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Aetna Medicare Advantage

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Unlike traditional Medicare, Medicare Advantage plans sold by Aetna are managed healthcare plans most commonly known as Health Maintenance Organizations (HMO) and Preferred Provider Organizations (PPO).

For example, if you choose a Medicare Advantage plan over traditional Medicare the Advantage Plan becomes your Primary insurance carrier. The Part B premium you pay will still go to Medicare, but Medicare in turn subsidizes your plan carrier.

There are two kinds of Medicare plans that don’t work the same. Plans such are HMO’s and PPO’s replace Original Medicare with benefits that are as good as or better then Part A and B.

Most 2019 Aetna Medicare Advantage plans will also include Part D for drug coverage.

Aetna Medicare supplement plans also known as Medigap are all standardized plans ranging from Plan A to Plan N which are designed to work with Original Medicare to pay the deductibles, copays, and coinsurance that Part A and B have.

Medigap plans do not include Part D in the coverage. With Original Medicare you are not restricted to any networks and you can see any provider in the United States. Unlike Advantage plans you don’t need a referral to see a specialist.

There are over 100 insurance carriers that market Medicare Advantage plans throughout the United States. About half of all those enrollments come from the top-rated insurance companies which include Aetna HMO and PPO plans.

One of the largest markets for Aetna in the southeast region of the United States where they have a stronghold on Advantage plans is Pennsylvania, New Jersey, and Delaware.

Depending on what state and county you live in, you could find a wide assortment of 2019 Aetna plans ranging from different monthly premiums to plans with deductibles and plans without.

Aetna HMO Plans

An HMO plan is a type of health insurance plan that usually limits coverage to care from doctors who work for or contract with the HMO. It generally won’t cover out-of-network care except in an emergency. An HMO may require you to live or work in its service area to be eligible for coverage.

Over the last few years this is the most recognized kind of Medicare Advantage plan in the United States, but it is the not the most popular in all states. Some HMO plans you may find have no monthly premium, this may because that particular-HMO plan does a great job at controlling its healthcare costs.

HMO plans are known to have the most constraining regulations when it comes to covering medical procedures. These services are provided from licensed physicians from within the HMO’s provider network.

Aetna PPO Plan

PPO plans use a network, but the network may extend to an entire region or in some cases, even nationwide as long as the provider accepts Medicare.

Aetna has a very large network because they service recipients throughout the United States. Just like having an HMO, a PPO requires you to pay a monthly premium and share in the healthcare costs such as copays and deductibles. Unlike and HMO, a PPO does not require you to need a referral when seeing a specialist.

Aetna Special Needs Plans

Special Needs plans are also known as the acronym (SNP). Most people who qualify for special needs are folks who might be living in a nursing home or a similar facility.

Another example of a special needs recipient might be when someone suffers from two chronic conditions such as high blood pressure and high cholesterol. If anyone of these events were to take place, a Medicare recipient would be able to join a SNP at any time during the year.

Additional benefits that could be found in Aetna Advantage plans may include preventive dental and vision, Travel Advantage benefits, and Wellness programs that may include Silver Sneakers to help pay for a gym membership. All Advantage plans also have 24-hour hotlines for emergencies and information.

Examples of cost sharing such as copays and deductibles are:

  • Diabetic supplies
  • Primary care physician visit
  • Podiatrist
  • In-patient hospital care
  • Outpatient x-rays
  • Emergency care
  • Urgent care

Examples of additional benefits:

  • Wellness program, which may include a fitness program such as “Silver Sneakers”
  • Travel advantage program
  • 24-hour nursing hotline

Need a Helping Hand?

Call (855) 494-0097 to request a free walkthrough from your local agent.

