Aetna Medicare Value Plan

Choosing the right Medicare plan is a crucial decision. The Aetna Medicare Value Plan promises comprehensive healthcare coverage, including medical, dental, vision, and more. But can it meet your needs at an affordable cost?

This article provides a clear-cut look into what the Aetna Medicare Value Plan has to offer, detailing key benefits, cost implications, and enrollment criteria to help you make an informed choice.

 

Key Takeaways

 

  • Enrollment in the Aetna Medicare Value Plan requires eligibility verification and can be done online during the Medicare open enrollment period, with PCP selection and plan management facilitated through the Aetna website or app.

 

  • The Aetna Medicare Value Plan provides cost-saving options with potential $0 monthly premiums, a network of healthcare providers, and additional wellness programs and services to enhance the health of members.

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Aetna Medicare Value Plan: An Overview

The Aetna Medicare Value Plan is a Medicare Advantage plan that provides a wide range of benefits, designed to serve as a comprehensive healthcare package for seniors.

It encompasses Medicare Advantage HMO POS plans, PPO plans, and Dual Special Needs Plans (DSNP), providing options to suit varying individual needs. This plan goes beyond the scope of Original Medicare, offering more than just fundamental health care services and medical supplies.

 

Understanding the Benefits of Aetna Medicare Advantage Plans

The Aetna Medicare Value Plan includes the following benefits:

 

 

This comprehensive plan ensures that members receive well-rounded healthcare, catering to all aspects of their well-being.

 

What is the Aetna Medicare Value Plan?

The Aetna Medicare Value Plan offers the following benefits:

 

  • Medical and prescription drug coverage
  • Dental coverage
  • Vision coverage
  • Hearing coverage

 

With this health plan, members have access to a more extensive healthcare package compared to traditional Medicare.

Eligibility for the Aetna Medicare Value Plan encompasses:

 

  • Individuals aged 65 or above
  • Those with a qualifying disability as determined by Social Security Disability
  • Those dual-eligible for both Medicare and Medicaid

 

Enrollment in both Part A and Part B of Medicare is mandatory for the Aetna Medicare Advantage (PPO) plan, which is designed to improve health outcomes.

 

How to enroll in the Aetna Medicare Value Plan

 

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Eligibility for the Aetna Medicare Value Plan requires individuals to be at least 65 years old or have a qualifying disability that qualifies them for Social Security Disability.

The plan is also accessible to those enrolled in both Medicare and Medicaid, making it a comprehensive Medicare Advantage HMO option.

For enrollment, documentation verifying your age, work history, as well as your citizenship or permanent resident status may be required.

The enrollment period for this plan is from January 1 through March 31 annually, during the Medicare open enrollment period. Enrollment can be completed online through Aetna’s secure website.

 

 

 

Locating a primary care provider (PCP) within the Aetna network

A primary care provider (PCP) is pivotal in overseeing your overall health and coordinating your care. Locating a PCP within the Aetna network is a simple process. Members can log in to their member website or utilize the Aetna Health app to access the provider search tool.

If you encounter any missing data or need further assistance, you can contact Aetna’s Member Services office for guidance.

It is also possible to select or change your PCP through the secure member site of the Aetna Medicare Plan whenever necessary. If your primary care provider is no longer within Aetna’s network, a new PCP must be chosen. Assistance can be sought from your former doctor or Aetna’s Member Services office.

Understanding the Benefits of Aetna Medicare Advantage Plans

Aetna Medicare Advantage Plans offer a multitude of benefits, including:

 

  • Coverage for inpatient hospital stays
  • Coverage for doctor visits
  • Coverage for durable medical equipment
  • Prescription drug coverage
  • Supplementary benefits

 

These plans ensure that members have access to necessary treatments and offer convenience and cost savings. Aetna Medicare also offers Medicare Part D Prescription Drug Plans and Medicare Advantage plans that encompass prescription drug coverage in addition to supplementary benefits.

 

Furthermore, these plans provide added benefits such as dental, vision, and hearing coverage. However, it’s worth noting that these benefits may differ among individual plans and that a specific cap is imposed on the amount you are required to pay for covered medical care annually.

 

Hospital care and inpatient services

The Aetna Medicare Value Plan includes:

 

  • Hospital care services through Medicare Advantage PPO and HMO plans
  • Visits to any doctor within or outside the network for PPO
  • In-network providers for HMO
  • Emergency hospital care

 

This coverage ensures that members have access to necessary treatments whenever they need it.

The plan also offers coverage for inpatient hospital stays and related services. However, it’s important to note that certain limitations or restrictions may apply to effectively manage medically necessary healthcare in a cost-effective manner.

 

Prescription drug coverage

The Aetna Medicare Value Plan provides prescription drug coverage by utilizing Medicare Part D Prescription Drug Plans, ensuring members have access to their essential medications. The plan provides coverage for drugs that are included in their formulary, but there are limitations, including:

 

  • An initial coverage limit of $4,660 for total drug costs
  • Quantity limits based on manufacturer and FDA recommendations
  • Refill limits within a specific timeframe

 

Members can utilize the prescription drug coverage by:

 

  • Acquiring a stand-alone Medicare Part D plan or a Medicare Advantage plan that incorporates such coverage
  • Filling their prescriptions at an in-network pharmacy
  • Opting for mail delivery

 

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Additional benefits like dental, vision, and hearing

In addition to the comprehensive medical and prescription drug coverage, the Aetna Medicare Value Plan also offers dental benefits such as oral exams, cleanings, X-rays, fillings, and root canals, as well as vision benefits that encompass annual eye exams.

