Aetna Medicare Advantra Gold HMO

Selecting the appropriate Medicare plan holds significant importance.

The Aetna Medicare Advantra Gold HMO stands out with its essential benefits, including a broad network of providers and comprehensive prescription drug coverage.

This comprehensive guide aims to elucidate the plan’s distinctive features, provide insights into potential costs, and walk you through the enrollment process.

Armed with this information, you’ll be well-equipped to make a well-informed decision regarding your healthcare coverage.

 

Key Takeaways

 

  • Going beyond the essentials, this plan adds further value with supplementary services such as over-the-counter (OTC) benefits, fitness access through renowned programs like SilverSneakers, and inclusive coverage for routine care. These additional offerings enhance the overall value of the plan, providing a more comprehensive healthcare solution compared to basic Medicare coverage. 

 

  • Enrollment is conveniently accessible during the annual period running from January 1 through March 31. Moreover, individuals have additional opportunities for enrollment during Special Enrollment Periods, which are triggered by qualifying life events. The enrollment process can be seamlessly completed online, over the phone, or through traditional mail channels.

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Aetna Medicare Advantra Gold HMO: An Overview

 

Aetna Medicare Advantra Gold HMO Aetna Medicare Advantra Gold HMO: An Overview

 

The Aetna Medicare Advantra Gold HMO distinguishes itself with its extensive coverage and a broad network of healthcare providers, offering more than basic healthcare. This plan goes the extra mile to provide a myriad of benefits and services tailored to the diverse needs of its members.

Opting for an in-network primary care provider (PCP) ensures members have access to a comprehensive range of medical services. Some of the notable benefits and services offered by Aetna Medicare Advantra Gold HMO include:

  • Prescription drug coverage 

 

  • Preventive care services

 

  • Hospitalization coverage 

 

  • Specialist visits 

 

  • Emergency care 

 

  • Vision and dental coverage 

 

  • Fitness and wellness programs 

 

  • Transportation services

 

Choosing Aetna Medicare Advantra Gold HMO provides members with the assurance that their healthcare needs, including those covered by the Advantra Gold HMO POS plan, are well taken care of.

Additionally, the plan stands out by including routine foot care services. With a minimal copayment of $10, members can access vital podiatry services, contributing to the overall health of their feet.

Clearly, this health plan offers more than mere coverage; it provides peace of mind.

 

Plan Highlights

The Aetna Medicare Advantra Gold HMO proudly holds high star ratings, underscoring its dedication to providing quality care and ensuring customer satisfaction. With a stellar star rating of 4 or higher for the year 2024, this plan has demonstrated its commitment to excellence. However, the advantages extend beyond star ratings.

This plan goes the extra mile by incorporating an extensive range of fitness services, thoroughly outlined in the evidence of coverage document accessible on the Aetna Medicare website. From cardio workouts to strength training, these fitness services are designed to accommodate various fitness levels, allowing members to maintain an active and healthy lifestyle.

Furthermore, the Medicare plan encompasses a diverse array of routine care services, solidifying its position as a truly comprehensive health plan. As Medicare evaluates plans based on various criteria, this particular plan distinguishes itself with its multifaceted offerings, earning its place among the top Medicare plans available.

 

Network Availability

An indispensable aspect of any health plan lies in its network of healthcare providers. The Aetna Medicare Advantra Gold HMO excels in this realm, extending coverage across various healthcare services, encompassing routine care, fitness benefits, and prescription medications. This expansive network guarantees members seamless access to top-notch healthcare whenever the need arises.

The healthcare providers affiliated with this plan are committed to delivering high-quality medical care. They provide extensive coverage for a myriad of services, ensuring members receive optimal care. To explore the array of medical specialists included in the network, members can access detailed information on the Aetna Medicare website.

 

Extra Benefits and Services

 

Aetna Medicare Advantra Gold HMO Extra Benefits and Services

 

In addition to the fundamental coverage, the Aetna Medicare Advantra Gold HMO presents an array of additional benefits and services. These encompass fitness access, over-the-counter (OTC) benefits, and comprehensive routine care coverage for dental, vision, and hearing.

These supplementary benefits significantly enhance the plan, making it an outstanding choice for individuals seeking comprehensive coverage.

