Aetna Medicare Premiere

Exploring your Medicare options? Aetna Medicare Premiere combines a premier care network, cost-management tools, and comprehensive benefits to optimize your health care experience.

This article breaks down the plan’s key advantages, from in-network savings to additional health perks, helping you understand why it stands out in the Medicare Advantage landscape.

 

Key Takeaways

 

 

  • Coverage options under Aetna Medicare Premiere plans are customizable by location and include additional services such as vision and wellness programs, ensuring a personalized health care experience based on individual needs and preferences.

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Unveiling Aetna Medicare Premiere: Your Gateway to Comprehensive Health Coverage

Imagine a world where you have access to:

 

  • A network of top-tier healthcare providers
  • High-quality medical care
  • The Aetna Premier Care Network
  • Comprehensive health coverage
  • Esteemed providers
  • A convenient and cost-effective framework

 

Say hello to the Aetna Medicare Premiere, your gateway to comprehensive health coverage. Offering the Aetna Premier Care Network, this plan ensures that you receive the best medical care from esteemed providers, all within a convenient and cost-effective framework.

 

Unveiling Aetna Medicare Premiere- Your Gateway to Comprehensive Health Coverage

What’s more intriguing is that the Aetna Premier Care Network Plus Multi-Tier plan within the Aetna Medicare Premiere caters to diverse needs and preferences. It is formulated to provide members with cost savings and convenience in accessing medical care.

And how do you identify these healthcare providers within the plan? A provider search tool lets you find providers that offer both standard and maximum savings, including inpatient hospital services.

 

Embrace the Network Advantage

Exploring the network advantage of Aetna’s Medicare Premiere, we discover a realm of cost-effective healthcare. This membership brings you convenience, potential savings, and an improved healthcare experience.

Remaining within Aetna’s network is vital, as it paves the way to cost savings and efficient healthcare expense management.

Meet the Aetna Whole Health network, a coordinated cadre of healthcare providers dedicated to delivering comprehensive, individualized care.

This network ensures a comprehensive view of members’ medical records and individual needs, including access to first aid supplies. Aetna’s integrated care model, intelligent data usage, and care coordinators’ involvement in the Aetna Whole Health network ensure that members receive convenient and seamless services, including:

 

  • Comprehensive medical care
  • Individualized treatment plans
  • Access to first aid supplies
  • Prescription drugs

 

Navigating Your Plan Documents

Comprehending and navigating your plan documents can be compared to a treasure hunt, with the treasure being access to a broad spectrum of healthcare services and medical care. Chapter 4 of the Evidence of Coverage (EOC) of Aetna Medicare Premiere reveals the treasure chest, with details about star ratings, prescription drug formulary, and the summary of benefits.

The EOC, your legal contract with the Medicare plan, outlines the expenses and advantages associated with the Aetna Medicare Premiere plan, providing comprehensive information about the plan’s coverage.

But what about regulations pertaining to referrals or prior authorizations? Chapter 4 of the EOC is your guide, revealing the applicability and specifics of these regulations.

A referral is a preapproval granted by the primary care provider to consult a specialist, and a prior authorization denotes the necessity for the provider to obtain approval from Aetna before coverage is provided for a specific item or service.

Tailored Health Services with Aetna Medicare Advantage

The Aetna Medicare Advantage offers a range of personalized health services to meet your unique health needs, including:

 

 

These services are designed to complement the care provided by your primary care physician.

One of the key aspects of this customization is the prior authorization process. This process requires a physician to seek approval for procedures, tests, or prescriptions on behalf of the patient, ensuring that the care provided is suitable for the patient’s health needs.

 

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Additionally, the Aetna Medicare Advantage plans offer:

 

  • Substantial prescription drug benefits
  • Reduced costs on mail-order prescriptions
  • The option to access extra savings and convenience through 3 Medicare Part D Prescription Drug Plans.

 

Prior Authorization: A Step Towards Customized Care

In healthcare, prior authorization serves as a gatekeeper, verifying that the services delivered are essential and appropriate for the patient. This requirement involves the healthcare professionals seeking pre-approval from a health plan before delivering a specific service to a patient.

The rationale behind implementing prior authorization in customized care is to guarantee that patients receive essential services and treatments while controlling expenses and upholding the quality of care. In Aetna Medicare Premiere plans, the attending physician initiates a request for a particular procedure, test, or prescription.

Aetna conducts a comprehensive evaluation of the individual’s health and pertinent information before reaching a decision.

Certain treatments or services, like hip and knee replacements, radiology or imaging services, and procedures conducted in any facility except inpatient, usually necessitate prior authorization.

