Includes PPO, HMO, HMO-POS medical plans with or without drugs.
Dental care, eyewear and hearing benefits
In most cases, Original Medicare won’t cover routine dental, vision or hearing care. Learn how your Aetna Medicare Advantage plan has you covered.
Learn about Medicare Advantage benefits
Want to know more about what’s covered? Take a look at each tab for more on dental, vision and hearing benefits with Aetna Medicare Advantage. Plans can vary. So, you should check your Evidence of Coverage (EOC) for details on your plan.
Dental benefit
Aetna® has Medicare Advantage plans with a dental benefit. Many plans cover preventive care. Like oral exams, cleanings and X-rays. We also offer plans with even more dental services. Like fillings and extractions.
How it works
Most dental benefits use the Aetna PPO network. That stands for preferred provider organization. See if your dentist is in the Aetna network.
|
Dental benefit |
|
|---|---|
|
Who you can see for dental care |
See an in-network dentist* |
|
Oral exams |
Covered |
|
Routine cleanings |
Covered |
|
X-rays |
|
|
Fillings |
|
|
Extractions |
|
|
Teeth whitening |
Teeth whitening is a cosmetic service. It’s not covered. |
Dental benefit |
Who you can see for dental care |
|---|---|
See an in-network dentist* |
|
Dental benefit |
Oral exams |
Covered |
|
Dental benefit |
Routine cleanings |
Covered |
|
Dental benefit |
X-rays |
Dental benefit |
Fillings |
Dental benefit |
Extractions |
Dental benefit |
Teeth whitening |
Teeth whitening is a cosmetic service. It’s not covered. |
Check your Evidence of Coverage for more details on your plan’s benefits.
Vision benefit
Aetna® has Medicare Advantage plans with a vision benefit. It covers one routine vision exam per year. Some plans also include a benefit amount (allowance) each year to buy prescription eyewear.
How it works
Plans are offered as a network benefit or as a direct member reimbursement (DMR) benefit.
With a network benefit: You can see any vision provider in your plan’s network. See if your provider is in the network.
With a DMR benefit: You can see a licensed provider of your choice. You may need to pay out of pocket, first. Then you can file a claim to get paid back up to your plan's benefit amount. Or you can use an Aetna network provider. If you do, they’ll bill us directly. You won't need to file a claim.
Visit AetnaMedicareVision.com for a list of network providers.
|
Vision benefit |
Network |
Direct member reimbursement |
|---|---|---|
|
Who you can see for vision care |
||
|
How vision coverage works |
Network providers bill us directly. |
Pay up front and file a claim. Or see a network provider. |
|
Routine vision exam |
Covered |
Covered |
|
Eyewear coverage |
Vision benefit |
Who you can see for vision care |
|---|---|
Network |
|
Direct member reimbursement |
|
Vision benefit |
How vision coverage works |
Network |
Network providers bill us directly. |
Direct member reimbursement |
Pay up front and file a claim. Or see a network provider. |
Vision benefit |
Routine vision exam |
Network |
Covered |
Direct member reimbursement |
Covered |
Vision benefit |
Eyewear coverage |
Network |
|
Direct member reimbursement |
Check your Evidence of Coverage for more details on your plan’s benefits.
To file a claim
To file a claim
You may have a DMR plan for your vision benefit. If so, we’ll need some info to process your claim and pay you back. You may need to ask for some of these items during your visit. So be sure to ask for all the information you need while you’re there.
- A copy of the paid, itemized receipt from the provider, with:
- The date of service
- The name of your provider
- The address of your provider
- A brief description of the services or items you need reimbursement for. For example, tooth crown. Or the procedure codes, if any. Submit both the description and the codes if you have them.
- Your diagnosis codes
- Your first and last name
- Your member ID number
- Your date of birth
Put your member ID on every item you send us. Including the receipt from the provider. Then, send them to us with your claim form.
Hearing benefit
Aetna® Medicare has teamed up with NationsHearing® to provide hearing benefits. We have Medicare Advantage plans that cover one routine hearing exam per year. And plans that cover hearing aids and one hearing aid fitting per year.
How it works
We offer Medicare HMO and PPO plans. These are also known as health maintenance organization and preferred provider organization plans.
With an HMO plan: You can see any NationsHearing provider for a hearing exam.
With a PPO plan: You can see any licensed provider for a hearing exam.
Hearing aids are only covered through NationsHearing.
|
Hearing benefit |
HMO |
PPO |
|---|---|---|
|
Who you can see for hearing care |
See any NationsHearing provider. |
See any licensed provider. |
|
How hearing coverage works |
Contact NationsHearing to schedule your visit. |
Contact your provider or NationsHearing to schedule your visit. |
|
Routine hearing exam |
Covered |
Covered |
|
Hearing aids |
Covered |
Covered |
|
Hearing aid fitting |
Covered |
Covered |
Hearing benefit |
Who you can see for hearing care |
|---|---|
HMO |
See any NationsHearing provider. |
PPO |
See any licensed provider. |
Hearing benefit |
How hearing coverage works |
HMO |
Contact NationsHearing to schedule your visit. |
PPO |
Contact your provider or NationsHearing to schedule your visit. |
Hearing benefit |
Routine hearing exam |
HMO |
Covered |
PPO |
Covered |
Hearing benefit |
Hearing aids |
HMO |
Covered |
PPO |
Covered |
Hearing benefit |
Hearing aid fitting |
HMO |
Covered |
PPO |
Covered |
Check the Evidence of Coverage for more details on each plan’s benefits.
Questions? We’ve got answers
Member Services
Access resources and contact information that is specific to your plan.
For who you can see for dental services
Members of some plans can also see dentists that are not part of their plan’s network. Members of these plans that choose a provider not in their plan’s network may have higher costs.
For benefits that vary by plan
Check your plan’s Evidence of Coverage (EOC) for details on what’s covered by that plan. This benefit is not included on all plans.
For who you can see with a network plan
Members of some plans can also see licensed vision providers that are not part of the network but may have higher costs.
For who you can see with a DMR plan
Must be a licensed vision provider in the U.S.