Aetna Medicare Advantage Plans in Tennessee for 2025
Confused about the potential Aetna Medicare Advantage plans in Tennessee? Cut through the complexity with this concise guide. This article covers eligibility, potential benefits like prescription drug coverage that you may expect from HMO or PPO plans, and how these plans compare to Original Medicare.
Whether you’re looking for standard coverage or have special healthcare needs, you’ll find essential tips to help you navigate the potential Aetna Medicare Advantage plans Tennessee offerings and make an informed choice.
Key Takeaways
- Aetna offers a range of Medicare Advantage plans in Tennessee, including HMO-POS, PPO, and D-SNPs, focusing on total healthcare management and requiring varying levels of network adherence.
- Some of these Medicare Advantage plans from Aetna may include additional benefits that could go beyond Original Medicare, such as dental, vision, hearing, drug coverage, and various wellness and support services, which could benefit customers with more comprehensive health coverage.
- Eligibility for Aetna’s plans requires enrollment in both Medicare Parts A and B, with specified enrollment periods and opportunities for Special Enrollment under certain conditions; some of these plans may offer an extensive network of healthcare providers and additional resources, potentially emphasizing careful selection of in-network providers that could minimize costs.
Compare Plans in One Step!
Enter Zip Code
Aetna Medicare Advantage Plans in Tennessee
Aetna, a leader in the healthcare industry, will likely offer a range of Medicare Advantage plans in Tennessee. These plans, which include HMO-POS, PPO, and Dual Special Needs plans (D-SNP), are designed to provide comprehensive coverage that could potentially enhance the care received through Original Medicare.
The plans could focus on total health care management, with specific features and availability that could vary by service area within Tennessee.
Plan Types: HMO and PPO
Aetna offers Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) Medicare Advantage plans in Tennessee, each catering to different healthcare needs. If you opt for an Aetna Medicare Advantage HMO plan, you will need a primary care provider (PCP) who coordinates all health services, including issuing necessary referrals for specialties.
Participants in Aetna HMO plans are required to use in-network doctors and hospitals for non-emergency care and might need a PCP referral for specialist visits and hospital care.
Contrarily, Aetna’s PPO plans may provide greater flexibility in selecting healthcare providers. You have the option to:
- Receive care from both in-network and out-of-network providers without referrals
- Enjoy greater flexibility and do not require a primary care physician
- Seek care from in-network providers, which can result in lower costs.
Prescription Drug Coverage
Prescription drug coverage might be included in some of these Aetna Medicare Advantage plans in Tennessee, potentially offering significant benefits for beneficiaries. This coverage could help reduce possible out-of-pocket costs for necessary medications.
Whether you choose a Medicare Advantage PPO or HMO-POS plan, you could potentially enjoy the benefit of prescription drug coverage. The possible integrated Part D prescription drug coverage might offer an advantage over Original Medicare, which could require separate enrollment for prescription drug plans.
As an added convenience, some of the eligible Aetna Medicare Advantage plans might offer a mail-order service, potentially providing a straightforward way for beneficiaries to receive their prescribed medications.
Possible Benefits
Some of the Aetna Medicare Advantage plans in Tennessee could include some of the following benefits:
- Dental coverage
- Vision coverage
- Hearing coverage
By potentially enhancing your overall healthcare coverage and focusing on the possible benefits, which may ultimately improve health outcomes.
Eligibility and Enrollment for Aetna Medicare Advantage Plans in Tennessee
Residency could determine eligibility for Aetna Medicare Advantage plans in Tennessee. Most Tennesseans who are older and legal US residents are eligible for Medicare, as well as some residents under 65 with certain health conditions.
To enroll in Aetna Medicare Advantage plans, Tennessee residents may reach out to a licensed agent at 1-833-641-4938 (TTY 711), Mon-Fri 8 am-9 pm EST.
Eligibility Requirements
To be eligible for an Aetna Medicare Advantage plan, Tennessee residents must be enrolled in both Medicare Parts A and B. While completing your enrollment in an Aetna Medicare Advantage plan, you will likely need to provide your Medicare number and the effective dates for both Medicare Parts A and B.
