Find Aetna in-network doctors by comparing Aetna Medicare Advantage plan networks where you live or by searching the online Aetna network provider lookup tool. You should visit an in-network Aetna Medicare doctor so you can pay lower out-of-pocket costs.
Full Answer
How do I find Aetna Medicare providers?
The easiest way to find contracted Aetna providers is to use Aetna’s online Medicare Advantage . You simply enter your location (zip code) and the type of medical provider you are looking for, and the tool lists Aetna’s Medicare providers in your area. You can also use Aetna’s provider search tool to find health-care...
What is Aetna Medicare PPO?
Aetna Medicare Plans (PPO) give you the flexibility to visit providers that are both in-network and out-of-network. Your out-of-pocket costs for receiving care are typically lower when you visit an in-network provider. Why choose an Aetna Medicare Advantage plan?
Will my doctor accept my Aetna Medicare Advantage plan?
The answer to whether your doctor will accept your Aetna Medicare Advantage (also called Medicare Part C) plan depends on the specific plan you’re enrolled in and whether your doctor is in your plan’s network.
How does Aetna out-of-network health insurance work?
This rate is usually much lower than what they would charge if you were not an Aetna member. And they agree to accept the contract rate as full payment. You pay your coinsurance or copay along with your deductible. Some plans do not offer any out-of-network benefits. For those plans, out-of-network care is covered only in an emergency.
Does Aetna Medicare PPO require referrals?
How do Medicare Advantage PPO plans work? Preferred provider organization (PPO) plans let you choose any provider who accepts Medicare. You don't need a referral from a primary care physician for specialist or hospital visits. However, using providers in your plan's network may cost less.
Is Aetna PPO a good plan?
We award Aetna 4.0 out of 5.0 stars. Aetna is one of the largest health insurers in the US, and is highly rated by AM Best and the BBB. The company offers a variety of health plans for employer groups, and a limited number of plans (Medicare supplements, dental plans) for individuals and families.
What is network by Aetna?
A network is a group of health care providers. It includes doctors, specialists, dentists, hospitals, surgical centers and other facilities. These health care providers have a contract with us. As part of the contract, they provide services to our members at a certain rate.
What is the highest rated Medicare Advantage plan?
Best Medicare Advantage Plans: Aetna Aetna Medicare Advantage plans are number one on our list. Aetna is one of the largest health insurance carriers in the world. They have an AM Best A-rating. There are multiple plan types, like Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs).
Do doctors prefer HMO or PPO?
PPOs Usually Win on Choice and Flexibility If flexibility and choice are important to you, a PPO plan could be the better choice. Unlike most HMO health plans, you won't likely need to select a primary care physician, and you won't usually need a referral from that physician to see a specialist.
Is Aetna Medicare Advantage the same as Medicare?
Both terms refer to the same thing. Instead of Original Medicare from the federal government, you can choose a Medicare Advantage plan (Part C) offered by a private insurance company. These plans include all of the benefits and services of Parts A and B. They may include prescription drug coverage as part of the plan.
Does Aetna have different networks?
The Aetna Premier Care Network Plus differs from the Aetna Premier Care Network. It can be based on an accountable care organization (ACO) or joint venture (JV) network.
What does in network vs out of network mean?
When a doctor, hospital or other provider accepts your health insurance plan we say they're in network. We also call them participating providers. When you go to a doctor or provider who doesn't take your plan, we say they're out of network.
What is Aetna narrow network?
The narrow network health plan will incorporate lower cost sites of care and will offer premiums that Aetna projects will be 20 percent lower than its PPO competitors.
What is the biggest disadvantage of Medicare Advantage?
Medicare Advantage can become expensive if you're sick, due to uncovered copays. Additionally, a plan may offer only a limited network of doctors, which can interfere with a patient's choice. It's not easy to change to another plan. If you decide to switch to a Medigap policy, there often are lifetime penalties.
Are there disadvantages to a Medicare Advantage plan?
Medicare Advantage offers many benefits to original Medicare, including convenient coverage, multiple plan options, and long-term savings. There are some disadvantages as well, including provider limitations, additional costs, and lack of coverage while traveling.
Can I switch from a Medicare Advantage plan back to Original Medicare?
