Aetna Medicare Explorer Plan PPO

Deciding on the right Medicare plan can be challenging. If you’re exploring the Aetna Medicare Advantage plans in 2025, you likely want to know what makes Aetna Medicare Explorer plan different and whether it’s the right fit for you. This plan offers the convenience of a Medicare Advantage PPO plan with the added benefits of $0 premiums and comprehensive healthcare coverage.

We’ll address everything from network flexibility to prescription drug benefits and how this plan may cater to your individual healthcare goals without sidestepping budget considerations.

 

Key Takeaways

  • The Aetna Medicare Explorer Plan PPO offers comprehensive healthcare coverage, including inpatient, dental, vision, and hearing care, with the flexibility to see any doctor who accepts Medicare. It also provides extensive prescription drug coverage, fitness memberships, and OTC benefits.

 

  • This plan features a $0 monthly premium, predictable copayments for services like doctor visits, and caps on out-of-pocket expenses, which are $8,300 for in-network and $12,450 for combined in-network and out-of-network services.

 

  • Enrollment in the Aetna Medicare Explorer Plan PPO is straightforward and available to individuals over 65 years old or those with a qualifying disability, with an annual enrollment period from January 1 through March 31.

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Aetna Medicare Explorer Plan PPO: Key Features and Benefits

Navigating your health should be straightforward. The Aetna Medicare Explorer Plan PPO provides this ease with its uncomplicated approach, covering an expansive range of healthcare services and medical supplies.

 

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From dental to vision and hearing benefits, the plan offers a concierge of services to cater to your healthcare needs. What’s more, you have the liberty to consult any doctor who accepts Medicare and adheres to the plan’s terms, even if they are out of network. This flexibility extends to inpatient hospital care as well, ensuring you get the care you need when you need it.

The plan excels in the area of prescription drug coverage. It offers competitive drug pricing through its preferred pharmacy network, ensuring you get your medications without breaking the bank. But that’s not all.

The plan also includes supplementary benefits such as gym memberships and coverage for hearing, vision, and dental, further enhancing the overall value of the healthcare plan.

The comprehensive fitness membership, for instance, offers SilverSneakers instructor-led group fitness classes at no extra charge, providing a valuable opportunity to maintain an active and healthy lifestyle.

 

Enhanced Prescription Drug Coverage

Envision a Medicare plan that caters to your medical requirements and simultaneously offers extensive drug coverage for your prescriptions. The Aetna Medicare Explorer Plan PPO offers:

 

  • Coverage that encompasses medical and prescription drugs
  • Customized benefits and services
  • Improved access to on-site care in facilities
  • Supplementary benefits for members

 

This means you have the peace of mind knowing that your prescription needs, including pain relievers, are well taken care of.

To sweeten the deal, the plan includes a mail-order benefit offered through the CVS Caremark® Mail Service Pharmacy.

This means you can have your medications delivered straight to your doorstep, eliminating the need for regular pharmacy visits. Additionally, Aetna’s preferred pharmacy network provides comprehensive coverage for a wide range of medications and access to a diverse selection of national and local pharmacies, ensuring you get your medications conveniently and timely.

 

In-Network Providers and Services

Access to quality healthcare is indispensable, and the Aetna Medicare Explorer Plan PPO is designed to guarantee it. The plan’s in-network providers encompass a comprehensive network of:

 

  • doctors
  • pharmacies
  • dentists
  • hospitals, including those offering podiatry services

 

Whether you need medical care from doctors, pharmacy services, dental care, or hospital services, the plan has got you covered. It even covers various aid supplies, including first aid supplies, as part of its benefits, ensuring your healthcare needs are comprehensively catered for.

Choosing in-network providers with the Aetna Medicare Explorer Plan PPO guarantees access to high-quality care at reduced expenses.

You have the flexibility to consult any doctor, whether in or out of network, provided they accept Medicare and adhere to the plan’s terms. This includes coverage for first aid supplies and other essential medical items.

Furthermore, Aetna ensures the quality of care through ongoing quality management and improvement initiatives, with a specific focus on the performance of in-network providers.