For individuals who qualify for both Medicare and Medicaid, Aetna might offer a Medicare Advantage Dual-eligible Special Needs Plan (D-SNP) in Tennessee. This plan might be specially designed to cater to the unique needs of such individuals, possibly ensuring comprehensive healthcare coverage.
Enrollment Periods
Enrollment in Aetna Medicare Advantage plans is confined to specific periods, rather than being open year-round. The Annual Election Period, which runs from October 15th to December 7th, is when Tennessee residents can enroll in Aetna Medicare Advantage plans.
In addition, the Medicare Advantage Open Enrollment period for current Medicare Advantage plan members takes place from January 1 to March 31 annually.
Special Enrollment Periods (SEPs) allow Tennessee residents to enroll in a Medicare Advantage Plan or make changes outside the regular enrollment periods, given certain circumstances arise, such as:
- moving to a new area
- changes in Medicaid status
- loss of coverage
- living in an institution
Comparing Aetna Medicare Advantage Plans with Original Medicare
You might question how some of these Aetna Medicare Advantage plans could compare to Original Medicare in terms of Medicare coverage as a Medicare beneficiary.
Original Medicare could allow beneficiaries the freedom to see a range of doctors who accept Medicare and consists of Part A, which will likely cover hospital insurance, and Part B, which may include medical insurance. Since certain Medicare plans could evaluate its plans based on various factors, it’s essential to consider the differences between Medicare Advantage and Original Medicare.
Coverage Differences
One possible difference between Aetna Medicare Advantage plans and Original Medicare could be the annual out-of-pocket limit for medical care, which might not be a feature of Original Medicare.
Some of these Aetna Medicare Advantage plans might cover additional benefits such as routine dental, vision, and hearing services, which are generally not covered by Original Medicare. They may also offer preventive care benefits.
Moreover, Aetna Medicare Advantage members may also have 24/7 coverage anywhere in the world in case of an emergency. Members could access emergency services from any provider, with follow-up care coordination rules that could be applicable based on the plan type.
This worldwide coverage could be an added benefit that’s not offered by Original Medicare.
Potential Costs and Premiums
The potential costs should be a critical deciding factor when choosing a Medicare plan. Here are some costs to consider:
- Original Medicare will likely include a monthly premium for Part B which all beneficiaries must pay.
- For Aetna Medicare Advantage Part C plans, there might be an additional premium on top of the Part B premium.
- Part A premium could be free for those who have paid Medicare taxes for a sufficient amount of time.
Possible deductibles and coinsurance for certain out-of-network care may be higher than in-network services with some of the Aetna Medicare Advantage plans, possibly leading to increased out-of-pocket expenses for members.
Utilizing out-of-network providers with certain Aetna Medicare Advantage plans could potentially lead to higher costs and full payment responsibility for services if they are not covered by the plan outside of emergencies.
Provider Network and Health Care Professionals
Some of Aetna’s Medicare Advantage plans in Tennessee could encompass a broad network of health care providers, such as specialists, primary care doctors, and hospitals. Members may generally receive the highest level of benefits when they obtain care from network providers.
Aetna will likely supply resources that could assist members in selecting suitable healthcare professionals within their provider network to satisfy their unique health needs.
In-Network vs. Out-of-Network Providers
Staying in-network with certain Aetna Medicare Advantage plans could mean:
- Utilizing health care providers with whom Aetna has negotiated rates
- Potentially help members save on specific health care costs
- Members could be encouraged to use in-network providers and ask for referrals to in-network specialists, hospitals, or surgical centers that may lower overall healthcare costs.
For out-of-network services, charges that may be above the ‘allowed’ amount via balance billing might not count toward a member’s out-of-pocket limit, leading to potential additional expenses.
However, members with ‘NAP’ on their Aetna ID card might be able to access discounts for out-of-network care from NAP providers, which could avoid balance billing and could provide more predictable out-of-pocket costs for out-of-network services.
PPO plan members have the flexibility to choose both in-network and out-of-network providers but must confirm that the out-of-network providers accept the PPO plan and are eligible for Medicare payment.
