Aetna HMO Medicare: How Does Aetna Medicare Advantage Work?

Aetna HMO Medicare: Aetna was founded in 1853 in Hartford, Connecticut, and is known as the first Medicare claim in 1966 that began offering health insurance plans. Aetna is the fourth-largest provider of Medicare, as it has several benefits, including vision, dental, and hearing benefits.

Aetna HMO Medicare: How Does Aetna Medicare Advantage Work?

However, Aetna HMO Medicare offers a wide range of Medicare health care plans with benefits and features to provide convenience.

Aetna Medicare has amazing health insurance plans such as health maintenance organization (HMO). It preferred provider organization (PPO) and other dual eligible special needs plans (D-SNPs).

They have additional benefits, which include concierge services that assist customers in locating healthcare resources and providers in your area.

With Aetna, you get expanded SNPs available for Medicare and Medicaid that help with several expenses, such as groceries.

Advantages of Aetna HMO Medicare

Aetna Medicare has several advantages; below are some of them:

Multiple Benefits offerings:

Aetna has multiple benefits such as dental, hearing, and vision. In addition to these benefits, Aetna Medicare beneficiaries have access to over-the-counter allowance, in-home health visits, and meal delivery services.

Strong $0- Premium Offerings:

Another benefit of Aetna Medicare is granting access to 84% of Medicare beneficiaries a $0 monthly premium.

Broad Availability:

Benefits of Aetna include having a broad availability, which means their plans are available in 46 states and Washington, D.C. They also offer stand-alone drug plans in 50 states plus Washington, D.C

Drugs Savings:

An awesome advantage is that all Aetna Medicare prescription drug plans come with a $0 deductible for all Tier 1 and Tier 2 drugs and a $0 copay on Tier 1 drugs.

How Does Aetna HMO Medicare Advantage Work?

Aetna works by offering several kinds of Medicare plans, and they vary in structure, features, and benefits. Below are some of the plans:

HMO Plan:

Aetna Plans include HMO, which stands for health maintenance organization; it requires you to choose or have a PCP (primary care physician).

With an HMO plan, if you wish to see a specialist or visit a hospital, it must be in-network. That is, it must be hospitals and specialists who have contracts with your HMO.

However, if this isn’t the case and you wish to visit an out-of-network specialist or hospital, you may need to get a referral from your PCP except in the case of an emergency.

HMO-POS plan:

This refers to HMO point-of-service plans if you are using this plan, you may likely have to have an in-network PCP that allows you to visit an in-network care provider and acquire specialist referrals.

With this plan, out-of-network visits will typically cost more. Take note that HMO-POS plans do not permit out-of-network dentists.

PPO Plan:

Aetna plans include PPO, which stands for preferred provider organization; this does not limit your visits to in-network providers or out-of-network providers.

However, out-of-network services cost more and don’t require PCP or referrals.

Aetna D-SNP Plan:

This plan stands for a dual-eligible special needs plan; it is usually available to individuals eligible for Medicare and Medicaid.

They offer several forms of extra resources which include prescription drugs, eyeglasses, hearing aids, routine dental services, and over-the-counter products.

Their services include a personal care team that helps coordinate provider visits, develop a care plan with doctors, and help you understand other parts of your medications.

It is important to note that Aetna’s D-SNP is limited to individuals in certain states and some countries are not eligible.

The Cost of Aetna HMO Medicare Plans

The cost of Aetna Medicare plans depends on your country, chosen plan, and your exact health needs.

Monthly premiums for HMO, HMO-POS, PPO, and D-SNP range from $0 to $99. They have an annual deductible that ranges from $0 to $1,000 and an annual maximum out-of-pocket cost that ranges from $5000 to $11,300.


What is the Difference Between the Aetna Medicare and Medicare?

Aetna Medicare and Medicare are the same. Aetna offers Aetna Medicare under Medicare part C which allows other private organizations like Aetna to offer the Medicare health plan options.

Also, Aetna Medicare provides the coverage of Medicare Part A, which includes hospital insurance and skilled nursing facility care.

Aetna Medicare also provides coverage for Medicare Part B, which includes insurance for doctors, therapy, and outpatient care.

Can Aetna Medicare be called an Advantage plan?

Yes, Aetna Medicare is categorized under the Medicare Advantage program which is referred to as part C.

What are the possible Downsides of the Medicare Advantage Plan?

Aetna Medicare has numerous advantages. However, there is a downside, which is the plan’s cost. Usually, the part B premium of Aetna Medicare must be paid for in most cases at about $164.90.

How Do I Find the Right Medicare Advantage Plan?

To find the best plan that suits you well, consider the following questions:

  • What is the cost of the plan?
  • Is your preferred doctor/hospital in the plan’s network?
  • Does the plan cover my drug prescriptions?
  • Are there dental coverages?

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