Medicare Blog

what doctors are included in aetna advantage medicare

by Mr. Bernie Legros Sr. Published 2 years ago Updated 1 year ago
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Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals.

Full Answer

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.

Is Aetna a good health provider?

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.26 fév. 2021

What are Medicare Advantage plans does Aetna offer?

As mentioned, Aetna Medicare Advantage plans may offer extra benefits not normally covered by Original Medicare, including prescription drug coverage and routine vision or dental benefits. If you’d like to learn more about Aetna Medicare plan options, visit the Aetna page to find coverage that may fit your needs.

Does Aetna have a Medicare Advantage plan?

Depending on where you live, you may be able to enroll in one of the following types of Aetna Medicare Advantage plans: Aetna Medicare Advantage HMO (Health Maintenance Organization) plans may have lower costs than other types of Medicare Advantage plans because they use a contracted provider network to keep health-care expenses low.

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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.

How many states have Aetna Medicare Advantage plans?

What states offer Aetna Medicare Advantage plans? Aetna offers Medicare Advantage plans in 49 states.

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 a Medicare Advantage Plan PPO?

A Medicare Preferred Provider Organization (PPO) plan is a type of Medicare Advantage Plan, an alternative to Original Medicare. A PPO provides you with access to your Medicare-covered services plus more benefits that Medicare doesn't cover, such as dental, vision, and hearing.

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 highest rated Medicare Advantage plan?

List of Medicare Advantage plansCategoryCompanyRatingBest overallKaiser Permanente5.0Most popularAARP/UnitedHealthcare4.2Largest networkBlue Cross Blue Shield4.1Hassle-free prescriptionsHumana4.01 more row•Jun 22, 2022

Does Aetna Medicare Advantage have copays?

$25 copay for up to a 30-day supply from retail pharmacy; $50 copay for up to a 90-day supply from mail-order pharmacy. $35 copay for up to a 30-day supply from retail pharmacy; $70 copay for up to a 90-day supply from mail-order pharmacy.

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 is better HMO or PPO?

HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral. Out-of-pocket medical costs can also run higher with a PPO plan.

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.

What is the biggest difference between Medicare and Medicare Advantage?

With Original Medicare, you can go to any doctor or facility that accepts Medicare. Medicare Advantage plans have fixed networks of doctors and hospitals. Your plan will have rules about whether or not you can get care outside your network. But with any plan, you'll pay more for care you get outside your network.

What are the advantages and disadvantages of Medicare Advantage plans?

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.

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...

Who are Aetna’s providers for Medicare Advantage plans?

Aetna’s Medicare Advantage providers include primary care doctors, specialists, hospitals, surgical centers, laboratories, imaging centers, dentists, pharmacists, and other health-care professionals.

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 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 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, and other professionals such as physical therapists. You can use the tool to search by health condition, as well.

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 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 Aetna have Medicare?

Aetna is a private company contracted with Medicare to provide benefits to beneficiaries under the Medicare Advantage program. Like many companies that offer Medicare plans, Aetna may require you to use certain providers to minimize your out-of-pocket health-care costs. If you’re enrolled in an Aetna plan, this article will help you find Medicare providers in an Aetna network who may treat you.

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 ...

Why choose an Aetna Medicare Advantage plan?

Each year , the Centers for Medicare and Medicaid Services (CMS) release Star Ratings that measure the performance of Medicare Advantage plans. 3

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.

How many people will be in Aetna in 2020?

About eleven percent of all Medicare Advantage enrollees in 2020 are enrolled in an Aetna Medicare plan. This accounts for over 2.6 million Medicare Advantage plan beneficiaries. 2

How to contact Medicare by phone?

For a complete list of available plans please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048) , 24 hours a day/7 days a week or consult www.medicare.gov.

Does Aetna have a pharmacy network?

Aetna Medicare’s pharmacy network includes limited lower cost, preferred pharmacies in applicable areas. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. 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 does Aetna have?

Aetna networks include close to 1.2 million health care professionals, more than 700,000 primary care doctors and specialists and over 5,700 hospitals. 2

How do I find an Aetna Medicare provider near me?

You can speak with a licensed insurance agent to find out what Aetna Medicare Advantage plans are offered in your area. The agent can also tell you whether your health care provider is in that plan’s network.

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.

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.

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.

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 ...

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.

How many tiers are there in a drug plan?

Each main plan type has more than one subtype. Some subtypes have five tiers of coverage. Others have four tiers, three tiers or two tiers. This search will use the five-tier subtype. It will show you whether a drug is covered or not covered, but the tier information may not be the same as it is for your specific plan. Do you want to continue?

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.

Is Aetna Inc. responsible for the content of its websites?

Links to various non-Aetna sites are provided for your convenience only. 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.

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.

What is a delegated provider?

Delegated provider/entity: Is contracted with Aetna to perform specific delegated function (s) for example, credentialing or utilization management, etc.

What is transition of coverage for Part D?

Transition of coverage for Part D. Members who are taking Part D drugs that are not on the plan's formulary, or that are subject to utilization management requirements, can get a transition supply of their drug under certain circumstances.

Is Aetna a Medicare Supplement?

The Aetna Supplemental Retiree Medical Plan is a fully insured, non-network-based commercial retiree group health product. In all states but Florida and Minnesota, it is offered as a supplementary medical plan, not a Medicare plan. In Florida and Minnesota, it is approved as a group Medicare Supplement product.

Do MA/MMP plans require FDR?

MA/MMP: Providers who participate only in our MA/MMP plans no longer need to complete an annual FDR Attestation.

Is Aetna Medicare Part D?

We welcome pharmacies to the Aetna Medicare Part D pharmacy network. The network includes retail and non­retail pharmacies, both independent and chain.

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 seeing out of network dental providers more expensive?

Varies by plan. Seeing out-of-network providers generally costs more. But most allow non- network dental providers.

Does Aetna offer Medicare Advantage?

Medicare Advantage plans for every need. In addition to PPO plans, Aetna offers you other Medicare Advantage plan options — many with a $0 monthly plan premium. We can help you find a plan that’s right for you.

Does Aetna have a meal at home program?

Yes. Meals-at-home program. (meals delivered to your home after a hospital stay) Yes, in many plans. Yes, in many plans. Yes, in many plans. Aetna Medicare Advantage plans at a glance. Our PPO plans. Requires you to use a provider network.

Can you use a network provider for HMO?

With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. Most of our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care.

Does a dental plan have RX coverage?

Yes, if plan has Rx coverage. Yes, if plan has Rx coverage . Yes. Dental, vision and hearing coverage. Yes, in many plans. Yes, in most plans. Yes. ER and urgent care coverage worldwide. Yes.

Does Aetna accept Medicare?

With Aetna Medicare Advantage PPO plans, you can visit providers in or out of our provider network who accept Medicare and our plan terms. Which could help you balance your choices with your budget.

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