Aetna Individual Medicare Advantage Answered questions 100% correct

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HMO Traditional - ANSWER Network providers, PCP SELECTION, REFERRALS REQUIRED some services are considered direct access and don't need a referral; FLU AND PNEUMONIA SHOTS emergency and urgent care ... mammograms or not in their service area COPAY WILL APPLY OR SPECIALIST CO PAY WILL APPLY OPEN ACCESS HMO; Network providers, no PCP selection, no referrals Visit Aetna's Once confirmed ready to sell visit indivi Medicare section on Aetna's producer world Beginning Oct. 1 indi premiums, etc. will be available - ANSWER Medicare Advantage Plan types - ANSWER WE OFFER HIGH QUALITY MEDICARE ADVANTAGE PLANS (MA) HMO AND PPO AVAIL IN 46 STATES 1,874 COUNTIES MOST ARE INTEGRATED WITH PRESCRIPTION DRUG COVERAGE MAPD PLANS Medicare ADVANTAGE PRESCRIPTION PLANS ELIGIBILITY REQUIRMENTS for Medicare Advantage Plans - ANSWER Have Medicare Parts A and B and lives in the service area Under 65 and received disability benefits for 24 months from SS Received disability benefits from Railroad Retirement Board for 24 months Enrollment periods - ANSWER include initial coverage election period (ICET) Initial Enrollment Period (IEP) Annual Enrollment Period (AEP) Open Enrollment period (OEP) Special Enrollment period (SEP) Effective date 1st of Month Definitions available on Producer World PPO - ANSWER OUT OF NETWORK DR HAS TO BE ELIGLE FOR MEDICARE PAYMENTS AND MUST ACCEPT THE PLAN MEMBERS CAN GO TO ANY NETWORK PROVIDER IF THEY GO OUT OF NETWORK THEY MAY HAVE TO PAY A HIGHER COST has a network of providers In a ppo plan members don't have to select a PCP most include prescription drug coverage and a max out of pocket limits (OOP) - ANSWER coverage for urgent /er medical care anywhere in the world In network coverage - ANSWER plan covers preventative care, annual wellness visits Glaucoma screenings Bone Mass Measurements Prostate Cancer Screenings colorectal screenings Pneumonia flu hepatitis vaccine screening mammograms Pap smear/pelvic exams ever 24 months diabetes screenings depression screenings some plans include, dental, hearing aid, eyewear, podiatry, chiropractic prescription drug coverage - ANSWER all MAPD plans have a pres drug component consist of a formulary network and benefits design over 65,000 pharmacies 24,000 preferred Formulary covers more drugs Cost sharing members cost share at a preferred pharmacy lower than AEtna Medicare.ccom - ANSWER Producer Workd Indiv Medicare Health and Wellness Program - ANSWER HMOS AND PPO'S Case management benefits Discounts and Value Added servcies - ANSWER available to MA AND MAPD Members Access to discounted prices Can not be discussed with prospects Not subjec to Medicare appeal process medigap plans (private insurance) - ANSWER Help pay health care costs not covered by Original Medicare Choose or keep doctors who accept Medicare patients Referrals are not required to see a specialist Standarized plans with same basic benefits Part A coinsurance plus 365 additional days after Medicare benefits are used up Part A hospice coinsurance/copayment first 3 pints of blood Part B coinsurance Coverge for other costs not paid for by Medicare, deductibles, Excess charges, skilled nursing varies by plans Does not cover prescription drugs Plan Details - ANSWER No pre-existing limitations No network constraints No referral required Medically underwritten guaranteed renewable coverage can not be cancelled No change in coverage if Electronic claims [Show More]

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