Aetna offers both PPO and HMO Medicare Advantage plans in the different California Counties.
Aetna Medicare PPO & HMO Plans
Open-Enrollment starts October 15 and ends December 7. All changes and new enrollments take effect on January 1. Call me on October 1, that is when I will have access to all Medicare Advantage companies and plans through out California. Or check back here, I should have the information online.
- Monthly Premium: $89
- Deductible: $0 ($750 for out of network only)
- Dr visit Copay: $10
- Specialist Copay: $40
- Hospital: $210/days 1-4
- Out of pocket maximum: $7,550
- Benefits and copays may change slightly per county.
MEDICARE ADVANTAGE PLANS: Are sometimes called Medicare Part C plans • Include everything that Original Medicare covers and may add other benefits like prescription drug coverage, fitness and more • Are offered by private companies approved by Medicare.
2021 Aetna PPO plans in CA also offer…
We’ve got the ONLY PPO plans with a national network in Los Angeles, Orange, San Diego, Kern and Fresno Counties. That means members have the freedom to see any provider in our extensive PPO network across the country. And with the Explorer feature, they can be outside of the service area for up to 12 months.
- $98 PPO premium options with very rich Part D coverage
- $0 Rx copays on Tiers 1 and 2 at preferred pharmacies in select markets
- No referrals needed for specialist care
- $125 eyewear allowance for any licensed provider
- Optional Dental options:
- $16 dental monthly premium option
- National PPO network includes:
- 700,000+ doctors across the US
- 3,000+ hospitals
- 65,000 network pharmacies & 23,000 preferred pharmacies
Some of the terms you need to be aware of:
- DEDUCTIBLE ‐ The amount you must pay for health care or prescriptions before Original Medicare, your Medicare Advantage Plan, your prescription drug plan or your other insurance begins to pay.
- COPAYMENT ‐ The amount you may have to pay as your share of the cost for a medical service or supply. This includes doctor visits, hospital outpatient visits or prescription drugs on the formulary. A copayment is a set amount, not a percentage. For example, you might pay $10 or $20 for a doctor’s visit or prescription drug.
- CO-INSURANCE ‐ The amount you have to pay as your share of the cost for services or prescription drugs after you pay any deductible. Coinsurance is a percentage (like, 20%).
Some Aetna contracted pharmacies offer preferred cost sharing. We want you to pay the lowest price possible for your drugs. When you choose to get your drugs at one of these retail pharmacies, you’ll typically pay a lower amount. And with over 20,000 retail pharmacies with preferred cost‐sharing, finding one is easy. We also have many local independent pharmacies as well.
Albertsons, A‐S Medication Solutions LLC, Bi‐Lo, Brookshire Grocery, Cardinal MCC, Coborns, Costco, Giant Eagle, HEB, Hy‐Vee, Kroger, Meijers, Publix, Quick Check, Save‐mart, Shopko, Super Valu Pharmacies, Thrifty White, Walgreens, Walmart, Wegmans.
Aetna offers you special programs to help you keep up your good health:
- Informed Nurse Line (24‐hour access to a registered nurse for health information)
- Nurse case manager
- Nurse health coaches
- An in‐home health assessment at no extra cost to you
- Fitness benefits
I’m here to help …
Just call me or the Member Services number on your plan ID card. I can help you with: Your claims • Your benefits • Using your plan • Changing plans and help with Medicare Part D comparisons.
Enroll … I can take most of the information over the phone, or I can email or mail you the Aetna enrollment form for your county. When complete, please fax to: 916-258-0296 for processing. I will be happy to mail the enrollment kit to you.