Aetna elite ppo 2021

Aetna elite ppo 2021 DEFAULT

Medicare Advantage PPO Plans

Requires you to use a provider network

No. But seeing out-of-network providers generally costs more.

Yes, unless it's an emergency

Varies by plan. Seeing out-of-network providers generally costs more. But most allow non-network dental providers.

Requires you to have a primary care physician (PCP)

Requires referral to see a specialist

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Limits what you pay out-of-pocket for medical care each year

Includes prescription drug (Rx) coverage

Includes Rx mail-order benefit 

Yes, if plan has Rx coverage

Yes, if plan has Rx coverage

Yes, if plan has Rx coverage

Dental, vision and hearing coverage

ER and urgent care coverage worldwide

Yes, through SilverSneakers®

Yes, through SilverSneakers®

Yes, through SilverSneakers®

Over-the-counter (OTC) benefit

Meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay)

Sours: https://www.aetnamedicare.com/en/compare-plans-enroll/medicare-advantage-ppo-plans.html

2021 Medicare Advantage Plan Benefit Details for the Aetna Medicare Elite Plan (PPO)

— Plan Health Benefits —** Base Plan ** Premium• Health plan premium: $0• Drug plan premium: $0• You must continue to pay your Part B premium.• Part B premium reduction: NoDeductible• Health plan deductible: $1,000 annual deductible • Other health plan deductibles: In-network: No • Drug plan deductible: $250.00 annual deductibleMaximum out-of-pocket enrollee responsibility (does not include prescription drugs)• $11,300 In and Out-of-network
$7,550 In-network Optional supplemental benefits• Yes Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?• In-network: No Doctor visits• Primary In-network: $10 copay per visit • Primary Out-of-network: $50 copay per visit • Specialist In-network: $45 copay per visit • Specialist Out-of-network: $60 copay per visit Diagnostic procedures/lab services/imaging• Diagnostic tests and procedures In-network: $0-45 copay (authorization required) • Diagnostic tests and procedures Out-of-network: 30% coinsurance (authorization required) • Lab services In-network: $0 copay (authorization required) • Lab services Out-of-network: 30% coinsurance (authorization required) • Diagnostic radiology services (e.g., MRI) In-network: $0-350 copay (authorization required) • Diagnostic radiology services (e.g., MRI) Out-of-network: 30% coinsurance (authorization required) • Outpatient x-rays In-network: $50 copay (authorization required) • Outpatient x-rays Out-of-network: 30% coinsurance (authorization required) Emergency care/Urgent care• Emergency: $90 copay per visit (always covered) • Urgent care: $65 copay per visit (always covered) Inpatient hospital coverage• In-network: $850 per stay (authorization required) • Out-of-network: $500 per day for days 1 through 20
$0 per day for days 21 through 90 (authorization required) Outpatient hospital coverage• In-network: $0-395 copay per visit (authorization required) • Out-of-network: 30% coinsurance per visit (authorization required) Skilled Nursing Facility• In-network: $0 per day for days 1 through 20
$184 per day for days 21 through 100 (authorization required) • Out-of-network: 30% per stay (authorization required) Preventive care• In-network: $0 copay • Out-of-network: 0-30% coinsurance Ground ambulance• In-network: $245 copay • Out-of-network: $245 copay Rehabilitation services• Occupational therapy visit In-network: $40 copay (authorization required) • Occupational therapy visit Out-of-network: 30% coinsurance (authorization required) • Physical therapy and speech and language therapy visit In-network: $40 copay (authorization required) • Physical therapy and speech and language therapy visit Out-of-network: 30% coinsurance (authorization required) Mental health services• Inpatient hospital - psychiatric In-network: $1,871 per stay (authorization required) • Inpatient hospital - psychiatric Out-of-network: 30% per stay (authorization required) • Outpatient group therapy visit with a psychiatrist In-network: $40 copay (authorization required) • Outpatient group therapy visit with a psychiatrist Out-of-network: 30% coinsurance (authorization required) • Outpatient individual therapy visit with a psychiatrist In-network: $40 copay (authorization required) • Outpatient individual therapy visit with a psychiatrist Out-of-network: 30% coinsurance (authorization required) • Outpatient group therapy visit In-network: $40 copay (authorization required) • Outpatient group therapy visit Out-of-network: 30% coinsurance (authorization required) • Outpatient individual therapy visit In-network: $40 copay (authorization required) • Outpatient individual therapy visit Out-of-network: 30% coinsurance (authorization required) Medical equipment/supplies• Durable medical equipment (e.g., wheelchairs, oxygen) In-network: 20% coinsurance per item (authorization required) • Durable medical equipment (e.g., wheelchairs, oxygen) Out-of-network: 30% coinsurance per item (authorization required) • Prosthetics (e.g., braces, artificial limbs) In-network: 20% coinsurance per item (authorization required) • Prosthetics (e.g., braces, artificial limbs) Out-of-network: 30% coinsurance per item (authorization required) • Diabetes supplies In-network: 0-20% coinsurance per item (authorization required) • Diabetes supplies Out-of-network: 0-20% coinsurance per item (authorization required) Hearing• Hearing exam In-network: $45 copay • Hearing exam Out-of-network: $60 copay • Fitting/evaluation In-network: $0 copay (limits apply) • Fitting/evaluation Out-of-network: $60 copay (limits apply) • Hearing aids In-network: $0 copay (limits apply) • Hearing aids Out-of-network: $0 copay (limits apply) Preventive dental• Oral exam: Not covered• Cleaning: Not covered• Fluoride treatment: Not covered• Dental x-ray(s): Not coveredComprehensive dental• Non-routine services: Not covered• Diagnostic services: Not covered• Restorative services: Not covered• Endodontics: Not covered• Periodontics: Not covered• Extractions: Not covered• Prosthodontics, other oral/maxillofacial surgery, other services: Not coveredVision• Routine eye exam In-network: $0 copay (limits apply) • Routine eye exam Out-of-network: $60 copay (limits apply) • Other In-network: $45 copay • Other Out-of-network: $60 copay • Contact lenses: Not covered• Eyeglasses (frames and lenses): Not covered• Eyeglass frames: Not covered• Eyeglass lenses: Not covered• Upgrades: Not coveredWellness programs (e.g., fitness, nursing hotline)• Covered Transportation• Not coveredFoot care (podiatry services)• Foot exams and treatment In-network: $45 copay • Foot exams and treatment Out-of-network: $60 copay • Routine foot care: Not coveredMedicare Part B drugs• Chemotherapy In-network: 20% coinsurance (authorization required) • Chemotherapy Out-of-network: 30% coinsurance (authorization required) • Other Part B drugs In-network: 20% coinsurance (authorization required) • Other Part B drugs Out-of-network: 30% coinsurance (authorization required) Package #1• Monthly Premium: $51.00 • Deductible: Package #2• Monthly Premium: $57.70 • Deductible:
Sours: https://q1medicare.com/MedicareAdvantage-PartC-MedicareHealthPlanBenefits.php?source=2020MARxFinder&countyCode=36081&state=NY&contractId=H5521&planId=120&segmentId=0&plan=Aetna%20Medicare%20Elite%20Plan%20(PPO)&utm_source=partd&utm_medium=rxfinder&utm_campaign=planname
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PPO health plans full of freedom

