Aetna Medicare PPO Plans
Considering Aetna Medicare PPO plans? Understand the essentials: flexible provider choice and potential cost savings within a Managed Medicare framework.
We’ll guide you through the details, benefits, and enrollment process so you can determine if an Aetna Medicare PPO plan aligns with your healthcare needs in 2025.
Key Takeaways
- Aetna Medicare PPO plans offer flexibility in provider choice without the need for referrals, consistent out-of-pocket costs for covered benefits, and the potential to save up to $1,200 per year on Medicare Part B premiums.
- Aetna Medicare Advantage PPO plans present extensive benefits including $0 deductible, comprehensive prescription drug coverage, and added perks such as SilverSneakers fitness membership and coverage for dental, vision, and hearing care.
- Enrollment in Aetna Medicare PPO plans is contingent on meeting eligibility requirements and enrolling during specific periods, with additional resources offered like Member Services and online tools for managing healthcare and plan benefits.
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Aetna Medicare PPO: An Overview
Aetna Medicare PPO plans are an excellent choice for federal employees seeking comprehensive coverage.
These plans offer:
- Flexibility to access any provider, whether in-network or out-of-network
- Consistent out-of-pocket costs for covered medical benefits
- Liberty to access healthcare services from any doctor or hospital that accepts Medicare, without the need for a referral or primary care physician.
Moreover, the Aetna Medicare Advantage plan provides extensive coverage that includes medical, hospital, and prescription drug benefits.
This means you have the freedom to select in-network or out-of-network providers for these services. But what exactly is a PPO plan? Let’s find out.
What is a PPO Plan?
The acronym PPO stands for Preferred Provider Organization. It’s a type of health plan that contracts with medical providers to form a network of participating providers, offering members a range of healthcare choices.
These managed-care health insurance plans offer a network of participating providers. As a plan participant, you have the freedom to choose from this network, offering a flexible approach to accessing healthcare services.
One example of such a plan is the Aetna Open Choice PPO plan. Offered by Aetna Life Insurance Company, this is a specialized PPO plan that allows members to access any healthcare provider without requiring a referral.
What’s more, it provides cost savings for care when selecting in-network providers. We will now investigate the specifics of Aetna’s Medicare Advantage PPO plans in more detail.
Aetna Medicare Advantage PPO Plans
Aetna’s Medicare Advantage PPO plans offer the following benefits:
- Access to the SilverSneakers fitness membership
- $0 deductible
- Comprehensive prescription benefits
- Coverage for dental and vision care, including oral exams, cleanings, X-rays, fillings, extractions, and additional services
- Vision coverage includes an annual eye exam and allowances for eye wear.
What sets these plans apart is a unique feature that lowers the Medicare Part B premium. Aetna Medicare Advantage PPO plans provide a reduction in Medicare Part B premiums of up to $100 per month, resulting in potential savings of up to $1,200 per year.
This is made possible due to the Medicare contract between Aetna and the Centers for Medicare & Medicaid Services (CMS). Having understood Aetna’s Medicare PPO plans, we will now examine the advantages of opting for Medicare Advantage plans.
Benefits of Choosing an Aetna Medicare PPO Plan
Choosing an Aetna Medicare PPO plan comes with a plethora of benefits. One of the most significant benefits is the flexibility it provides in selecting healthcare providers, including your primary care provider.
Aetna Medicare PPO plans allow individuals to access healthcare from providers within or outside their network who agree to the Medicare terms and the plan’s conditions. This includes specialists and other healthcare professionals.
Another benefit of choosing an Aetna Medicare PPO plan is the potential for financial savings. Selecting in-network providers with an Aetna Medicare PPO plan can provide financial benefits as in-network care may result in lower costs for plan members.
Additionally, some Aetna Medicare PPO plans may coordinate with state Medicaid programs to offer additional benefits and cost savings. We will now explore these benefits in more detail.
Flexibility in Provider Selection
The Aetna Medicare PPO plan offers the following benefits:
- Freedom to choose any provider without referrals
- Flexibility to select any provider who accepts Medicare and adheres to the plan’s terms
- Coverage for skilled nursing facility stay services
- No requirement to choose a primary care physician
You can also consult specialists without the requirement of referrals. However, it is important to note that the availability of specific providers and benefits may change upon contract renewal between Aetna and the Centers for Medicare & Medicaid Services (CMS). But what about the cost? We will now examine this aspect.
Cost Savings and Efficiency
The Aetna Open Choice PPO plan manages claims for in-network care by providing lower, contracted rates. This is important because Medicare evaluates plans based on various factors, including cost-sharing, quality of care, and customer satisfaction.