 

Prescription Drug Perks: The OTC Benefit and Mail Order Convenience

Prescription drug benefits in Aetna Medicare Advantage include:

 

  • Integrated medical and pharmacy benefits within a unified plan
  • Reduced expenses on mail-order prescriptions
  • Additional valuable benefits and services designed to suit individual needs

 

The OTC benefits for Medicare Advantage plan holders assist in covering the expenses of eligible OTC health and wellness products.

For those who prefer convenience, Aetna’s mail order service is a game-changer. You can request prescription medications through Aetna’s mail order service by contacting their specialized number, accessing the member website on Aetna.com, or utilizing the Aetna Health℠ app.

However, it’s important to note that Aetna’s OTC and mail order drug benefits may be subject to coverage limits determined by medical guidelines and FDA-approved recommendations. There could also be restrictions on returns or exchanges.

Coordinated Care at Its Finest: Aetna’s Specialized Networks

Aetna’s specialized networks can be compared to a well-oiled machine, guaranteeing coordinated care and an extensive range of covered services. The Aetna Medicare Premiere offers the Aetna Premier Care Network (APCN), a specialized network comprising top-tier network providers selected to deliver high-quality care.

 

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Aetna ensures coordinated care within its specialized networks by providing Aetna Premier Care Network Plus (APCN Plus) and implementing the SNPs Model of Care (MOC) for special needs members. This leads to improved care coordination, specialized behavioral health benefits, increased access to care, reduced costs, and more integrated care for consumers.

Aetna’s specialized networks encompass doctors, specialists, dentists, hospitals, surgical centers, primary care doctors, walk-in clinics, urgent care centers, and select MinuteClinic services.

These networks play a significant role in improving healthcare delivery by promoting value-based care, innovative and connected care solutions, digital access to benefits information, robust health care networks, and cost-effective care through medical management.

 

From Pain Relievers to CT Scans: Covered Services Explored

The Aetna Medicare Premiere plans encompass a broad spectrum of services, illustrating a vibrant array of healthcare coverage.

This spectrum includes health care services, medical supplies, and additional institutional benefits such as dental, vision, and hearing coverage. These plans also cover certain services that are not part of Original Medicare.

Did you know that Aetna Medicare Premiere covers the following:

 

  • Pain reliever medications
  • CT scans with a coverage of $200 for in-network scans
  • Laboratory tests with no cost when conducted at in-network labs, and a 30% cost for tests at out-of-network labs
  • Emergency services

 

Ensuring Access to Essential Aid Supplies

Healthcare extends beyond doctor visits or hospital stays, it also involves access to essential aid supplies. Aetna Medicare Premiere plans encompass a variety of such supplies, including:

 

  • Diabetic supplies under Part D
  • Alcohol swabs
  • Pain relief
  • First aid
  • Cold and allergy medicine
  • Dental care items
  • Durable medical equipment (DME) and medical supplies

 

Aetna facilitates access to these necessary aids and offers the convenience of home delivery for these essential supplies.

To access these essential aid supplies, members need to ensure that their emergency kits contain medications and important contacts and regularly check and replenish the supplies. In case of first aid, they must assess the safety of the situation, form an initial impression, obtain consent, and use personal protective equipment (PPE).

It’s important to note that some Aetna plans may contain exclusions for services or supplies considered medically necessary, with individual plans detailing covered services, exclusions, and any relevant limits.

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Cost Management with Aetna Medicare Premiere Plans

Managing medical expenses can be compared to walking a tightrope, but with Aetna Medicare Premiere Plans, this task is simplified. These plans feature copays for doctor visits and medical services, represented by set dollar amounts such as $20 for a doctor visit.

Moreover, there might be coinsurance, a percentage that individuals pay for covered services after meeting their deductible, such as 10% for a covered prescription drug. With the cost share feature, Aetna Medicare plans help in managing your healthcare expenses more effectively.

The Aetna Medicare Premiere Plan offers various tools for managing medical costs, such as a detailed overview of the plan’s expenses and coverage.

 

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It encompasses a range of benefits including dental, vision, and hearing coverage, concierge services, as well as gym memberships and fitness programs. What about supplementary savings options? Aetna Medicare Premiere Plans provide such options including Medicare Part D Extra Help for low-income individuals, which helps in reducing prescription drug costs, and discounts on wellness services.

 

Exploring Additional Savings Opportunities

Saving every penny counts, and Aetna Medicare bolsters these savings with initiatives like Medicare Extra Help, aiding in covering Medicare prescription drug costs. Members can also access benefits including:

 

  • Dental coverage
  • Vision coverage
  • Hearing coverage
  • Concierge services
  • Fitness memberships
  • And more

 

Moreover, individuals enrolled in Dual Eligible Special Needs Plans may receive an Extra Benefits Card for daily expenditures and avail discounts on wellness and a range of health-related products and services.

The eligibility for cost-saving benefits encompasses the receipt of Medicare benefits and the fulfillment of state Medicaid requirements, which could encompass income and asset thresholds, citizenship, and residency.

