Medicare Advantage Plans
What is a Medicare Advantage (MA) Plan?
Medicare Part C is also called Medicare Advantage (MA). It's an alternative to Original Medicare. Medicare Advantage may include prescription drug coverage, along with extra benefits, and is offered through private insurance companies. An MA plan is the only option that includes hospital, medical and prescription drug coverage with one ID card.
In general, Medicare Advantage:
- Offers the same or greater benefits than Original Medicare
- Includes prescription drug coverage, if you enroll in a Medicare Advantage plan with Medicare prescription drug coverage
- May include additional benefits like wellness, vision, hearing and dental care, plus fitness club membership*
- May have copays, deductibles and/or coinsurance for covered services
- Protects you with an annual out-of-pocket cost maximum, which limits how much you pay each year for medical services
Is there a monthly premium?
You pay your Medicare Advantage plan premium as well as your Part A and B premiums if necessary.
Coverage Rules in Medicare Advantage Plans
Medicare Advantage Plans must cover all of the services that Original Medicare covers. When you are in an MA plan, you still have Medicare. There are several types of MA plans including:
- Health Maintenance Organization (HMO) Plans - Provides coverage for plan members through a network of locally contracted providers. Members in our HMO plans must use plan providers (sometimes called “in network” providers), except in emergency or urgent care situations or for out-of-area renal dialysis or other services. If you obtain routine care from out-of-network providers, neither Medicare nor your Medicare Advantage Plan will be responsible for the costs.
- Preferred Provider Organization (PPO) Plans - Provides coverage for plan members through a network of locally contracted providers. Members in our PPO plans can go to any doctor, specialist or hospital whether they are in- or out-of-network. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers.
- Private Fee-for-Service (PFFS) Plans - require no special networks or providers. You can visit any doctor or hospital that is eligible to receive payment from Medicare, agrees to treat you and accepts the plan's terms and conditions.
- HMO Point-of-Service (HMO POS) Plans - Provides coverage for plan members through a network of locally contracted doctors and hospitals. Members in our POS plans may use a provider who is not in our network for some services. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers. While the POS option provides more choice and flexibility, it is important to remember that not all services are available outside the network of contracted providers.
* additional benefits may vary by plans and/or by county.
Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal.
See Evidence of Coverage for a complete description of benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by location. ©2015 Aetna Inc.
This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, provider network, premium and/or copayments/coinsurance may change on January 1 of each year.
Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next.
Our dual-eligible Special Needs Plan is available to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details.
You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members.
This information is available for free in other languages. Please call our customer service number at 1-866-865-0662 (TTY: 711) OR Coventry Health Care at 1-877-988-3589 (TTY: 711), 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Esta información está disponible en otros idiomas de manera gratuita. Comuníquese con Servicios al Cliente al 1-866-865-0662 (TTY: 711), de 8 am a 8 pm, siete días a la semana, desde el 1º de octubre hasta el 14 de febrero, y de 8 am a 8 pm, de lunes a viernes, desde el 15 de febrero hasta el 30 de septiembre.
Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.
For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 7 to 14 days. You can call First Health Part D at 1-866-865-0662 (TTY: 711), 8 a.m. to 8 p.m., local time, seven days, from October 1 - February 14; 8 a.m. to 8 p.m. Monday - Friday, from February 15 - September 30, if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign-up for automated mail-order delivery.
Cost sharing for members who get “Extra Help” is the same at preferred and network pharmacies.
The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.
Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change.
This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to www.aetnamedicare.com
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