Yes, you can elect to switch to traditional Medicare from your Medicare Advantage plan during the Medicare Open Enrollment period, which runs from October 15 to December 7 each year. Your coverage under traditional Medicare will begin January 1 of the following year.
How Can I Find Health-Care Providers That accept Aetna’S Medicare Plans?
Aetna is a private company contracted with Medicare to provide benefits to beneficiaries under the Medicare Advantage program. Like many companies...
Who Are Aetna’S Providers For Medicare Advantage Plans?
If you are enrolled in a Medicare Advantage plan with Aetna, you may be required to get your health care from doctors and other providers who are i...
How Do I Find Aetna Providers?
The easiest way to find contracted Aetna providers is to use Aetna’s online Medicare Advantage . You simply enter your location (zip code) and the...
What Happens If I Don’T Use Aetna’S Providers?
If you’re enrolled in a Medicare Advantage plan through Aetna, and you choose to use a provider outside your plan’s provider network, one or more o...
How to contact Aetna Medicare?
If you have any questions about your Aetna Medicare Advantage plan or how to find Aetna network providers, you can contact Aetna Customer Service at 1-800-282-5366 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days a week, from October 1 – February 14 and 8 a.m. to 8 p.m., local time, Monday – Friday, from February 15 – September 30.
How to find contracted Aetna?
The easiest way to find contracted Aetna providers is to use Aetna’s online Medicare Advantage . You simply enter your location (zip code) and the type of medical provider you are looking for, and the tool lists Aetna’s Medicare providers in your area. You can also use Aetna’s provider search tool to find health-care facilities, pharmacists, ...
How does Aetna work?
If you’re enrolled in a Medicare Advantage plan through Aetna, and you choose to use a provider outside your plan’s provider network, one or more of the following things may happen: 1 Your plan may pay less toward your care. Some plans do cover certain out-of-network services, while others pay nothing for non-emergency care outside the network. 2 The fees for health services may be higher. This is because Aetna providers agree to accept a certain amount for your care. For example, if you usually pay 20% of the Medicare-approved cost for in-network care, you may be responsible for up to 50% of the cost for out-of-network care. 3 Any amount you pay might not contribute to your plan deductible, if you have one. 4 You may need preauthorization for any services you receive in order for any coverage to apply.
Why is Aetna fee higher than Medicare?
The fees for health services may be higher. This is because Aetna providers agree to accept a certain amount for your care. For example, if you usually pay 20% of the Medicare-approved cost for in-network care, you may be responsible for up to 50% of the cost for out-of-network care.
Does Aetna have Medicare Advantage?
Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals. Aetna’s network providers have agreed under contract to provide care for its members, usually at lower rates than they would otherwise charge you ...
Does Aetna pay for out of network care?
Depending on the plan you choose, you may be required to get all your care from providers in your Aetna Medicare Advantage plan network; you may have to pay in full (other than emergency treatment) for out-of-network care.
Does Medicare cover out of network services?
If you’re enrolled in a Medicare Advantage plan through Aetna, and you choose to use a provider outside your plan’s provider network, one or more of the following things may happen: Your plan may pay less toward your care. Some plans do cover certain out-of-network services, while others pay nothing for non-emergency care outside the network.
Find a doctor
Find doctors or pharmacies within your network and search for other providers like dentists or specialists.
Shopping for a new plan?
If you're looking for a new plan, check to see if your provider or pharmacy is covered.
Who is part of Aetna Medicare?
Aetna Medicare networks include doctors, pharmacies and other providers. Health care providers who could be part of an Aetna Medicare plan network include, but aren’t limited to:
How to speak to an Aetna agent?
To speak with one, call 1-800-891-6309, TTY: 711. They’re available 24 hours a day, 7 days a week.
What is Aetna Medicare Advantage?
Aetna Medicare Advantage plans provide coverage with a nationwide network of health care providers, hospitals and other facilities. The type of Aetna Medicare Advantage (Medicare Part C) plan you have determines which doctors and other medical providers are in your network.
What are the benefits of Aetna?
Some of the other extra benefits many Aetna Medicare Advantage plans may offer include: Vision and hearing benefits, including eye exams and an annual allowance for select products and services. Over-the-counter (OTC) benefits that give you an allowance for select items such as vitamins and cold medicine.