Choosing a Health Care Professional
Aetna Medicare Advantage members may use the online provider directory to find in-network health care professionals by entering specific search criteria such as:
- ZIP code
- County
- City
- Provider’s name
- Facility
- Specialty
- Condition
Members could have access to their secure Aetna member account where they can search the provider directory for in-network health care professionals and potentially receive cost estimates for network care.
It’s important for Aetna Medicare Advantage members may contact providers before scheduling appointments to ensure they are still part of the Aetna network, as provider information could be updated regularly. This might be able to ensure that you receive the highest level of benefits and manage your healthcare costs efficiently.
Tennessee Medicare Resources and Support
Besides Aetna’s extensive Medicare Advantage plans, several resources and support services could also be available to Tennessee Medicare beneficiaries. Some of these may include the State Health Insurance Assistance Program (SHIP) and the Tennessee Commission on Aging and Disability.
These resources could offer vital support and information, possibly helping beneficiaries navigate the often complex Medicare landscape, which may include understanding their medicare contract.
State Medicaid Programs
SHIP in Tennessee could potentially offer free assistance to residents exploring Medicare plans and options. SHIP could offer:
- Personalized insurance counseling
- Assistance to Medicare-eligible individuals and their support networks
- Information needed to make informed decisions about healthcare coverage
Information and Assistance (I&A) staff could serve as an initial contact point for Tennessee residents who may be seeking help with Medicare, possibly guiding them to the right resources. Some of these resources might be federally funded through grants, possibly reinforcing the accessibility and reliability of their support to Tennesseans with Medicare-related needs.
Tennessee Commission on Aging and Disability
The Tennessee Commission on Aging and Disability guides a system that could promote health, dignity, independence, and security for older adults and adults with disabilities through community and in-home services.
The Commission could assist Medicare beneficiaries with information, counseling, and utilization of Medicare and related health coverage. It may also help in identifying and preventing Medicare and Medicaid fraud.
A comprehensive directory of aging programs and services may also be available on the Commission’s website, searchable by type or location. The Commission could offer some of the following programs and services:
- Aging and Disability Resource Connection (ADRC) might provide a single point of entry to long-term support services, in-home care, transportation, meals, and home modifications.
- Home and Community-Based Services will likely facilitate services for older adults and those with physical disabilities.
Various other programs and services could potentially serve as advocates and guardians, which may address issues within long-term care facilities and for those who cannot make personal decisions, could include:
- OPTIONS for Community Living
- Caregiver support
- The Long-Term Care Ombudsman Program
- Public Guardianship for the Elderly
Summary
Some of the Aetna Medicare Advantage plans in Tennessee may offer a comprehensive approach to healthcare by potentially offering a variety of plan options that could suit different healthcare needs. From prescription drug coverage to possible benefits like dental, vision, and hearing services, some of these Aetna plan could provide a substantial level of coverage compared to Original Medicare.
With a large network of healthcare providers and resources that could help members make informed choices, Aetna will likely ensure a smooth healthcare journey for its members. Lastly, remember that support may be available through various Tennessee Medicare resources like SHIP and the Tennessee Commission on Aging and Disability.
Frequently Asked Questions
→ What is the difference between Aetna Medicare and Aetna Medicare Advantage?
Aetna Medicare Advantage plans are Part C plans offered by Aetna® Medicare, which will likely be similar to Original Medicare but might include additional benefits that may not be covered by Original Medicare.
→ Does Aetna provide coverage in Tennessee?
Yes, Aetna will likely provide coverage in Tennessee, possibly offering comprehensive health insurance plans to residents across the state.
→ How does prescription drug coverage work in Aetna Medicare Advantage plans?
In certain Aetna Medicare Advantage plans, prescription drug coverage may be included in most plans in Tennessee. The possibility of having integrated Part D coverage might require separate enrollment with Original Medicare.
→ How do Aetna Medicare Advantage plans compare with Original Medicare?
Some Aetna Medicare Advantage plans may offer more benefits and could have an annual out-of-pocket limit compared to Original Medicare. Some plans may also cover additional services and might offer preventive care benefits.
→ How do I find Medicare Advantage Plans available in my area?
To find Medicare Advantage Plans available in your area, members may use Medicare’s Plan Finder Tool or contact State Health Insurance Assistance Programs (SHIPs) for more information.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.