Aetna Medicare PPO Choice and HMO Prime Plans for Orange County.

The Open-Enrollment starts October 15 and ends December 7. All changes and new enrollments take effect on January 1.  Call me in October or November, 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

Aetna Medicare:  Choice PPO   –   Plus HMO   –   Select HMO   –   Prime HMO

• Monthly Premium:  $0
• Deductible:  $0
• Dr visit Copay:  $10
• Specialist Copay:  $40
• Hospital:  $395/days 1-5.  $0 per day, days 21-100.
• Out of pocket maximum:  $7,550
• Benefits and copays may change slightly per county.

Aetna Medicare Plus HMO:  Plan Details

• Monthly Premium:  $0
• Deductible:  $0
• Dr visit Copay:  $0
• Specialist Copay:  $0
• Hospital:  $0 per stay
• Out of pocket maximum:  $999

Aetna Medicare Select HMO:  Plan Details

• Monthly Premium:  $0
• Deductible:  $0
• Dr visit Copay:  $0
• Specialist Copay:  $0
• Hospital:  $0 per stay
• Out of pocket maximum:  $2,000

Aetna Medicare Prime HMO:  Plan Details

• Monthly Premium:  $0
• Deductible:  $0
• Dr visit Copay:  $0
• Specialist Copay:  $0
• Hospital:  $0 per stay
• Out of pocket maximum:  $2,200

Also included:

• SilverSneakers Fitness program
• Covid 19 testing ($0 copay)
• Nurse hotline – speak to a registered nurse 24/7
• Telehealth – receive primary care and urgent care via a virtual visit for the same cost as an in-person visit.

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.

• Print Application (Orange County)

DOCTORS & HOSPITALS … Aetna has the Only Medicare Advantage PPO plan in Orange County for the 2021 plan year.  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.

• Print Enrollment form (Orange County)

2021 Aetna Medicare Choice & Select HMO Plans:

With the Aetna Choice HMO plan 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 Application (Orange County)

Questions?  Contact me anytime.