All choice, no referrals

With the Aetna Open Choice® PPO plan, members can visit any provider, in network or out, without a referral. But when they stay in network, we’ll handle the claims and offer lower, contracted rates. So they save. And you can, too.

Plan highlights

  • Broad networks
  • Discounted network rates
  • No claims to handle
  • Great for fully insured and self-funded customers

Freedom to choose and save

With the Aetna Choice® POS II plan, members can visit any doctor, hospital or facility, in or out of network, with no referrals. But depending on their plan, choosing a primary care physician (PCP) and staying in network could cost less.

Plan highlights

  • Choice of in-network or out, every time
  • No referrals
  • Opportunity to choose a PCP
  • Ideal for self-funded customers
  • In Texas, PCP is known as physician (primary care). In the State of Washington,  PCP refers to primary care provider.

Lots of flexibility, with a little guidance

With the Aetna Managed Choice® plan, you get all the cost advantages of a managed care plan without sacrificing freedom. Members just select a network PCP to guide their care. Or they can go out of network for a higher cost.

Plan highlights

  • A PCP to help guide care
  • Referrals for specialty services
  • Great for fully insured and self-funded customers

Managed care with maximum flexibility

The Aetna Open Access® Managed Choice® plan takes some of the "managed" out of managed care, while keeping the savings. Members can visit any provider. And while we don't require PCP selection, we encourage it to promote guided, quality care.