 

Additional Benefits: Fitness, OTC, Dental, and More

Healthcare entails more than just illness treatment; it’s equally about fostering overall health and wellness. That’s why the Aetna Medicare Explorer Plan PPO goes the extra mile to provide additional benefits that promote a healthy lifestyle, beyond what Original Medicare offers.

 

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The plan provides an over-the-counter (OTC) benefit that covers the cost of eligible OTC health and wellness products, allowing you to maintain your health without incurring extra costs.

But it doesn’t stop there. The plan also includes:

 

  • Dental coverage, providing services like oral exams, cleanings, X-rays, fillings, and root canals
  • Vision coverage, assisting with the expenses related to eyewear
  • Hearing coverage, including one annual routine hearing exam and hearing aid fitting, both covered at 100 percent
  • Supplementary hearing benefits

 

Understanding the Cost Structure

Comprehending your Medicare plan’s cost structure is pivotal for efficient healthcare expense management. The Aetna Medicare Explorer Plan PPO has a friendly cost structure designed with your comfort in mind. For instance, it has a monthly premium cost of $0 per month.

Yes, you heard it right, $0 per month! This means you get all the comprehensive coverage and benefits of the plan without the burden of monthly premiums.

The plan also has a friendly copayment structure, with copayments established as predetermined dollar amounts. For instance, a doctor visit may have a fixed $20 copayment. Similarly, the coinsurance rate represents a percentage of the cost, for example, 10% for a covered prescription drug.

 

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The plan also has an out-of-pocket maximum of $8,300 for in-network services and $12,450 for in-network and out-of-network services, helping you manage your healthcare expenses effectively.

 

Premiums and Copayments

A salient advantage of the Aetna Medicare Explorer Plan PPO is its non-existent monthly premium. This means you get comprehensive coverage without any monthly premium costs. And when it comes to copayments, the plan ensures you know exactly what you’ll pay upfront.

The copayment for primary care visits under the plan is a predetermined fixed dollar amount, typically around $20. This means you have a clear understanding of your costs before you visit your doctor, making it easier to budget for your healthcare expenses.

The plan also provides different copayments for in-network and out-of-network providers. This means you have the flexibility to choose your providers based on your healthcare needs and financial comfort, making the plan suitable for a variety of healthcare needs.

 

Coinsurance and Out-of-Pocket Maximums

In the Aetna Medicare Explorer Plan PPO, your coinsurance is set as a proportion of the cost, such as 10% for a covered prescription medication. This means you pay a small portion of the cost while the plan covers the rest.

The plan also has different coinsurance rates for various types of services, providing flexibility and options to cater to a wide range of healthcare needs.

One of the key cost management features of the plan is its out-of-pocket maximum. This serves to cap the amount you are required to pay for medical services annually. As of 2023, the maximum out-of-pocket limits are set at $8,300 for in-network services and $12,450 for both in-network and out-of-network services.

This means your healthcare expenses are controlled, ensuring you can access the care you need without worrying about your budget.

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Star Ratings: How Medicare Evaluates Plans

Selecting a Medicare plan can be daunting, but Medicare’s star rating system simplifies the process. The Medicare Star Rating system is a comprehensive evaluation tool created by the Centers for Medicare & Medicaid Services (CMS) to assess the quality and effectiveness of Medicare Advantage and Part D prescription drug plans.

 

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These ratings, which range from 1 to 5 stars, enable beneficiaries to make informed comparisons and select the most suitable plan based on their individual requirements.

Medicare evaluates plans based on criteria such as quality of care, customer service, clinical outcomes, effectiveness of care, patient satisfaction, and safety when determining their Star Ratings.

The star rating system is updated on an annual basis, with the final ratings being released in October of each year. This means you can always stay updated on the performance of different plans, including the Aetna Medicare Explorer Plan PPO.

 

Changes and Updates: Staying Informed

Keeping abreast of changes and updates to your plan is vital for effective healthcare management. The Aetna Medicare Explorer Plan PPO provides an Annual Notice of Change (ANOC) that provides a comprehensive yearly summary of plan modifications and outlines the changes that will take effect in the upcoming year.

