gold HMO. Items that can be obtained at in-network pharmacies, such as Continuous Glucose Monitors (CGM) and related supplies, are covered under the plan.
Members are eligible for coverage of Durable Medical Equipment (DME) at in-network pharmacies, following nationally recognized guidelines and resources.
The coverage for durable medical equipment involves cost sharing of 0% – 20% for each Medicare-covered item. Additionally, there is a maximum plan allowance of $500 yearly for non-Medicare covered eyewear, indicating a limit on coverage for certain items.
For specific services, including certain durable medical equipment, it is necessary for a Primary Care Physician (PCP) to acquire prior authorization from Aetna Medicare.
Coinsurance, Copayments, and Deductibles
Grasping the concepts of coinsurance, copayments, and deductibles is key to efficiently managing healthcare costs.
The yearly deductible for Aetna Medicare Advantra Gold HMO is $0, which means members can start enjoying benefits without having to meet a deductible first.
In the plan, coinsurance represents the percentage of the bill that the beneficiary pays after meeting their deductible, while copayments are predetermined fixed dollar amounts for services or medications.
The coinsurance rates for services covered under the plan consist of a 50% coinsurance for comprehensive dental services, along with a maximum benefit of $3,000 for preventive and comprehensive dental services combined.
The plan also establishes a maximum limit of $7,550 for Parts A & B services, setting a cap on out-of-pocket expenses for members.
How to Enroll in Aetna Medicare Advantra Gold HMO
The process of enrolling in Aetna Medicare Advantra Gold HMO is uncomplicated and easy to follow. Individuals must meet the requirements of being enrolled in Medicare Part A and Medicare Part B, as well as residing in the service area to qualify for enrollment.
Call us today at 1-833-641-4938 to speak to one of our licensed insurance agents and start the enrollment process today!
Enrollment Periods
The Annual Enrollment Period for the Aetna Medicare Advantra Gold HMO plan, which takes place each year from January 1 through March 31, offers individuals the opportunity to join the plan annually.
Additionally, life events such as moving or losing other health coverage can trigger a Special Enrollment Period, allowing individuals to make plan changes outside the Annual Enrollment Period.
Online Enrollment
To enroll in the Aetna Medicare Advantra Gold HMO, you can use the online enrollment application available on the Aetna website. Here are the steps to complete the online enrollment:
- Select the plan you want to enroll in.
- Fill out the online enrollment application.
- Log in to your Aetna Medicare secure member website to finalize the enrollment.
Individuals typically need to be age 65 or older to apply for the plan online. This means that most Medicare-eligible individuals can take advantage of the convenience of online enrollment.
Summary
The Aetna Medicare Advantra Gold HMO offers comprehensive coverage, a wide network of healthcare providers, and a host of extra benefits, making it an excellent choice for those seeking a robust Medicare plan.
From fitness access to over-the-counter benefits and routine care coverage, this health plan goes above and beyond to meet the diverse needs of its members. With clear information on costs, coverage, and enrollment procedures, navigating this plan is a breeze.
Frequently Asked Questions
→ Is Aetna Gold a Medicare Advantage plan?
Yes, Aetna Gold is a Medicare Advantage plan offered by Aetna Inc.
→ Is Advantra the same as Aetna?
No, Advantra is a Medicare Advantage plan offered by Aetna, one of the largest insurance companies in the United States.
→ What is the difference between Aetna Medicare and Aetna Medicare Advantage?
The main difference between Aetna Medicare and Aetna Medicare Advantage is that Aetna Medicare Advantage (Part C) plans are run by private insurance companies and can include additional benefits not offered by Original Medicare.
→ What extra benefits does the Aetna Medicare Advantra Gold HMO provide?
The Aetna Medicare Advantra Gold HMO provides fitness access, a quarterly allowance for over the counter (OTC) items, and routine care coverage for dental, vision, and hearing, offering added benefits for its members.
→ What is the formulary for the Aetna Medicare Advantra Gold HMO?
The formulary for the Aetna Medicare Advantra Gold HMO is a comprehensive list of drugs that covers a diverse range of medications, ensuring members have access to the drugs they need.
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.