These additional benefits are already included in the monthly premium, ensuring members have access to a wide range of healthcare services without incurring supplementary costs.

Members can utilize these wellness services by participating in activities such as:

 

  • Utilizing the fitness benefit
  • Engaging in gym memberships
  • Attending fitness classes
  • Utilizing the dental, vision, and hearing coverage

 

These programs are intended to uphold and enhance one’s health and are included in the plan without any extra charges.

Comparing Aetna Medicare Value Plan with Other Medicare Advantage Options

Despite the comprehensive array of benefits offered by the Aetna Medicare Value Plan, it’s important to compare it with other Medicare Advantage options to find the best fit for your needs. UnitedHealthcare Medicare Advantage plans provide supplementary benefits such as routine vision, hearing, dental, and fitness coverage, accompanied by $0 copays for virtual visits.

On the other hand, Aetna Medicare Advantage plans, including the Aetna Medicare Value Plan, offer additional features including hearing, vision, and dental coverage, gym memberships, and comprehensive health advocacy.

In terms of monthly plan premiums, the Aetna Medicare Value Plan provides options with potential monthly premiums as low as $0, whereas the estimated average premium for Humana Medicare Advantage plans in 2024 is $18.50 per month.

The Aetna Medicare Value Plan necessitates a pre‐service organization determination prior to receiving services from out‐of‐network providers, except in cases of emergencies. On the other hand, Blue Cross Blue Shield Medicare Advantage plans delineate geographic service areas and networks of providers for receiving care.

 

Monthly plan premiums

The average monthly premium for the Aetna Medicare Value Plan amounts to $164.90 in 2023. This amount is determined by considering Medicare costs, such as monthly premiums, copays, and coinsurance. However, the monthly premium can be influenced by various factors, including:

 

  • Prescription drugs
  • Dental, vision, and hearing services
  • Gym memberships
  • The location of the plan

 

When compared with other Medicare Advantage Plans, the Aetna Medicare Value Plan provides:

 

  • A monthly premium that can be as low as $0, presenting a cost-effective alternative
  • Benefits and services that prioritize your overall health, encompassing medical and prescription drug coverage
  • Premium payments that are managed through InstaMed.

 

Access to specialists and out-of-network providers

Under the Aetna Medicare Value Plan, individuals have the option to select an in-network primary care provider (PCP) who will manage their specialist healthcare. In order to consult a specialist for covered, non-urgent medical needs, it is necessary to obtain a referral from the PCP.

As a participant of the Aetna Medicare Value Plan, you possess the flexibility to seek services from out-of-network providers who acknowledge Medicare and consent to the terms of the plan. However, seeking care from an out-of-network provider under the Aetna Medicare Value Plan typically results in higher costs compared to consulting an in-network specialist.

 

Drug coverage and pharmacy networks

The Aetna Medicare Value Plan provides Medicare Part D Prescription Drug coverage, ensuring members have access to essential medications. The plan provides coverage for drugs that are included in their formulary, but there are limitations, including:

 

  • An initial coverage limit of $4,660 for total drug costs
  • Quantity limits based on manufacturer and FDA recommendations
  • Refill limits within a specific timeframe

 

 

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Pharmacies that are part of the Aetna Medicare Value Plan can be located using the Pharmacy Locator tool on AetnaMedicare.com or by contacting the number provided on your member ID. Members can ascertain if their pharmacy is within the Aetna network by utilizing the employer plan search feature on the Aetna website or by accessing their member website.

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Navigating the Aetna Medicare Website

The Aetna Medicare website is a useful tool for managing your plan and accessing relevant information. To set up a secure member account, you can register as a new user or log in if you already have an account. This account provides the ability to oversee claims, access plan details, and perform other related tasks.

Aetna Medicare offers a host of online resources and key features to aid in plan management. These include:

 

  • Viewing plan documents
  • Making premium payments
  • Finding forms
  • Receiving informative emails and newsletters
  • Learning about benefits such as dental, vision, and hearing coverage.

 

Searching for a plan by zip code

To locate Aetna Medicare Value Plan options in your vicinity, you may input your ZIP code on Aetna’s website to examine the available plans and compare their benefits and costs. The availability of Aetna Medicare Plans is subject to variation based on zip code.

To review your options, you can input your ZIP code on the Aetna Medicare website in order to assess the plans available in your area and to compare their benefits, costs, and drug coverage.

Subsequent to conducting a zip code search on Aetna’s website, users have the capability to compare multiple plans simultaneously. The provided information is tailored to your plan benefits and is up-to-date, enabling you to make informed decisions based on the most recent details available for Aetna Medicare Value Plans.