Plan highlights

  • Managed care with freedom
  • Any doctor, hospital or facility
  • PCP encouraged, not required
  • Ideal for fully insured customers
Sours: https://www.aetna.com/health-insurance-plans/ppo.html
Aetna investigated after stunning admission

View Coverage & Benefits

If you’re enrolled in a standard Aetna Medicare Plan (HMO) 

If you get coverage from an out‐of‐network provider, your plan won’t cover their charges. Medicare and Aetna Medicare won’t be responsible either. 

Generally, you must get your health care coverage from your primary care physician (PCP). Your PCP will issue referrals to participating specialists and facilities for certain services. For some services, your PCP is required to obtain prior authorization from Aetna Medicare.

You’ll need to get a referral from your PCP for covered, non‐emergency specialty or hospital care, except in an emergency and for certain direct‐access service. There are exceptions for certain direct access services.

You must use network providers, except for:

  • Emergency or urgent care situations
  • Out‐of‐area renal dialysis

If you get routine care from out‐of‐network providers, Medicare and Aetna Medicare won’t be responsible for the costs.

If you’re enrolled in Aetna Medicare Plan (PPO)

You have the flexibility to receive covered services from network providers or out‐of‐network providers. Out‐of‐network/non‐contracted providers are under no obligation to treat Aetna Medicare members, except in emergency situations. For a decision about whether we’ll cover an out‐of-network service, we encourage you or your provider to ask us for a pre‐service organization determination before you receive the service. Please call us or see your Evidence of Coverage for more information, including the cost share for out‐of‐network services.

Although you don’t have to choose a primary care physician, we encourage you to do so. If you receive covered services from an out‐of-network doctor, it’s important to confirm that they:

  • Accept your PPO plan
  • Are eligible to receive Medicare payment
Sours: https://www.aetnamedicare.com/en/for-members/view-coverage-benefits.html

Elite 2021 aetna ppo

What Aetna Medicare Advantage Plans Are Offered in 2021?

at a glance
  • Aetna is one of the largest private insurance companies that offers Medicare Advantage plans.
  • Aetna offers HMO, HMO-POS, PPO, and D-SNP plans.
  • Not all of Aetna’s Medicare Advantage plans may be available in your area.
  • As of 2018, Aetna provided medical benefits to more than 22.1 million members, offering access to 1.2 million healthcare professionals and a network of over 5,700 hospitals.

Aetna is a health insurance company based in Connecticut. It’s one of many private insurers that Medicare has approved to sell Medicare Advantage (Part C) plans.

Aetna offers a wide range of Medicare Advantage plans designed to fit multiple budgets and healthcare needs. Not every plan is available in every state, county, or even ZIP code.

Now we’ll take a closer look at how the four types of Aetna Medicare Advantage plans typically work.

Aetna HMO plans

With most of Aetna’s Health Maintenance Organization (HMO) plans, you’re required to choose an in-network primary care physician (PCP). You’ll have access to a specified network of doctors and hospitals that includes specialists.

You may need a referral from your PCP to see a specialist. In the case of an emergency, you’ll be able to use an out-of-network doctor, ER, or hospital. All plans include worldwide ER and urgent care coverage.

Aetna HMO-POS plans

HMO Point-of-Service (HMO-POS) plans are HMOs that include an out-of-network option. Plan members may access medical treatment outside their HMO network for specific treatments or under special circumstances. With an Aetna HMO-POS plan, you’ll typically pay more to see an out-of-network doctor.

Aetna HMO-POS plans also require you to choose a PCP. Some will require specialist referrals from your PCP as well.

Aetna PPO plans

Aetna’s Preferred Provider Organization (PPO) plans let you use any doctor, in and out of network, provided that they accept Medicare and Aetna’s plan terms. Seeing an out-of-network provider will typically cost more.

You’re not required to choose a PCP and don’t need referrals to see specialists.

Aetna D-SNPs

Dual Eligible Special Needs Plans (D-SNPs) are designed for people who are eligible for both Medicare and Medicaid. This is known as being “dual eligible.”

These plans offer the most comprehensive benefits for people with the highest need. Most of these plans include access to a personalized care team.