Pennsylvania Counties

H3931-112 Choice Plan HMO

(Bucks, Chester, Delaware, Lehigh, Montgomery, Northampton, Philadelphia)

H3931-070 Silver Plan HMO

(Adams, Allegheny, Armstrong, Beaver,

Bedford, Berks, Blair,
Bradford, Bucks, Butler,
Cambria, Cameron, Carbon,
Centre, Chester, Clarion,
Clearfield, Clinton, Crawford,
Cumberland, Dauphin, Delaware,
Elk, Erie, Fayette,
Forest, Franklin, Fulton,
Greene, Huntingdon, Indiana,
Jefferson, Juniata, Lackawanna,
Lancaster, Lawrence, Lebanon,
Lehigh, Luzerne, Lycoming,
McKean, Mercer, Mifflin,
Monroe, Montgomery, Montour,
Northampton, Northumberland, Perry,
Philadelphia, Pike, Potter,
Schuylkill, Snyder, Somerset,
Sullivan, Susquehanna, Tioga,
Union, Venango, Warren,
Wayne, Westmoreland, Wyoming,
York)

H5521-122 Gold Plan PPO

(Adams, Allegheny, Armstrong, Beaver,

Bedford, Berks, Blair,
Bucks, Butler, Cambria,
Cameron, Carbon, Centre,
Chester, Clearfield, Clinton,
Columbia, Crawford, Cumberland,
Dauphin, Delaware, Elk,
Erie, Fayette, Forest,
Franklin, Fulton, Greene,
Huntingdon, Indiana, Jefferson,
Juniata, Lackawanna, Lancaster,
Lawrence, Lebanon, Lehigh,
Luzerne, Lycoming, McKean,
Mercer, Mifflin, Monroe,
Montgomery, Montour, Northampton,
Northumberland, Perry, Philadelphia,
Potter, Schuylkill, Snyder,
Somerset, Sullivan, Susquehanna,
Union, Venango, Warren,
Washington, Wayne, Westmoreland,
Wyoming, York)

H3931-004 Premier Plan HMO

(Bucks, Chester, Delaware, Montgomery)

H3931-055 Basic Plan HMO

(Bucks)

H3931-064 Standard Plan HMO

(Bucks, Chester, Delaware, Montgomery)

H3931-065 Standard Plan HMO

(Philadelphia)


New Jersey Counties

Aetna Medicare Standard Plan HMO H3152-022 (Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Salem)

Aetna Medicare Premier Plan HMO H3152-048 (Bergen, Essex, Hudson, Hunterdon, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren)

Aetna Medicare Basic Plan HMO H3152-045 (Atlantic, Bergen, Burlington, Camden, Cape May, Cumberland, Essex, Gloucester, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Salem, Somerset, Sussex, Union, Warren)

Aetna Medicare NNJ Prime Plan HMO H3152-080 (Bergen, Essex, Hudson, Hunterdon, Morris, Passaic, Somerset, Sussex, Union, Warren)

Aetna Medicare Standard Plan PPO H5521-124 (Atlantic, Burlington, Camden, Cape May, Cumberland, Gloucester, Salem)

Aetna Medicare Standard Plan PPO H5521-037 (Bergen, Essex, Hudson, Hunterdon, Mercer, Middlesex, Monmouth, Morris, Ocean, Passaic, Somerset, Sussex, Union, Warren)

Aetna Medicare Elite Plan HMO H3152-082 (Middlesex, Monmouth, Ocean)

Aetna Medicare SNJ Prime Elite Plan PPO H5521-123 (Burlington, Camden, Gloucester)


Delaware Counties

Aetna Medicare Choice Plan HMO H3931-104 (Kent, New Castle, Sussex)

Aetna Medicare Standard Plan HMO H3931-102 (Kent, New Castle, Sussex)

Aetna Medicare Premier Plan PPO H5521-095 (Kent, New Castle, Sussex)


North Carolina Counties

Aetna Medicare Premier Plan PPO H5521-081 (Alexander, Burke, Caldwell, Catawba, Iredell, McDowell, Rowan)

