HMO and PPO Plans at Aetna

You might have heard already that the Medicare Advantage 2019 plans are also known as the Part C schemes, and the private insurance companies offer them. Aetna is also a private insurance company and this company also provides the high-quality Part C schemes known as the Aetna Medicare Advantage schemes.  Availability of all different types of the Medicare Advantage schemes is based on location of enrollee because not all plans are available at every place. Let us discuss two major types of the Medicare Advantage plans at Aetna:

Aetna Medicare Advantage HMO plan

The Health Maintenance Organization plans (HMO plans) are more affordable than the other types.  Reason for the lower costs for these plans is that HMO schemes have a contracted provider network for healthcare services for its members. Following are some essential details regarding HMO schemes:

  • According to plan’s policies, member can only use in-network service providers for low out-of-pocket expenses however, you may see an out-of-network by requesting your scheme provider doctor or avail services of an out-of-network hospital but that will include high out-out-pocket costs and copays. Members may also have to follow plan’s terms and conditions regarding seeing a specialist or having medical tests.
  • Choosing a primary care doctor is a must in HMO schemes. primary care doctor manages all of your test and checkups and may also give you a referral for seeing a specialist.
  • Most of insurers provide HMO schemes which cover Prescription Drug coverage as well. But drugs which these plans cover is decided by  insurer only, and  insurer also generates a list of covered drugs so that  enrollees can make sure that whether this plan covers their drugs or not.

Aetna Medicare Advantage PPO plan

Millions of people also choose Preferred Provider Organization plan due to versatility it offers which includes:

  • In these schemes, member is not required to get a referral in order to see a specialist.
  • Similarly, there is no restriction regarding selection of a primary care doctor.
  • Majority of private insurance companies make sure that their Preferred Provider Organization plans offer prescription drug coverage.
  • These plans (just like other Medicare Advantage plans) also offer supplemental benefits which are not offered by Original Medicare such as hearing, vision, and dental coverage.
  • There is no restriction on only using in-network service providers because you can use out-of-network service providers also but they might charge a bit more.