Will my doctor accept my Aetna Medicare plan?

At a glance

  • $0 premium plans available in some areas
  • Many plans offer prescription drug coverage and routine vision and dental benefits
  • About 1.75 million people are enrolled in an Aetna Medicare Advantage Plan1

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.

Aetna networks include close to 1.2 million health care professionals, over 690,000 primary care doctors and specialists and over 5,700 hospitals.1

Seven percent of all Medicare Advantage enrollees in 2017 were enrolled in an Aetna Medicare plan. This accounts for over 1 million Medicare Advantage plan beneficiaries.2

Aetna Medicare Advantage plans

If you’re enrolled in an Aetna Medicare Advantage plan, you’re likely a member of an:

  • Aetna MedicareSM Plan (HMO)
  • Aetna Medicare Open Access Plan (HMO)
  • Aetna Medicare Prime Plan (HMO)
  • Aetna MedicareSM 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.

Aetna Medicare Plans (HMO) have a contracted provider network. This means that you have access to tens of thousands of health care providers across the United States who are in your plan network.

Aetna Medicare Open Access Plans (HMO) give you access to tens of thousands of network health care providers nationwide. In-network coverage is also available when you travel, and you are not required to seek a referral from your primary care physician to see a specialist.

Aetna Medicare Prime Plans (HMO) require you to use providers from your local provider network, except for out-of-network renal dialysis, urgent care or emergency situations.

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?

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

For 2018, Aetna Medicare Advantage Prescription Drug (MAPD) plans earned an overall weighted average rating of 4 out of 5 stars. And 87% of Aetna Medicare plan members are enrolled in plans with a rating of 4 stars or higher.4

Get help from a licensed insurance agent

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

Speak with a licensed insurance agent by calling TTY users: 711 24 hours a day, 7 days a week.

More Aetna articles

2 Jacobson, Gretchen; Damico, Anthony; Neuman, Tricia; Gold, Marsha. Medicare Advantage 2017 Spotlight: Enrollment Market Update. (Jun. 06, 2017). Kaiser Family Foundation. Retrieved from https://www.kff.org/medicare/issue-brief/medicare-advantage-2017-spotlight-enrollment-market-update.
3 Every year, Medicare evaluates plans based on a 5-star rating system.
4 Medicare Star Ratings released Oct. 11, 2017. https://www.aetnamedicare.com/en/compare-plans-enroll/star-ratings.html.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

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.

This information is not a complete description of benefits. Call TTY Users: 711 for more information.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

Out-of-network/non-contracted providers are under no obligation to treat Aetna members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. 

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. You will receive notice when necessary.

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.       

Medicare beneficiaries may also enroll in an Aetna Medicare plan through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov.           

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.

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.

Medicare has neither reviewed nor endorsed this information.

Every 5 minutes on average, we help someone enroll in a Medicare Advantage plan.4

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