Is Aetna Medicare Advantage the Same as Medicare?

If you’re exploring the potential Medicare options, you may wonder if Aetna Medicare Advantage is the same as Medicare. Simply put, these are two separate plans.

Some of Aetna’s Medicare Advantage plans may offer additional perks and a different cost structure than Original Medicare. This article will navigate you through these possible variances.

Key Takeaways

• Some of the Aetna Medicare Advantage plans (Part C) may offer additional benefits over Original Medicare, such as prescription drug coverage, routine dental, vision care, and hearing services, but may also come with different cost structures and potential network restrictions.

• There are several types of Aetna Medicare Advantage plans including HMO, PPO, and Special Needs Plans (SNPs), each offering varied levels of coverage, flexibility, and provider network requirements.

• Choosing between Aetna Medicare Advantage and Original Medicare will likely require valuating your health needs, financial considerations, and provider network availability to determine the most suitable and cost-effective healthcare coverage.

Aetna Medicare Advantage vs. Original Medicare: Key Differences

The potential Aetna Medicare Advantage and Original Medicare may offer similar benefits, but a deeper examination reveals some significant differences.

Aetna Medicare Advantage, also known as Medicare Part C, is a comprehensive health insurance plan that will include all the services covered by Original Medicare but may also offer additional benefits that Original Medicare does not provide.

Some Aetna Medicare Advantage plans, offered by private insurance companies, could provide additional benefits like dental, hearing, and vision care.

Coverage Comparison

Aetna Medicare Advantage plans encompass the services provided under Medicare Parts A and B. Medicare Part A covers inpatient hospital stays, care in skilled nursing facilities, hospice care, and some home health care, also known as hospital insurance.

Medicare Part B, on the other hand, covers certain doctors’ services, outpatient care, medical supplies, and preventive services. These will likely be the main services that could be covered by both Original Medicare and Aetna Medicare Advantage.

Aetna Medicare Advantage may also go beyond this by potentially providing:

• Prescription drug coverage through Medicare Part D plans, a benefit not included in Original Medicare

• Coverage for routine dental services, such as cleanings, oral exams, and X-rays, which may not be part of Original Medicare’s coverage

• Vision benefits

Cost Differences

Cost-wise, Aetna Medicare Advantage plans and Original Medicare will likely have significant differences. Aetna will likely offer a variety of Medicare Advantage plans, each with its cost structure.

The pricing of these plans may be influenced by various factors such as geographical location and the specific health requirements of the individual. Moreover, beneficiaries will likely be obligated to cover the Medicare Part B premium.

Some plans may also include prescription drug coverage, potentially affecting the premium cost. Hence, while comparing the potential costs of Aetna Medicare Advantage and Original Medicare, these variables should be considered.

Types of Aetna Medicare Advantage Plans

Aetna will likely offer a suite of Medicare Advantage plans that have been designed to cater to different healthcare needs and preferences. The primary categories of these plans are Health Maintenance Organization (HMO) plans, Preferred Provider Organization (PPO) plans, and Dual Special Needs Plans (D-SNP).

Offering a variety of plan types could enable Aetna to help provide potentail benefits and resources to its diverse member base.

HMO Plans

Aetna HMO Medicare Advantage plans offer a wide range of benefits, including:

• Dental, vision, and hearing coverage

• Concierge services

These plans require members to select an in-network primary care provider (PCP) who oversees their care and facilitates their access to essential services.

The process for obtaining referrals in Aetna Medicare Advantage HMO Plans is dependent on the specific plan. Generally, patients do not require a referral from their PCP for most services.

However, for certain covered non-emergency specialty or hospital care, a referral from the PCP may be necessary, except in cases of emergencies and certain direct-access services.

PPO Plans

Aetna’s PPO Medicare Advantage plans offer more flexibility compared to HMO plans. These plans allow members to access additional care without a referral, a feature not available in HMO plans. Additionally, HMO POS plans provide a middle ground between HMO and PPO plans, offering a balance of flexibility and cost-effectiveness.

Despite their flexibility, bear in mind that Aetna Medicare Advantage PPO plans could lead to higher costs when seeking care from out-of-network providers.

However, they offer the freedom to access both network and out-of-network providers, giving members a wider choice when it comes to their healthcare options.

Special Needs Plans (SNPs)

Aetna also offers Special Needs Plans (SNPs) that cater to individuals with specific health conditions or financial needs. These plans offer care management programs to assist with both medical and non-medical needs.

One type of SNP is the Dual Special Needs Plan (D-SNP), designed for members who are recipients of Medicaid benefits and/or receive assistance with Medicare premiums or Parts A & B cost-sharing.

This plan, known as the dual eligible special needs, is available in specific counties within certain states where Aetna Medicare provides D-SNP coverage.