Aetna Medicare Elite Plan (HMOPOS)

What Is the Aetna Medicare Elite Plan?

The Aetna Medicare Elite Plan (HMOPOS) is a Medicare Advantage offering that combines healthmaintenanceorganization (HMO) structure with the flexibility of a pointofservice (POS) option. Enrollees receive the same coverage as original Medicare (Parts A and B) and typically gain additional benefits such as prescription drug coverage (PartD), vision, dental, hearing, and wellness programs. The POS portion allows members to see outofnetwork providers in certain circumstances, usually after a referral and with higher costsharing.

Key Features and Benefits

• Medical coverage Hospital stays, skilled nursing facility care, home health services, and outpatient services.
• Prescription drug coverage (PartD) A wide formulary with tiered copays.
• Vision benefits Annual eye exams, allowance for frames and lenses.
• Dental benefits Routine cleanings, twoperson examinations, and a yearly allowance for major procedures.
• Hearing benefits Hearing exams and discounts on hearing aids.
• Wellness programs Gym memberships, nutrition counseling, and chroniccondition management tools.
• Telehealth 24/7 virtual visits with boardcertified physicians.
• Care coordination Dedicated care managers help navigate complex health needs.

How the HMOPOS Structure Works

In a traditional HMO, you must use doctors, hospitals, and pharmacies that belong to the plans network. The Aetna Elite HMOPOS adds a pointofservice option: if you need care from an outofnetwork provider, you can receive it after a referral from your primary care physician (PCP). The costshare for outofnetwork services is higher, and some services may require prior authorization.

Eligibility and Enrollment

To enroll in the Aetna Medicare Elite Plan you must:

• Be enrolled in Medicare PartA and PartB.
• Live in the plans service area (check the statebystate availability map on Aetnas website).
• Not have endstage renal disease (ESRD), unless the plan specifically accepts it.

Enrollment periods:

• Initial Enrollment Period (IEP) The 7month window around your 65th birthday.
• Annual Election Period (AEP) October15throughDecember7 each year.
• Special Enrollment Periods (SEP) Triggered by life events such as moving, losing other coverage, or qualifying for Medicaid.

Cost Overview (2024 Sample)

Exact amounts can differ based on your zip code, whether you qualify for any subsidies, and any supplemental benefits you select.

How to Choose the Right Plan for You

Consider the following factors when evaluating the Aetna Medicare Elite Plan:

• Provider network Verify that your regular doctors, preferred hospitals, and pharmacies are innetwork.
• Prescription needs Check that your medications are covered and note tier placement.
• Additional benefits If you need dental or vision coverage, compare the allowance amounts with other Medicare Advantage options.
• Travel habits The POS feature can be valuable if you split time between two states or travel frequently.
• Cost tolerance Lower premiums often mean higher outofpocket costs for services; balance what works best for your budget.

Steps to Enroll

1. Visit Aetnas Medicare website and enter your ZIP code to verify plan availability.
2. Review the Summary of Benefits and Coverage (SBC) PDF; this document outlines every cost and benefit in plain language.
3. Gather required information: Medicare card, a list of current prescriptions, and your preferred pharmacys details.
4. Enroll online, by phone (1800XXXXXXX), or with a licensed insurance agent.
5. After enrollment, youll receive a welcome kit that includes your new Medicare card, member ID, and a guide to using the plans online portal.

Common Questions

Can I keep my current doctor?

If your doctor participates in the Aetna network, you can continue seeing them without a referral. If not, you may still see them under the POS option after obtaining a referral, but expect higher outofpocket costs.

What if I travel out of state?

The plan offers nationwide coverage for emergencies. For routine care while traveling, you can use the POS benefit to see outofnetwork providers, again after a referral and with higher costsharing.

Do I still need Medicare PartD?

No. The Elite Plan includes its own prescription drug coverage, so you do not enroll separately in a PartD plan.

How does the plan handle outofpocket maximums?

All Medicare Advantage plans, including this one, have an annual outofpocket maximum. Once you reach that limit, the plan covers 100% of allowable costs for covered services for the rest of the year.

Why Choose Aetna Medicare Elite?

Aetna has a long history of serving Medicare beneficiaries and offers a robust network of providers, especially in urban and suburban areas. The Elite Plans combination of a traditional HMO network with a POS fallback can be appealing for those who value continuity of care with their current doctors while still having a safety net for occasional outofnetwork needs.

The added dental, vision, and hearing benefits also reduce the need for separate supplemental policies, simplifying your overall healthcare expenses.

Next Steps

1. Assess your healthcare usage. Review the services you use most oftenprimary care, specialists, medications, dental, vision, etc.

2. Compare plans. Use Medicares Plan Finder tool to see how the Aetna Elite Plan stacks up against other local Medicare Advantage options.

3. Contact Aetna. Speak with a representative to clarify any doubts about network providers or specific benefits.

4. Enroll before the deadline. The Annual Election Period closes on December7 each year; act early to avoid missing your chance.

For more detailed information, consult the official CMS Medicare Advantage handbook or call Aetnas Medicare customer service line.