Aetna Medicare PPO Choice and HMO Select Plans for San Diego County.

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.

Please call for Plan information in your County

You can go to any doctor, specialist or hospital whether they are in- or out-of-network. With the exception of emergency or urgent care, it may cost more to get care from out-of-network providers.

We’ve got the ONLY PPO plans with a national network in Riverside, San Bernardino, Orange County, Los Angeles, San Diego, Kern and Fresno. 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. 

PLAN PREMIUM … As a member of our PPO plan, you pay a monthly plan premium of $89. In addition, you must continue to pay your Medicare Part B premium.  You can pay by check, auto deduction from your bank account or through your social security account.

DOCTORS & HOSPITALS … Aetna has the Only Medicare Advantage PPO plan in San Diego County.  As a member of our PPO Prime plan, you can choose to receive care from out-of-network providers. Our plan will cover services from either in-network or out-of-network providers, as long as the services are covered benefits and medically necessary. However, if you use an out-of-network provider, your share of the costs for your covered services may be higher.

NETWORK PROVIDERS … are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with the Aetna HMO or PPO  to accept our payment and your cost-sharing amount as payment in full. We have arranged for these providers to deliver covered services to members in our plan. The providers in our network bill us directly for care they give you. When you see a network provider, you pay only your share of the cost for their services

Aetna Medicare Choice HMO Plan …

With the Aetna Select HMO plan in San Diego you must choose a Primary Care physician who organizes your health care, and will refer you to specialists for care.

HMO PRIMARY CARE PHYSICIAN … What is the role of a PCP in coordinating covered services? Your PCP will provide most of your care, and when you need more specialized services, they will coordinate with other providers. They will help you find a specialist and will arrange for covered services you get as a member of our plan.

Some of the services that the PCP will coordinate include: x-rays, laboratory tests, therapies, care from doctors who are specialists, hospital admissions “Coordinating” your services includes consulting with other plan providers about your care and how it is progressing. Since your PCP will provide and coordinate most of your medical care, we recommend that you have your past medical records sent to your PCP’s office.

What if you are outside the plan’s service area when you have an urgent need for care? When you are outside the service area and cannot get care from a network provider, our plan will cover urgently needed services that you get from any provider at the lower in-network cost-sharing amount.

Types of out-of-pocket costs you may pay for your covered services. To understand the Aetna HMO and PPO payment information, you need to know about the types of out-of-pocket costs you may pay for your covered services.

• The “deductible” is the amount you must pay for medical services before our plan begins to pay its share.
• A “copayment” is the fixed amount you pay each time you receive certain medical services. You pay a copayment at the time you get the medical service.
• “Coinsurance” is the percentage you pay of the total cost of certain medical services. You pay a coinsurance at the time you get the medical service.

ENROLL .. Print the Application when complete, simply email or fax the completed forms to 916-258-0296.

Questions?  Contact me anytime.