For those inclined towards fitness, the plan offers an array of services, ranging from gym memberships to wellness programs. It also allocates a quarterly allowance, allowing members to purchase approved health and wellness products like pain relief medications and first aid supplies through the OTC benefit.

Furthermore, the plan extends coverage for dental, vision, and hearing benefits, ensuring holistic care for its members.

 

Fitness Access

Acknowledging the crucial role fitness plays in overall health, the Aetna Medicare Advantra Gold HMO introduces fitness access to its members. This feature includes:

  • SilverSneakers instructor-led group fitness classes

 

  • The FLEX program, a network of senior fitness classes

 

  • Customized workout programs tailored to individual fitness levels

 

These fitness benefits are offered at no extra cost for the majority of members, making it a valuable inclusion in the plan. Members can take advantage of these benefits at any fitness facility, ensuring flexibility and convenience.

The introduction of the fitness access provision reflects Aetna’s dedication to promoting a healthy lifestyle among its members.

 

Over-the-Counter (OTC) Benefit

 

Aetna Medicare Advantra Gold HMO Extra Benefits and Services

 

The OTC benefit stands out as a valuable feature of the Aetna Medicare Advantra Gold HMO. This provision grants members a quarterly allowance to purchase approved health and wellness products, encompassing pain relief medications, first aid supplies, cold and allergy medicines, and dental care items.

Members can easily make use of their OTC benefit to acquire a variety of products, including:

  • Pain relievers

 

  • Dental care items

 

  • Cold and allergy medicine

 

  • First aid supplies

 

  • Vitamins and supplements

 

  • Eye and ear care products

 

  • Skin care items

 

  • Feminine hygiene products

 

While there are no explicit restrictions on the items available for purchase, certain items may be subject to specific limits, and returns or exchanges are not allowed. The quarterly allowance varies depending on the benefit plan, prompting members to review their plan documents or contact customer service for additional details.

 

Routine Care Coverage

Comprehensive routine care coverage is a key feature of the Aetna Medicare Advantra Gold HMO, encompassing vital services such as dental, vision, and hearing benefits. This focus on preventive care and essential health services is designed to provide extensive support to members.

While Original Medicare lacks coverage for routine dental care, the Aetna Medicare Advantra Gold HMO fills this gap by offering specific dental services like cleanings, X-rays, and fillings.

It’s important to note that there may be a benefit maximum for these dental services. Additionally, the plan provides an annual routine hearing exam and covers hearing aid fittings at 100 percent, with potential assistance for hearing aid purchases.

With this routine care coverage, members can access the essential care they require, promoting overall health and well-being.

Prescription Drug Coverage

Incorporating prescription drug coverage as a crucial element, the Aetna Medicare Advantra Gold HMO provides a comprehensive approach to managing medication expenses. The coverage includes an extensive formulary, convenient mail order options, and a cost-sharing arrangement aimed at ensuring members can effectively handle their prescription costs.

As members progress into the coverage gap phase, they are responsible for covering 25% of the cost for both generic and brand-name prescription drugs. Additionally, there is an out-of-pocket threshold for prescription drug costs, which is capped at $6,350.

Once this threshold is surpassed, significant cost reductions apply to subsequent drug purchases, thanks to the Catastrophic Coverage Phase. This structure aims to provide members with a strategic and cost-effective approach to managing their prescription needs.

 

Formulary

The Aetna Medicare Advantra Gold HMO formulary serves as an extensive catalog of drugs covered by the plan. This compilation encompasses a diverse range of medications, aiming to provide members with access to a broad spectrum of drugs that cater to their specific needs.

The formulation of the formulary involves a meticulous process, incorporating a thorough list of drugs covered by the plan to address the medication requirements of its members. While there might be exclusions within the formulary, members can refer to the specific plan’s formulary or contact Aetna directly for detailed information on any exclusions. This ensures transparency and clarity regarding the availability of medications under the plan.

 

Mail Order Options

The Aetna Medicare Advantra Gold HMO presents the added convenience of mail order options for prescription drugs, utilizing the CVS Caremark® Mail Service Pharmacy. This feature allows members to access and refill their mail order prescriptions seamlessly.