Does Aetna have a nationwide network?
Aetna Medicare Advantage plans feature nationwide networks. The type of Aetna Medicare Advantage plan you have will determine the rules and requirements regarding your in-network plan coverage. With an Aetna health maintenance organization (HMO) plan, you’re typically required to choose a primary care physician ...
What is a network provider?
A network is a group of health care providers. It includes doctors, specialists, dentists, hospitals, surgical centers and other facilities. These health care providers have a contract with us. As part of the contract, they provide services to our members at a certain rate. This rate is usually much lower than what they would charge ...
What is Medicare based rate?
Medicare-based rates, which are determined and maintained by the government. “Reasonable,”, “usual and customary” and “prevailing” charges , which are obtained from a database of provider charges. Other types of rate schedules. To find the method and percent, check your plan documents.
Is coinsurance higher than network deductible?
This is higher than your network deductible (sometimes, you have no deductible at all for care in the network). You must meet the out-of-network deductible before your plan pays any out-of-network benefits. With most plans, your coinsurance is also higher for out-of-network care.
Does Aetna pay for out of network care?
But it pays less of the bill than it would if you got care from a network doctor. Also, some plans cover out-of-network care only in an emergency.
Is Aetna higher than the amount it recognizes?
It is usually higher than the amount your Aetna plan “recognizes” or “allows.”. We do not base our payments on what the out-of-network doctor bills you. We do not know in advance what the doctor will charge. An out-of-network doctor can bill you for anything over the amount that Aetna recognizes or allows.
Is coinsurance higher for out of network?
With most plans, your coinsurance is also higher for out-of-network care . Coinsurance is the part of the covered service you pay after you reach your deductible (for example, the plan pays 80 percent of the covered amount and you pay 20 percent coinsurance).
What is the number for Aetna?
1-877-890-1409. 1-877-890-1409 TTY Users: 711. They’re available 24 hours a day, 7 days a week. They can help you find a doctor, pharmacist or other health care provider near you who accepts an Aetna Medicare Advantage plan.
What is the average rating for Aetna?
For 2020, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4.3 out of 5 stars. The majority of Aetna Medicare plan members are in a plan rated 4.5 stars or higher out of 5 stars. 3.
What is a PPO plan?
Aetna Medicare SM Plan (PPO) Aetna Medicare Prime Plan (PPO) Aetna Medicare Advantage Dual Special Needs plans (DNSP) Be sure to ask your health care provider if they accept the terms of your plan before you seek care. The Centers for Medicare and Medicaid Services releases annual Star Ratings for Medicare Advantage plans.
Does Aetna offer global coverage?
Health care providers who accept Aetna Medicare Advantage (also called Medicare Part C) plans can be found in many areas of the country. Aetna Medicare Advantage plans even offer global coverage for emergency care.
How to contact Aetnamedicare?
For up-to-date information about our network pharmacies, including pharmacies with preferred cost sharing, members please call the number on your ID card, non-members please call 1-855-338-7027 (TTY: 711) or consult the online pharmacy directory at http://www.aetnamedicare.com/pharmacyhelp.
How many doctors are in Aetna network?
Aetna networks include close to 1.2 million health care professionals, over 700,000 primary care doctors and specialists ...
What is an HMO plan?
Aetna Medicare Prime Plan (HMO) Aetna Medicare SM Plan (PPO) Aetna Medicare Prime Plan (PPO) Each type of plan has different network rules. No matter which Aetna Medicare Advantage plan you choose, be sure to ask your doctor or health care provider if they accept the terms of your plan before seeking care.
How to speak to an Aetna agent?
Speak with a licensed insurance agent by calling. 1-877-890-1409. 1-877-890-1409 TTY users: 711 24 hours a day, 7 days a week.
What is the average rating for Aetna?
For 2020, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4.3 out of 5 stars. And the majority of Aetna Medicare plan members are enrolled in plans with a rating of 4.5 stars or higher. 4.
Do you have to pay Medicare Part B premium?
You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members (those who have both Medicare and Medicaid, and meet the state’s requirements for full Medicaid benefits). The formulary, pharmacy network, and/or provider network may change at any time.