Utilizing healthcare providers within the Aetna Medicare PPO plan’s network could result in reduced expenses in comparison to out-of-network care, offering potential cost savings for plan members.
However, the cost efficiency of Aetna Medicare PPO plans can be influenced by factors such as location, age, and health condition of the member.
Having gained a clear understanding of the benefits, we will now examine the prescription drug coverage offered by Aetna Medicare PPO plans.
Prescription Drug Coverage in Aetna Medicare PPO Plans
Aetna Medicare PPO Plans provide comprehensive prescription drug coverage to its members. This coverage involves a network of pharmacies that are contracted by health plans to supply prescription drugs to plan members.
But that’s not all. Aetna Medicare PPO Plans provide access to mail-order pharmacy services through CVS Caremark® Mail Service Pharmacy. If your plan includes prescription drug coverage, you can opt to have your medications conveniently delivered to your home.
However, it is advisable to consult the list of covered prescriptions on the Aetna website or reach out to member services to verify coverage for individual medications.
But how much does this all cost? The expenses for prescription drug coverage within Aetna Medicare PPO Plans are not uniform and depend on the specific plan. We will now investigate how you can access this coverage.
In-Network Pharmacies
Aetna provides a user-friendly method for locating in-network pharmacies through a Medicare provider search tool accessible on their website. This tool allows individuals to search for network doctors, pharmacies, dentists, and hospitals.
Additionally, Aetna members have the option to log into the Aetna Medicare portal to identify compatible providers tailored to their specific plan.
Utilizing in-network pharmacies with an Aetna Medicare PPO plan provides members with:
- Coverage for most medications
- Tools for staying informed
- Opportunities for saving money
- Support for adhering to their prescribed medication regimens
However, members who receive “Extra Help” are not mandated to fill their prescriptions at preferred network pharmacies to access cost savings.
Mail Order Services
Aetna offers a convenient mail-order service for prescription medications. To enroll and utilize Aetna’s mail order pharmacy service, individuals can contact 1-888-792-3862 or access their member website.
Another option is to utilize the Aetna Health℠ app. Following enrollment, prescription requests typically arrive within 10 days.
The advantages of utilizing Aetna’s mail order pharmacy service include:
- Convenience for maintenance drugs
- Inclusion in pharmacy benefits and insurance
- Use of easy online tools for ordering and tracking
- Potential cost savings
Furthermore, there are no additional expenses associated with using the service as it is already included in your pharmacy benefits and insurance, and standard shipping is provided at no cost. All categories of medications are available through this service.
How to Enroll in an Aetna Medicare PPO Plan
Enrolling in an Aetna Medicare PPO plan is a straightforward process. However, it requires meeting certain eligibility requirements and enrolling during designated periods.
Eligibility Requirements
To be eligible for an Aetna Medicare PPO plan, individuals must be aged 65 or older, or have a qualifying disability for which they have been receiving Social Security Disability for over 24 months.
Furthermore, enrollment in both Medicare Parts A and B is a prerequisite for eligibility.
Interestingly, Aetna can offer enrollment to individuals in an Aetna Medicare PPO plan, even if they reside outside the standard service area, within an expanded service area. But when can you enroll in these plans?
Enrollment Periods
The enrollment periods for Aetna Medicare PPO plans consist of the Annual Enrollment Period (AEP) from October 15 through December 7, and the Open Enrollment Period (OEP) from January 1 through March 31.
Furthermore, new members are eligible for the Medicare Advantage Open Enrollment Period from January 1 through March 31 annually, and existing members have the option to change their plans during AEP.
However, there are certain special life events that can trigger a Special Enrollment Period for Aetna Medicare PPO Plans.
These events include:
- Loss of health coverage
- Relocation
- Marriage
- Childbirth
- Adoption
- Meeting certain household income criteria
Having understood the enrollment process, we will now explore how to navigate an Aetna Medicare PPO plan.
Navigating Your Aetna Medicare PPO Plan
Navigating an Aetna Medicare PPO plan involves understanding the provider network and plan benefits. Aetna provides a user-friendly method for locating in-network providers through a Medicare provider search tool accessible on their website.
This tool allows individuals to search for network:
- doctors
- pharmacies
- dentists
- hospitals
Moreover, understanding the benefits of your Aetna Medicare PPO plan involves:
- Verifying the “S” number on your member ID card for prescription coverage
- Understanding that you have the flexibility to consult any doctor within or outside the network who accepts Medicare and the plan terms
- Being aware that many plans offer extra benefits such as dental, vision, and hearing allowances
But how do you find in-network providers and understand provider network composition?
Finding In-Network Providers
To locate in-network providers, you can access Aetna’s online provider directory by logging in to your account on their website. If you are not a member, you can still access the directory by specifying the type of plan you have.