Aetna offers three standalone Part D prescription drug plans:

  • SilverScript Smart Rx
  • SilverScript Choice
  • SilverScript Plus

All of Aetna’s Medicare Advantage plans also include prescription drug coverage and offer a mail-order prescription drug benefit. You’ll also get an over-the-counter medication benefit that will provide free access to many products.

If you are currently shopping for Medicare Advantage or separate Part D plans, you can use the find a Medicare plan tool to view each available plan in your area. You can enter your medications to see which plans cover them and how much they will cost.

Aetna offers Medicare Advantage plans in 49 states. Medicare Advantage plans are not currently sold in Alaska.

Although there is wide availability throughout the country, specific types of plans and coverage options may only be offered in certain areas. This means that if your relative in another state has an Aetna plan, the same plan might not be available to you.

Coverage under Aetna Medicare Advantage plans vary based on the plan you choose. However many of Aetna’s plans include:

Some plans also offer:

Each plan may offer different benefits. Read them carefully to make sure you are getting the coverage you would use the most.

The Medicare Advantage marketplace is getting more competitive each year. There may be dozens of different plans to choose from in the area where you live.

The following are some examples of the costs you may see with Aetna’s Medicare Advantage plans in different areas of the country in 2021.

It’s important to know that these costs don’t include your monthly Part B premium, which you’ll have to pay in addition to your Part C plan costs.

By entering your ZIP code into Medicare’s plan finder tool, you can compare the various plans available in your area.

Medicare Advantage (Part C) plans cover at least as much as original Medicare (Part A and Part B) plans do. They’re popular because they usually provide extras, such as dental, vision, and hearing coverage.

Some Part C plans include prescription coverage as well, so that you don’t have to opt into a separate Medicare Part D plan.

Not every plan is available everywhere. Your state, county, and ZIP code will determine which plans you can join. The costs for each plan vary by location as well. There’s a wide range of Part C plans that accommodate a wide range of budgets.

  • Aetna offers many Medicare Advantage (Part C) plan options, including HMO, HMO-POS, PPO, and D-SNP.
  • Plans vary by cost and offerings in different states, counties, or even ZIP codes.
  • You must be eligible for original Medicare to join a Medicare Part C plan.
Sours: https://www.healthline.com/health/medicare/aetna-medicare-advantage-plans
What does the EPO, PPO, HMO, POS stand for in HEALTH INSURANCE? What is network provider?

Summary of Benefits for
2021 Aetna Medicare Elite Plan (PPO)


Aetna Medicare Elite Plan (PPO) H5521-120 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Aetna Medicare available to residents in New York. This plan includes additional Medicare prescription drug (Part-D) coverage. The Aetna Medicare Elite Plan (PPO) has a monthly premium of $0 and has an in-network Maximum Out-of-Pocket limit of $7,550 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $7,550 out of pocket. This can be a extremely nice safety net.

Aetna Medicare Elite Plan (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Aetna Medicare works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for Aetna Medicare Elite Plan (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Aetna Medicare and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Aetna Medicare except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.




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2021 Aetna Medicare Medicare Advantage Plan Costs

Name:

Aetna Medicare Elite Plan (PPO)

Plan ID:

H5521-120

Provider:Aetna Medicare
Year:2021
Type: Local PPO
Monthly Premium C+D: $0
Part C Premium: $0
MOOP: $7,550
Part D (Drug) Premium: $0
Part D Supplemental Premium $0
Total Part D Premium: $0
Drug Deductible: $250.0
Tiers with No Deductible:1
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan:H5521-121




Aetna Medicare Elite Plan (PPO) Part-C Premium

Aetna Medicare plan charges a $0 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



H5521-120 Part-D Deductible and Premium

Aetna Medicare Elite Plan (PPO) has a monthly drug premium of $0 and a $250.0 drug deductible. This Aetna Medicare plan offers a $0 Part D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0 this Premium covers any enhanced plan benefits offered by Aetna Medicare above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lower due to negative basic or supplemental premiums.



Aetna Medicare Gap Coverage

In 2021 once you and your plan provider have spent $4130 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Aetna Medicare plan does offer additional coverage through the gap.



H5521-120 Formulary or Drug Coverage

Aetna Medicare Elite Plan (PPO) formulary is divided into tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price.








