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Aetna OfficeLink Updates


March 2018
Issue Number 1
Volume 13

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Aetna Medicare Advantage plans

Below is a summary of how our Aetna Medicare Advantage plans work with primary care physician (PCP) selection, referrals and out-of-network benefits.


Aetna MedicareSM Plan (HMO) and Aetna Medicare Prime Plan (HMO)

  • Patients must choose and use a participating PCP.
  • Patients must get referrals from their PCP before getting non-emergency care from other participating providers. Exception: Behavioral health routine outpatient visits.
  • Services received outside of Aetna's participating provider network are not covered, except emergency/out-of-area urgent care or out-of-area renal dialysis — unless approved by Aetna in advance of receiving services.

Aetna MedicareSM Plan (HMO) Open Access

  • Patients are encouraged, but not required, to choose and use a participating PCP.
  • PCP referrals are not required.
  • Services received outside of Aetna's participating provider network are not covered, except emergency/out-of-area urgent care or out-of-area renal dialysis — unless approved by Aetna in advance of receiving services.

Aetna MedicareSM Plan (PPO) and Aetna Medicare Prime Plan (PPO)

  • Patients are encouraged, but not required, to choose and use a participating PCP.
  • PCP referrals are not required.
  • Patients receiving covered services from a nonparticipating provider are subject to out-of-network deductibles and coinsurance, and potential balance billing.

Visit the Provider Education & Manuals page for more information. If you need Provider Services, call 1-800-624-0756 for all Aetna Medicare Advantage plans.


Contracted Medicare providers must complete an annual Medicare Compliance Attestation by December 31 of each year.

Aetna

This material is for informational purposes only and contains only a partial, general description of plan benefits or programs and does not constitute a contract. Aetna arranges for the provision of health care services. While this material is believed to be accurate as of the print date, it is subject to change.