To make use of this service, members can either call the number on their ID card or opt for automated mail-order delivery. To ensure eligibility for this service, members should verify that their prescribed medication is available through mail order and request their doctor to e-prescribe to CVS Caremark.

Engaging in the mail order pharmacy service not only offers convenience but can also lead to potential cost savings for members.

 

Drug Pricing and Cost Share

Understanding the intricacies of drug pricing and cost-sharing is crucial for effectively managing prescription costs under the Aetna Medicare Advantra Gold HMO. The cost-sharing structure for prescription medications includes $2 copays for Tier 1 drugs, and eligible members can benefit from a $0 monthly plan premium.

Those meeting the criteria may also access reduced cost-sharing rates through the Extra Help program.

The pricing of drugs within the plan is categorized based on tier-based cost-sharing. To obtain comprehensive information about medication coverage and specific copay amounts, members can use the tools available on the Aetna member website.

Additionally, members have access to various cost-saving strategies, including obtaining a larger supply of drugs, opting for generic alternatives, utilizing in-network pharmacies, comparing prices, and taking advantage of preferred pharmacy pricing if provided by their plan.

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Navigating Costs and Coverage

 

Aetna Medicare Advantra Gold HMO Navigating Costs and Coverage

 

While grappling with the intricacies of costs and coverage can be daunting, Aetna Medicare Advantra Gold HMO provides transparent information to assist members in managing their healthcare expenses effectively.

Understanding the details of inpatient hospital and skilled nursing facility coverage, as well as the costs associated with durable medical equipment and supplies, coinsurance, copayments, and deductibles is crucial for navigating out-of-pocket expenses.

The plan encompasses:

  • A fee of $350 for each inpatient hospital stay

 

  • Skilled nursing facility coverage with no cost for the initial 20 days, followed by a charge of $203 per day from the 21st day onwards

 

  • Comprehensive coverage for durable medical equipment, with a coinsurance ranging from 0% to 20%

 

  • The possibility of a higher cost-share for non-OneTouch diabetic supplies.

 

Inpatient Hospital and Skilled Nursing Facility Coverage

Hospital stays and skilled nursing facility coverage are fundamental aspects of the Aetna Medicare Advantra Gold HMO. The plan provides coverage for inpatient hospital stays with a cost of $250 per stay.

Skilled nursing facility coverage includes no cost per day for the initial 20 days and $203 per day for days 21 through 100.

Upon reaching the 100th day in a skilled nursing facility, the Medicare coverage concludes, prompting the need to explore alternative options. Aetna offers in-network coverage at no cost for days 1-20 and charges $203 per day for days 21-100. However, there is no out-of-network coverage available.

 

Durable Medical Equipment and Supplies

Obtaining durable medical equipment and supplies is a crucial facet of the Aetna Medicare Advantra Gold HMO. The plan covers items available at in-network pharmacies, such as Continuous Glucose Monitors (CGM) and related supplies.

Members can access coverage for Durable Medical Equipment (DME) at in-network pharmacies, adhering to nationally recognized guidelines and resources. The cost-sharing for durable medical equipment ranges from 0% to 20% for each Medicare-covered item.

Additionally, there is a yearly maximum plan allowance of $500 for non-Medicare covered eyewear, signifying a limit on coverage for specific items.

For certain services, including particular durable medical equipment, obtaining prior authorization from Aetna Medicare through a Primary Care Physician (PCP) is necessary.

 

Coinsurance, Copayments, and Deductibles

Understanding the concepts of coinsurance, copayments, and deductibles is crucial for effectively managing healthcare costs. With Aetna Medicare Advantra Gold HMO, there is no yearly deductible, allowing members to access benefits without the need to meet a deductible first.

In the plan, coinsurance refers to the percentage of the bill that the beneficiary pays after fulfilling their deductible, while copayments are predetermined fixed dollar amounts for specific services or medications.

The coinsurance rates for covered services under the plan include a 50% coinsurance for comprehensive dental services, with a maximum benefit of $3,000 for combined preventive and comprehensive dental services.

The plan also establishes a maximum limit of $7,550 for Parts A & B services, placing a cap on out-of-pocket expenses for members.