2021 Aetna Medicare Elite Plan (PPO) Summary of Benefits




Additional Benefits





Comprehensive Dental


Diagnostic servicesNot covered
EndodonticsNot covered
ExtractionsNot covered
Non-routine servicesNot covered
PeriodonticsNot covered
Prosthodontics, other oral/maxillofacial surgery, other servicesNot covered
Restorative servicesNot covered



Deductible





Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI)$0-350 copay
Diagnostic radiology services (e.g., MRI)30% coinsurance (Out-of-Network)
Diagnostic tests and procedures$0-45 copay
Diagnostic tests and procedures30% coinsurance (Out-of-Network)
Lab services$0 copay
Lab services30% coinsurance (Out-of-Network)
Outpatient x-rays$50 copay
Outpatient x-rays30% coinsurance (Out-of-Network)



Doctor Visits


Primary$50 copay per visit (Out-of-Network)
Primary$10 copay per visit
Specialist$60 copay per visit (Out-of-Network)
Specialist$45 copay per visit



Emergency care/Urgent Care


Emergency$90 copay per visit (always covered)
Urgent care$65 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment$45 copay
Foot exams and treatment$60 copay (Out-of-Network)
Routine foot careNot covered



Ground Ambulance


$245 copay
$245 copay (Out-of-Network)



Hearing


Fitting/evaluation$60 copay (Out-of-Network)
Fitting/evaluation$0 copay
Hearing aids$0 copay (Out-of-Network)
Hearing aids$0 copay
Hearing exam$45 copay
Hearing exam$60 copay (Out-of-Network)



Inpatient Hospital Coverage


$500 per day for days 1 through 20
$0 per day for days 21 through 90 (Out-of-Network)
$850 per stay



Medical Equipment/Supplies


Diabetes supplies0-20% coinsurance per item (Out-of-Network)
Diabetes supplies0-20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)20% coinsurance per item
Durable medical equipment (e.g., wheelchairs, oxygen)30% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)30% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy20% coinsurance
Chemotherapy30% coinsurance (Out-of-Network)
Other Part B drugs30% coinsurance (Out-of-Network)
Other Part B drugs20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric$1,871 per stay
Inpatient hospital - psychiatric30% per stay (Out-of-Network)
Outpatient group therapy visit30% coinsurance (Out-of-Network)
Outpatient group therapy visit$40 copay
Outpatient group therapy visit with a psychiatrist30% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist$40 copay
Outpatient individual therapy visit$40 copay
Outpatient individual therapy visit30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist30% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist$40 copay



MOOP


$11,300 In and Out-of-network
$7,550 In-network



Option





Optional supplemental benefits





Outpatient Hospital Coverage


30% coinsurance per visit (Out-of-Network)
$0-395 copay per visit



Package #1


Deductible
Monthly Premium$51.00



Package #2


Deductible
Monthly Premium$57.70



Preventive Care


0-30% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


CleaningNot covered
Dental x-ray(s)Not covered
Fluoride treatmentNot covered
Oral examNot covered



Rehabilitation Services


Occupational therapy visit30% coinsurance (Out-of-Network)
Occupational therapy visit$40 copay
Physical therapy and speech and language therapy visit30% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit$40 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$184 per day for days 21 through 100
30% per stay (Out-of-Network)



Transportation





Vision


Contact lensesNot covered
Eyeglass framesNot covered
Eyeglass lensesNot covered
Eyeglasses (frames and lenses)Not covered
Other$45 copay
Other$60 copay (Out-of-Network)
Routine eye exam$60 copay (Out-of-Network)
Routine eye exam$0 copay
UpgradesNot covered



Wellness Programs (e.g. fitness nursing hotline)






Reviews for Aetna Medicare Elite Plan (PPO) H5521



2019 Overall Rating
Part C Summary Rating
Part D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in Aetna Medicare Elite Plan (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for Aetna Medicare Elite Plan (PPO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


Aetna Medicare Elite Plan (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




Coverage Area for Aetna Medicare Elite Plan (PPO)

(Click county to compare all available Advantage plans)

State: New York
County:Bronx,Kings,Nassau,New York,Queens,
Richmond,Rockland,Suffolk,Westchester,


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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

Sours: https://www.medicarehelp.org/2021-medicare-advantage/ma/aetna-medicare-elite-plan-ppo-H5521-120

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