Utilizing in-network providers with an Aetna Medicare PPO plan provides members with:
- Coverage for most medications
- Tools for staying informed
- Opportunities for saving money
- Support for adhering to their prescribed medication regimens
However, Aetna Medicare PPO members have the option to consult providers outside the network. However, they may encounter increased rates and out-of-network providers are not obligated to provide treatment.
What about the plan’s fitness benefit of your plan?
Understanding Your Plan Benefits
Understanding the benefits of your Aetna Medicare PPO plan is crucial for managing your healthcare costs. Copays within the Aetna Medicare PPO Plan vary based on the specific service, often involving a predetermined fixed dollar amount, such as $20 for a doctor visit.
Moreover, the deductible for an Aetna Medicare PPO Plan is $500.
Moreover, the out-of-pocket maximum for an Aetna Medicare PPO Plan is $8,300 for in-network services and $12,450 for combined in-network and out-of-network services. Next, let’s discuss some additional resources available to Aetna Medicare PPO members.
Additional Resources for Aetna Medicare PPO Members
Aetna Medicare PPO offers a variety of services through its Member Services, which include:
- Resources For Living consultants to assist with researching and connecting members to local community resources
- Additional benefits such as dental, vision, and hearing coverage
- Concierge services
- Gym memberships
- Fitness programs
Members have the option to contact Aetna Medicare PPO Member Services by dialing 1-844-826-5296 for Aetna Medicare Advantage and prescription drug plans, accessing the Aetna Medicare secure member website, or seeking assistance with inquiries regarding their Medicare plan.
Aetna Medicare provides digital resources including the Aetna Health app, access to essential plan documents such as Evidence of Coverage and Summary of Benefits, and online health tools offered through the Resources for Living program.
We will now investigate these resources in more detail.
Member Services
Aetna Medicare PPO offers a variety of member services, including PPO, HMO, and HMO-POS medical plans, with or without prescription drug coverage. For personalized assistance, individuals can reach out to Member Services and DSNP Customer Service.
Aetna Medicare PPO member services provide direct assistance through their contact number 1-844-826-5296 for Medicare Advantage and prescription drug plans.
They can help you with:
- Gaining a clear understanding of your Medicare plan benefits
- Assisting with claims issues, including coverage decisions and appeals for denied claims
- Registering complaints
- Providing tools and guidelines to submit insurance claims efficiently
Online Tools and Resources
The Aetna Medicare portal offers members the ability to access their Aetna Medicare plan information, including:
- Log in and retrieve their plan information
- Print a new ID card
- Search for healthcare providers
- Review claims
- Access documents such as Evidence of Coverage (EOC), Summary of Benefits, Star Ratings, and Formulary for prescription drugs.
Claims can be tracked through the Aetna Medicare portal by utilizing the available online tools. These tools enable users to:
- Access claim status information, such as the Electronic Funds Transfer (EFT) amount, EFT number, issue date, settlement date, and check amount
- Receive payments directly to their account
- Review claims payment details online.
Summary
In conclusion, Aetna Medicare PPO plans offer comprehensive coverage with the flexibility to choose in-network or out-of-network providers. They offer many benefits such as provider flexibility, cost savings, comprehensive prescription drug coverage, and additional resources and tools for members.
Whether you’re a federal employee or a retiree looking for a health plan that suits your needs, an Aetna Medicare PPO plan could be the right choice for you.
Frequently Asked Questions
→ What does Aetna Medicare PPO mean?
Aetna Medicare PPO means you can choose any provider who accepts Medicare and the plan terms without needing a referral for specialist or hospital visits.
This gives you more flexibility in choosing your healthcare providers.
→ Is Aetna Medicare the same as Aetna Medicare Advantage?
No, Aetna Medicare Advantage is a type of Medicare Advantage plan offered by Aetna, which is a private insurance company that provides additional benefits beyond Original Medicare.
→ What’s the difference between an HMO and a PPO with Aetna?
The main difference between the HMO-EPO plan and the PPO plan with Aetna is that the HMO-EPO plan only provides in-network coverage for services, except for urgent and emergent care, while the PPO plan offers both in-network and out-of-network coverage.
→ How does prescription drug coverage work in Aetna Medicare PPO plans?
Aetna Medicare PPO plans offer comprehensive prescription drug coverage through an in-network pharmacy and mail-order services.
→ How can I enroll in an Aetna Medicare PPO plan?
You can enroll in an Aetna Medicare PPO plan online through TakeAction.AetnaMedicare.com or by calling 1-855-335-1407 (TTY: 711). Finding the best option for you is just a few clicks or a simple phone call away.
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.