Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals.
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What doctors accept Aetna?
Use this page to find doctors, dentists and other health care professionals that accept Aetna coverage. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services.
What is the preferred pharmacy for Aetna?
The plan’s preferred pharmacy network comprises 4,200 Walmart, 580 Sam’s Club and 7,500 CVS/pharmacy locations. In addition to the preferred pharmacy network, members also can use any of the 52,700 pharmacies in the Aetna Medicare network.
How do I contact Aetna?
If you have any questions or would like to contact us, please use one of the methods below.
- Chat online and get answers
- Schedule an online appointment for personalized support
- Attend live webinars
- Use self-service tools for round-the-clock help
- Answer questions about benefits coverage
- Find network providers
- With ID card requests and claim inquiries
- Health information – To learn about various diseases and conditions
How do I find providers for Aetna?
- Aetna
- Aetna Medicare plans
- Aetna Medicare Advantage plans
- Aetna Medicare Part D
- Will my doctor accept my Aetna Medicare plan?
- Aetna Medicare plan reviews and ratings
- Does Aetna Medicare cover prescription drugs?
- Does Aetna Medicare cover vision?
- Does Aetna Medicare cover dental?
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.
Is Aetna Medicare considered an advantage plan?
Aetna Medicare Advantage D-SNPs Our dual-eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan, available to people who have both Medicare and Medicaid. We can help you find out if you qualify.
How many states have Aetna Medicare Advantage plans?
What states offer Aetna Medicare Advantage plans? Aetna offers Medicare Advantage plans in 49 states.
What is a Medicare Advantage PPO?
Medicare Advantage PPOs are types of Medicare Advantage plans that offer provider flexibility for beneficiaries who need it. With Medicare PPOs, you'll receive coverage for any provider you'd like, but you'll pay less if you use in-network providers and more if you use out-of-network providers.
Why do doctors not like Medicare Advantage plans?
If they don't say under budget, they end up losing money. Meaning, you may not receive the full extent of care. Thus, many doctors will likely tell you they do not like Medicare Advantage plans because private insurance companies make it difficult for them to get paid for their services.
What is the most popular Medicare Advantage plan?
AARP/UnitedHealthcare is the most popular Medicare Advantage provider with many enrollees valuing its combination of good ratings, affordable premiums and add-on benefits. For many people, AARP/UnitedHealthcare Medicare Advantage plans fall into the sweet spot for having good benefits at an affordable price.
Does Aetna Medicare Advantage plan require referrals?
Aetna Medicare PPO Prime plans PCP referrals are not required. Patients receiving covered services from a nonparticipating provider are subject to out-of-network deductibles and coinsurance and to potential balance billing.
What's the best Medicare Advantage plan for 2022?
Best Medicare Advantage Plans in 2022Best for size of network: UnitedHealthcare Medicare Advantage.Best for extra perks: Aetna Medicare Advantage.Best for member satisfaction: Kaiser Permanente Medicare Advantage.Best for low-cost plan availability: Humana Medicare Advantage.More items...•
Is Aetna Medicare Premier Plus PPO and Advantage Plan?
Aetna Medicare Premier Plus (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Aetna Inc.. Plan ID: H5521-272.
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.
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.
What Medicare Advantage plans do not cover?
Most Medicare Advantage Plans offer coverage for things Original Medicare doesn't cover, like fitness programs (like gym memberships or discounts) and some vision, hearing, and dental services. Plans can also choose to cover even more benefits.
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 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 ...
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.
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.
What is Aetna insurance?
Aetna is the brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates (Aetna). Health benefits and health insurance plans contain exclusions and limitations. See all legal notices.
Is Aetna liable for the content of linked sites?
Aetna Inc. and its subsidiary companies are not responsible or liable for the content, accuracy, or privacy practices of linked sites, or for products or services described on these sites. Please log in to your secure account to get what you need. You are now leaving the Aetna Medicare website.
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:
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.
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.
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 ...
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.
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.
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.
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, ...
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.
How to contact Aetna Medicare?
For information on Aetna Medicare Plan (HMO) (PPO) network providers in your area, just call us toll-free at 1-800-282-5366 (TTY: 711), Monday to Friday, 8 AM to 8 PM. You can also visit us on aetnamedicare.com.
How long is Aetna covered?