Additionally, commencing in 2024, the Extra Help program, offering prescription drug coverage under Medicare Part D, will be accessible to individuals who meet the criteria based on limited resources and income.

Aetna Medicare plan holders can access savings through Medicare Part D Extra Help for reduced prescription drug premiums and costs for individuals with low incomes. They can also benefit from:

 

  • Discounts on wellness services
  • Fitness memberships
  • Weight loss programs
  • Other offerings
  • Discount programs for reduced prices on specific services

 

The Importance of Star Ratings: Medicare Evaluates Plans Based on Quality and Performance

The Medicare Star Ratings serve as a report card for Medicare plans. They represent an assessment of the excellence and effectiveness of Medicare plans, determined by a set of distinct factors and criteria tailored to each plan category.

These ratings span from 1 to 5 stars, with 5 stars denoting outstanding performance and 1 star indicating subpar performance.

Medicare assesses plans based on a variety of quality measures, such as:

 

  • MIPS quality performance measures for physicians
  • Quality improvement initiatives
  • Pay for reporting
  • Public reporting

 

These assessments are then reflected in the star ratings.

The Medicare Star Ratings hold great significance for Aetna Medicare Premiere Plans as they enable consumers to assess the quality of the plans, empowering them to make well-informed decisions regarding their healthcare requirements.

A testament to the high quality of Aetna Medicare Premiere Plans is that 87 percent of Aetna’s Medicare Advantage members in MAPD plans were rated 4 stars or higher in 2024.

Customizing Your Coverage: Plan Options by Zip Code

Healthcare coverage isn’t a one-size-fits-all solution. Aetna provides location-based customizable coverage, guaranteeing a perfect fit. The availability of different parts of Medicare can vary in different areas. To customize Aetna Medicare coverage based on your zip code, individuals can:

 

  1. Input their ZIP code on the Aetna Medicare website.
  2. Assess plans available in their area.
  3. Compare benefits, costs, and drug coverage.
  4. Verify if their primary care physician is within the network.

 

This will enable them to find the best plan for their needs.

The aspects of Aetna Medicare coverage that can be customized based on location include benefits such as dental, vision, and hearing coverage, concierge services, gym memberships, and fitness programs.

 

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Additionally, Aetna offers Medicare Advantage plans tailored to specific ZIP codes. Aetna Medicare provides a range of vision insurance plans with different features and availability, which may differ by location.

 

Vision and Wellness Programs: Beyond Basic Coverage

Vision and wellness programs add the finishing touch to the comprehensive coverage offered by Aetna Medicare Premiere plans. These plans may encompass vision services including eye exams and eyewear benefits.

Aetna provides support for wellness programs for its Medicare Premiere plan members through a variety of initiatives, including fitness and nutrition challenges, biometric screenings, online fitness classes, health coaching, weight-loss programs, mental health services, tobacco cessation programs, MinuteClinic visits, and various discounts, among others.

Wellness programs are accessible in certain Aetna Medicare Premiere plans, encompassing offerings such as healthy lifestyle coaching, fitness classes, and SilverSneakers fitness programs. And the best part?

Members do not have to pay extra for wellness programs and vision benefits as they are already included in Aetna Medicare Premiere plans.

Summary

Aetna Medicare Premiere is more than just a health insurance plan. It’s a comprehensive package of extensive network, tailored health services, cost management, and customizable coverage based on location.

With offerings like vision and wellness programs, Aetna Medicare Premiere goes beyond basic coverage, ensuring that your individual health needs are met. So, why wait? Make an informed decision and step into the world of comprehensive health coverage with Aetna Medicare Premiere.

Frequently Asked Questions

 

 

What is Aetna prime Medicare?

Aetna Medicare Prime Plan is a Medicare Advantage plan offered by Aetna Inc. with a $0.00 monthly premium. It is evaluated annually by CMS based on a 5-star rating system.

 

→  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 and include additional benefits not covered by Original Medicare.

 

→  What is the payer ID for Aetna Medicare Premier PPO?

The payer ID for Aetna Medicare Premier PPO is 60054. You can use this electronic payer ID to submit claims and mail them to the address on the member’s ID card.

 

Does Aetna Medicare require prior authorization for CT scan?

Yes, Aetna Medicare requires prior authorization for CT scans, and your provider needs to request this approval for medical care.

 

What benefits are covered by Aetna Medicare Premiere plans?

Aetna Medicare Premiere plans cover a variety of services, including health care, medical supplies, dental, vision, and hearing coverage, as well as additional benefits like concierge services, gym memberships, and fitness programs.

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 ZRN Health & Financial Services, LLC, a Texas limited liability company

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Speak with a licensed insurance agent

 1-833-641-4938
TTY 711

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Russell Noga
( Medicare Expert )

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.