CVS Medicare Advantage Plans Ohio 2025

Understanding CVS Medicare Advantage Plans in Ohio

CVS offers Aetna Medicare Advantage plans in Ohio designed to provide all-inclusive healthcare coverage, including both Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) options.

Ohio residents can access local doctors, specialists, and hospitals through the extensive Aetna provider network available with CVS Medicare Advantage plans.

These plans not only offer robust prescription drug coverage but may also include vision and dental benefits. Thus, ensuring Medicare-eligible beneficiaries access to a comprehensive suite of services through their Medicare contract, benefiting nearly all Medicare members nationwide.

Exploring Plan Types

With CVS’s Aetna Medicare Advantage plans in Ohio, you have a variety of options to best fit your healthcare needs and preferences. The offerings include HMO-POS, PPO, and Dual Special Needs plans (D-SNP).

The HMO-POS plans offer some flexibility and coordinated care, allowing members to see doctors and specialists within their network or outside the network under certain conditions.

On the other hand, PPO plans enable members to see any doctor or specialist without needing a referral. This includes out-of-network providers, usually at a higher cost.

Catering to individuals eligible for both Medicare and Medicaid, the Dual Special Needs plans (D-SNP) offer benefits that address their specific health and financial needs. With such a diverse range of plan types, you can choose the one that best fits your lifestyle and health requirements.

Network Synergy

Aetna’s provider network and CVS Health have collaborated to create a model of integrated care. This model aims to simplify healthcare experiences, lower costs, and still retain a community-based approach.

This collaboration brings together over 10,000 pharmacy locations and an extensive network of healthcare providers, contributing to the network’s size and accessibility.

As a member, you benefit from a more personalized care approach through the synergy of clinical data from multiple channels. This includes receiving care and advice from a spectrum of participating healthcare providers, including:

• Primary care doctors

• Pharmacists at CVS Pharmacy locations

• MinuteClinic providers

• HealthHUB providers

This carefully designed healthcare system ensures a seamless experience for you.

Prescription Drug Coverage Excellence

One of the cornerstones of Ohio’s CVS Medicare Advantage plans is the comprehensive Medicare Advantage prescription drug coverage.

Members can verify prescription coverage by checking whether their medications are listed on the CVS Medicare Advantage plans’ formulary. The coverage operates on a tier system, categorizing drugs into tiers that influence member costs, with lower tiers generally being less expensive.

Enrollment Periods and Eligibility

To enroll in CVS Medicare Advantage plans, one must be eligible during the Initial Enrollment Periods or have other qualifying events. The Initial Enrollment Period for Medicare Advantage plans spans a seven-month window, beginning three months before and ending three months after an individual’s 65th birthday.

This is the time when you can join a Medicare Advantage Plan and start enjoying its benefits.

Joining the Plan

Enrolling in CVS Medicare Advantage plans has been simplified and made convenient with various methods available. Prospective members can enroll by calling 1-844-709-9937 (TTY user 711) Mon-Fri 8am-9pm Est or by visiting medicareadvantageplans2025.org.

Key Enrollment Dates

There are several key enrollment dates to keep in mind, including:

• Medicare Annual Enrollment Period

• Medicare Advantage Open Enrollment Period

• General Enrollment Period

• Special Enrollment Periods

These periods allow for plan changes outside the usual time frames due to events such as moving, changes in other coverage, changes in qualification for Medicaid or Extra Help, and residing in or moving from a long-term care facility.

Navigating Out-of-Network Services

Understanding coverage limits and cost-sharing when dealing with out-of-network services can be complex. Visiting an out-of-network doctor generally leads to higher out-of-pocket costs, as the plan pays less for out-of-network services than for in-network services.

The specific costs for out-of-network services depend on the method and percent used by the plan to set the recognized or allowed amount, which can be based on Medicare rates or other rate schedules.

Understanding Coverage Limits

When considering out-of-network services, it’s essential to comprehend the coverage limits. Members using out-of-network providers may have a separate deductible and will likely face higher coinsurance rates, requiring them to pay more before their plan covers out-of-network services.

Only a portion of out-of-network charges contributes to a member’s out-of-pocket limit, with any balance billing amounts not counting towards this cap.

Member Cost Sharing Explained

When utilizing out-of-network services, bear in mind that cost-sharing plays a significant role. Members are subject to cost sharing based on the allowed amount determined by the plan.

For out-of-network care, Aetna Medicare Advantage plans generally pay a smaller percentage of the allowed amount compared to in-network services, leading to higher coinsurance costs for members.

Summary

CVS Medicare Advantage Plans in Ohio offer a comprehensive healthcare solution that caters to the unique needs of each member.

With a wide variety of plan types, an extensive healthcare network, exclusive features, possible prescription drug coverage and additional benefits, these plans provide unparalleled services that prioritize your health and well-being. As you navigate your healthcare journey, remember that the right plan is the one that best fits your lifestyle and health requirements.