 

How to Enroll in Aetna Medicare Advantra Gold HMO

 

Aetna Medicare Advantra Gold HMO How to Enroll in Aetna Medicare Advantra Gold HMO

 

Enrolling in Aetna Medicare Advantra Gold HMO is a straightforward process. To qualify, individuals need to be entitled to Medicare Part A and reside in the plan’s service area. The enrollment period runs annually from January 1 to March 31, offering a specific window for joining the plan each year.

To enroll, individuals can choose from various convenient methods. They can complete the process online by visiting the designated enrollment platform at https://www.aetnamedicare.com/en/plan.H3959.001.html.

Alternatively, they can contact a licensed agent at 1-855-335-1407 for assistance. Enrollment can also be done through mail for those who prefer traditional methods.

 

Enrollment Periods

The Annual Enrollment Period (AEP) for the Aetna Medicare Advantra Gold HMO plan runs from January 1 to March 31 every year. During this time, individuals have the chance to enroll in the plan annually.

Moreover, certain life events like relocating or losing other health coverage can trigger a Special Enrollment Period. This allows individuals to make changes to their plan outside the Annual Enrollment Period.

 

Online Enrollment

To register for the Aetna Medicare Advantra Gold HMO, utilize the online enrollment application provided on the Aetna website. Follow these steps for a smooth online enrollment process:

  1. Choose the desired plan for enrollment.
  2. Complete the online enrollment application.
  3. Log in to your Aetna Medicare secure member website to confirm and complete the enrollment. Online enrollment is generally available for individuals aged 65 or older, making it a convenient option for most Medicare-eligible individuals.

 

Contact Information

For help with enrollment and inquiries about the plan, individuals can contact Aetna Medicare Advantra Gold HMO customer service at 1-877-225-0137 (TTY: 711). The customer service team is available every day from 8 AM to 11 PM ET.

If using the phone is not feasible, individuals can connect with customer service representatives through Twitter or use an alternate contact number at 1-800-282-5366 (TTY: 711).

For email assistance, individuals can visit the Aetna Medicare Advantra Gold HMO website and access the available email form.

Summary

The Aetna Medicare Advantra Gold HMO stands out as a comprehensive Medicare plan, providing extensive coverage, a broad network of healthcare providers, and additional benefits. With features like fitness access, over-the-counter benefits, and comprehensive routine care coverage, this health plan exceeds expectations in addressing the varied needs of its members.

The plan’s transparency about costs, coverage details, and enrollment processes makes it easy for individuals to navigate. Don’t settle for basic coverage; choose a health plan that genuinely addresses your unique needs.

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Frequently Asked Questions

 

What is Aetna Medicare Advantra Gold HMO? 

Aetna Medicare Advantra Gold HMO is a comprehensive Medicare plan offered by Aetna, providing a wide range of health coverage, including benefits like fitness access, over-the-counter allowances, and routine care coverage.

 

What extra benefits does Aetna Medicare Advantra Gold HMO offer? 

Aetna Medicare Advantra Gold HMO offers additional benefits such as fitness access, over-the-counter benefits, routine care coverage for dental, vision, and hearing needs, making it a holistic health plan.

 

How does the prescription drug coverage work in Aetna Medicare Advantra Gold HMO? 

The plan includes a comprehensive formulary, mail order options through CVS Caremark® Mail Service Pharmacy, and a cost-sharing arrangement to help members effectively manage their prescription costs.

 

What are the costs associated with Aetna Medicare Advantra Gold HMO? 

The plan features a $0 yearly deductible, transparent cost-sharing arrangements, and a maximum limit of $7,550 for Parts A & B services, ensuring members have clarity on their healthcare expenses.

 

How can individuals enroll in Aetna Medicare Advantra Gold HMO? 

Enrollment can be done online through the Aetna website. The Annual Enrollment Period, from January 1 to March 31, provides an opportunity for individuals to join the plan annually. Additionally, life events may trigger a Special Enrollment Period for plan changes outside this period.


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Compare Medicare Plans

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Speak with a licensed insurance agent

1-844-350-0776
TTY 711

Mon-Fri : 8am-9pm ET