If you need further assistance or have any questions or concerns, you can always contact Aetna Medicare. They provide:

 

  • A 24/7 customer service line
  • Online chat support
  • An email contact form
  • A mobile application known as Aetna Health

 

Whether you prefer to call, chat, email, or use the app, you can always get the help you need, when you need it.

 

Annual Notice of Change

The Annual Notice of Change (ANOC) is a crucial document that outlines any changes to your plan for the upcoming year. It is sent by Medicare Advantage or Part D plans in late September, giving you ample time to review the changes and plan your healthcare needs accordingly.

The ANOC provides comprehensive information about changes to the coverage, costs, and benefits of your Aetna Medicare Explorer Plan PPO for the forthcoming year. By reviewing the ANOC, you can understand potential impacts to your coverage and costs and make well-informed decisions about your healthcare needs.

 

Contacting Aetna Medicare for Assistance

Prompt assistance is essential for effective healthcare management. Aetna Medicare provides multiple channels of communication to assist you with your questions or concerns. Their customer service line operates 24 hours a day, 7 days a week, ensuring you can always get help when you need it.

Apart from the customer service line, Aetna Medicare also provides online chat support and an email contact form. And if you prefer using a mobile application, they have one too.

 

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The Aetna Health app provides customer support, information access, care connections, claims management, and other features. This means you have multiple ways to get the help you need, when you need it.

 

How to Enroll in the Aetna Medicare Explorer Plan PPO

The enrollment process for the Aetna Medicare Explorer Plan PPO is uncomplicated and direct. To qualify, individuals must be 65 years of age or older, or have a qualifying disability and have been receiving Social Security benefits. Once you meet these eligibility criteria, you are good to go.

You can enroll in the plan by contacting a licensed agent, utilizing the official Medicare website, or submitting the plan’s paper enrollment form.

You can also enroll online at TakeAction.AetnaMedicare.com. As part of the process, you may be asked to furnish evidence of your age, work history, and citizenship or permanent resident status.

The enrollment period for the plan is from January 1 through March 31 annually, so be sure to enroll during this period to start enjoying the comprehensive coverage and unique benefits of the Aetna Medicare Explorer Plan PPO.

Summary

The Aetna Medicare Explorer Plan PPO is more than just a Medicare plan; it’s a comprehensive healthcare solution designed with your needs in mind.

With its enhanced prescription drug coverage, wide network of providers, additional benefits, friendly cost structure, and easy access to specialist care, the plan offers a well-rounded healthcare solution that caters to a wide range of healthcare needs. So why wait?

Enroll in the Aetna Medicare Explorer Plan PPO today and start enjoying the peace of mind that comes with knowing your healthcare needs are well taken care of.

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Frequently Asked Questions

 

What does Aetna Medicare PPO mean?

Aetna Medicare PPO means you have the freedom to choose any provider who accepts Medicare and plan terms, without needing a referral from a primary care provider for specialist or hospital visits.

 

What does Aetna Medicare Advantage HMO and PPO plans cover routine?

Aetna Medicare Advantage HMO and PPO plans cover routine preventive care, such as annual wellness visits, screening mammograms, and prostate cancer screenings. Preferred pharmacies usually have a lower member’s cost share compared to standard pharmacies.

 

What is the difference between Aetna Medicare and Aetna Medicare Advantage?

The main difference between Aetna Medicare and Aetna Medicare Advantage is that Aetna Medicare Advantage is a Part C plan run by private insurance companies and can include extra benefits not found in Original Medicare.

 

What does PPO stand for in Medicare?

PPO stands for Preferred Provider Organizations in Medicare, which are private companies paid by the federal government to administer Medicare benefits.

 

What are the key features and benefits of the Aetna Medicare Explorer Plan PPO?

The Aetna Medicare Explorer Plan PPO offers comprehensive coverage for healthcare services, including dental, vision, and hearing benefits, enhanced prescription drug coverage, and a wide network of providers, along with additional benefits like fitness memberships and dental care.

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Speak with a licensed insurance agent

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Mon-Fri : 8am-9pm ET