 

Accessing your secure member account

In order to establish an Aetna Medicare secure member account, you need to:

 

  1. Access the Aetna Medicare secure member website
  2. Proceed through the registration process
  3. Furnish personal details
  4. Verify your identity
  5. Set up an account

 

The Aetna Medicare secure member account provides the ability to:

 

  • Manage claims
  • View plan details
  • Track progress toward the deductible
  • Access the digital ID card
  • Update your telephone number or address linked to your Aetna Medicare plan

 

The account provides a high level of security to safeguard the confidentiality and privacy of health information.

 

Utilizing online tools and resources

Aetna Medicare provides a range of online tools and resources designed to support members in leading healthier lives and managing their health. These offerings encompass care management programs, community support resources, and tools specifically tailored to assist with navigating drug plans. Additionally, members can conveniently access plan information through emails and newsletters.

 

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Members can also utilize Aetna Medicare’s online provider directory and medication search tool. The provider directory aids members in obtaining information regarding network providers in their specific area, while the medication search tool enables them to search for covered drugs under their plan and gain an understanding of the associated medication costs.

Making the Most of Your Aetna Medicare Value Plan

To maximize the value of your Aetna Medicare Value Plan, it’s important to take full advantage of all the available benefits. Establishing effective coordination with your primary care provider has the potential to improve health management and facilitate the delivery of more personalized care.

Additionally, involvement in activities like:

 

  • taking advantage of fitness benefits
  • maintaining gym memberships
  • attending fitness classes
  • using the dental, vision, and hearing coverage

 

By participating in our wellness programs, you can enjoy all the benefits that come with improving health outcomes. These programs are included in your plan without any extra charges, offering a cost-effective way to maintain and improve your health.

 

The role of your primary care provider in overall health

Your primary care provider plays a vital role in overseeing your overall health and coordinating your care. Under the Aetna Medicare Value Plan, individuals have the option to select an in-network primary care provider (PCP) who will manage their specialist healthcare.

In order to consult a specialist for covered, non-urgent medical needs, it is necessary to obtain a referral from the PCP.

Having a primary care provider facilitates a more organized and effective healthcare journey, as members do not require referrals to access covered services from network providers. This coordinated care greatly improves the user experience for Aetna Medicare Value Plan members.

 

Taking advantage of wellness programs and services

The Aetna Medicare Value Plan includes a wide range of wellness programs and services, such as:

 

  • Dental, vision, and hearing coverage
  • Concierge services
  • Gym memberships
  • Fitness programs
  • Fitness classes available through the SilverSneakers® program.

 

 

Aetna doctor in network finder

 

 

Members can leverage these wellness services by participating in customized workout programs, identifying gyms participating in the program, and monitoring their health progress. These services are included in the plan without any extra charges, making it easier for members to maintain and improve their health.

 

Utilizing the over-the-counter (OTC) benefit

The Aetna Medicare Value Plan offers benefits for over-the-counter (OTC) products, covering the costs of eligible OTC health and wellness items. These benefits include:

 

  • Pain relief
  • First aid supplies
  • Cold and allergy medication
  • Dental care items

 

Members can acquire these items by visiting CVS.com/otchs/myorder, logging in or registering for an account, and choosing from the available items for order.

Summary

In conclusion, the Aetna Medicare Value Plan provides comprehensive coverage, including hospital care, prescription drugs, and additional benefits like dental, vision, and hearing. It offers a wide range of benefits and features, including a low monthly premium, access to a large network of providers, and the flexibility to choose out-of-network providers.

Moreover, it provides access to a variety of online tools and resources, including a secure member account, online provider directory, and medication search tool. By establishing a strong relationship with a primary care provider, utilizing wellness programs, and taking advantage of the over-the-counter benefit, members can truly make the most of their Aetna Medicare Value Plan.

Frequently Asked Questions

 

 

What is an Aetna value plan?

An Aetna Value Plan is a straightforward and flexible healthcare plan that allows you to visit any licensed provider and offers reasonable deductibles and copays or coinsurance once the deductible is met.

 

Is Aetna Medicare PPO the same as Aetna Medicare Advantage?

No, Aetna Medicare PPO is not the same as Aetna Medicare Advantage. The Aetna Medicare Advantage Plan (PPO) offers comprehensive coverage in one plan.

 

Is Aetna a good Medicare Part D plan?

Aetna’s Medicare Part D plans receive an average star rating of 3.5 out of 5 and offer some of the lowest premiums in the market, making them a good choice for saving money on prescription drug coverage. Additionally, members have access to CVS Caremark’s digital tools.

 

How do you qualify to get $144 back from Medicare?

To qualify to get $144 back from Medicare, you need to be enrolled in Medicare Parts A and B, pay your own premiums, and live in a service area of a plan that offers a Part B giveback. This benefit is not provided by the federal government, and can only be obtained through a Medicare Advantage plan that offers this benefit.

 

How do I enroll in the Aetna Medicare Value Plan?

To enroll in the Aetna Medicare Value Plan, you can do so online during the Medicare open enrollment period from January 1 through March 31 annually. Be prepared to provide documentation verifying your age, work history, and citizenship or permanent resident status.

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

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Speak with a licensed insurance agent

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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.