Aetna Medicare Value Plan PPO H5521-139 (Alleghany, Wilkes)

Aetna Medicare Value Plan HMO H3931-081 (Iredell, Rowan)

Aetna Medicare Value Plan PPO H5521-169 (Chatham, Cumberland, Harnett, Lee, Moore, Sampson)

Aetna Medicare Premier Plan PPO H5521-081 (Alamance, Caswell, Davidson, Davie, Forsyth, Guilford, Randolph, Rockingham, Stokes)

Aetna Medicare Premier Plus Plan PPO H5521-170 (Alamance, Guilford, Randolph, Rockingham)

Aetna Medicare Premier Plan PPO H5521-081 (Orange, Person)

Aetna Medicare Prime Plan HMO H3931-087 (Orange, Person)

Aetna Medicare Value Plan HMO H3931-081 (Orange, Person)

Aetna Medicare Essential Plan PPO H5521-168 (Durham, Wake)

Aetna Medicare Premier Plan PPO H5521-183 (Durham, Wake)

Aetna Medicare Prime Plan HMO H3931-087 (Durham, Wake)

Aetna Medicare Value Plan HMO H3931-081 (Durham, Wake)

Aetna Medicare Value Plan PPO H5521-139 (Johnston)

Aetna Medicare Premier Plan PPO H5521-081 (Cabarrus, Gaston, Lincoln, Mecklenburg, Union)

Aetna Medicare Value Plan HMO H3931-081 (Cabarrus, Gaston, Mecklenburg, Union)


South Carolina Counties

Aetna Medicare Premier Plan PPO H5521-140 (York)

Aetna Medicare Premier Plan PPO H5521-140 (Greenville, Laurens, Pickens, Spartanburg)


Florida Counties

Aetna Medicare Choice Plan HMO-POS H1609-028 (Orange, Osceola, Seminole)

Aetna Medicare Select Plan HMO H1609-024 (Orange, Osceola, Seminole)

Aetna Medicare Choice Plan (HMO-POS H1609-028 (Clay, Duval, Marion, St. Johns)

Aetna Medicare Premier Plan PPO H5521-033 (Clay, Duval, Marion, St. Johns)

Coventry Medicare Summit Plan HMO H1609-021 (Clay, Duval, Marion, St. Johns)

Coventry Medicare Summit Plan HMO H1609-018 (Broward)

Aetna Medicare Choice Plan HMO-POS H1609-028 (Broward, Miami-Dade, Palm Beach)

Aetna Medicare Premier Plan PPO H5521-033 (Broward, Miami-Dade, Palm Beach)

Coventry Medicare Summit Plan HMO H1609-016 (Miami-Dade)

Coventry Medicare Summit Plan HMO H1609-020 (Palm Beach)

Aetna Medicare Premier Plan PPO H5521-033 (Charlotte, Lee, Manatee, Sarasota)

Aetna Medicare Choice Plan HMO-POS H1609-028 (Charlotte, Manatee, Sarasota)

Aetna Medicare Select Plan HMO H1609-025 (Charlotte, Manatee, Sarasota)

Aetna Medicare Select Plan HMO H1609-027 (Lee)

Coventry Medicare Summit Plan HMO H1609-020 (Martin)

Aetna Medicare Choice Plan HMO-POS H1609-028 (Martin, St. Lucie)

Aetna Medicare Premier Plan PPO H5521-033 (Martin, St. Lucie)

Coventry Medicare Summit Plan HMO H1609-021 (St. Lucie)

Aetna Medicare Premier Plan PPO H5521-033 (Hillsborough, Pasco, Pinellas, Polk)

Coventry Medicare Summit Plan HMO H1609-020 (Hillsborough, Pinellas)

Aetna Medicare Choice Plan HMO-POS H1609-028 (Hillsborough, Pinellas, Polk)

Coventry Medicare Summit Plan HMO H1609-022 (Polk)

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