If you need emergency care, you’re covered 24 hours a day, 7 days a week, anywhere in the world. Whether you’re in or out of an Aetna Medicare service area, please follow these guidelines when you think you need emergency care: Call the local emergency hotline (for example, 911) or go to the nearest emergency facility.
What is Aetna accreditation?
Accreditation by the National Committee for Quality Assurance. Aetna is committed to accreditation by the National Committee for Quality Assurance (NCQA). It demonstrates our commitment to continuous quality improvement and meeting customer expectations.
What is Aetna PHO?
Aetna contracts with provider organizations called an Independent Practice Association (IPA) or a Physician-Hospital Organization ( PHO). An IPA/PHO is an association of independent providers. It may include hospitals, primary care doctors and specialist doctors, who together provide health care services.
What is a provider?
A provider, by entering a ZIP code, county or city. A provider’s name, facility, specialty or condition. A hospital or urgent care center. You may have to select a product or plan name to complete the search. Read More Read Less.
Does Aetna require prior authorization?
Certain network health care services, such as hospitalization or outpatient surgery, require prior authorization from Aetna Medicare. This means that Aetna Medicare must approve the service before the plan will cover it. Check your Evidence of Coverage for a list of services that require prior authorization.
Can I travel outside of Aetna?
If you travel outside of the Aetna Medicare Plan (HMO) (PPO) service area. You’re covered for emergency and urgently needed care. You can always get emergency care from the closest available provider, in or out of the service area.
What is a PPO plan?
Preferred Provider Organization (PPO) Plans. A person or organization that's licensed to give health care. Doctors, nurses, and hospitals are examples of health care providers. , or hospital in PPO Plans. PPO Plans have network doctors, other health care providers, and hospitals.
What is SNP in medical?
Special Needs Plans (SNP) Generally, you must get your care and services from doctors or hospitals in the Medicare SNP network, except: Emergency or urgent care, like care you get for a sudden illness or injury that needs medical care right away. If you have. End-Stage Renal Disease (Esrd)
Can you go out of network with HMO?
Health Maintenance Organization (HMO) Plans. In some plans, you may be able to go out-of-network for certain services. But, it usually costs less if you get your care from a network provider. This is called an HMO with a point-of-service (POS) option.
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.
What does it mean to be a Medicare provider?
When it comes to providers, there are a couple points that are useful to know.
So how do you find these Aetna network providers?
There’s really no magic to finding Aetna’s network providers. If you enroll in a Medicare Advantage plan from Aetna, you’ll generally receive information about network providers.
What is Medicare Advantage Plan?
Medicare Advantage plans are offered by private insurance companies contracted with the Medicare program to provide benefits covered by Part A and Part B (except for hospice care, which is covered under Part A). These private companies look for ways to control health care expenses to help keep costs low for their members.
What are the providers of HMO?
HMO provider networks include doctors and specialists, hospitals, surgical centers, lab and x-ray facilities, and even pharmacies if your plan covers prescription drugs. You must get all care, except emergency treatment, from doctors who accept your Medicare Advantage HMO, or your plan may not pay any of your expenses.
What is a PPO plan?
PPOs let you see any provider or doctor who accepts your Medicare Advantage plan, but you pay a lot less when you use providers in the plan’s preferred provider network. Like HMOs, your plan network will include specialists, hospitals, and other providers you need for your health care needs. Private Fee-for-Service Plans (PFFS).
Can a non-network provider charge for Medicare?
In addition, a doctor who accepts your Medicare Advantage plan must accept your copayment or coinsurance amount as payment in full for your share of your health-care expenses. A non-network provider can charge you whatever their usual rate may be .
Does Medicare Advantage charge a copayment?
Your plan may charge you a lower copayment or coinsurance amount when you use health-care providers who participate in your plan; for example, you may pay a 20% coinsurance amount for in-network providers, but 50% for out-of-network care. In addition, a doctor who accepts your Medicare Advantage plan must accept your copayment or coinsurance amount ...
Can I see a doctor who accepts my Medicare Advantage plan?
If your plan has a provider network, you may want to see doctors who accept your Medicare Advantage plan to avoid paying more for out-of-network providers. Medicare Advantage plans often use different incentives to encourage you to get care from network providers. Your plan may charge you a lower copayment or coinsurance amount when you use ...
Does Medicare Advantage cover vision?
Medicare Advantage plans are only required to cover the same services as Part A and Part B, which do not include benefits for routine vision, dental, hearing, and prescription drugs. However, many Medicare Advantage plans do offer additional coverage for these services.