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How to make the most of your Medicare Advantage coverage

By Bonnie Vengrow

As you become familiar with your Medicare Advantage plan, here are some helpful tips to consider to get the most value out of your plan.


Choose a primary care physician in your network

Your primary care physician (PCP) is at the heart of your care team. They personalize your care, support your health goals and refer you to a specialist if needed.

You must select a PCP from your plan’s network if you have a Medicare Advantage health maintenance organization (HMO) plan. If you have a preferred provider organization (PPO) plan, you may not be required to select a PCP, though it’s a good idea to have one on file. You also don’t need a referral to see a specialist.

Before you use your medical or pharmacy benefits for the first time, check that your PCP, specialists, hospitals and pharmacies are in your plan's network. Aetna® lists in-network doctors and pharmacies in its online provider directory. You can also request to have a printed directory mailed to you. Or you can call Member Services for help. The telephone number is on your Aetna ID card.

If you are an HMO member, make sure the PCP you selected when you enrolled is listed correctly on your ID card. If there’s an error, or you want to change PCPs, just call Member Services for help.


Know where to find your benefit information

Once you’ve enrolled in a Medicare Advantage plan, you’ll receive an Evidence of Coverage, or EOC. This document explains your rights and responsibilities, outlines exactly what is covered and lists what you pay as a member of the plan. To see a list of medical benefits covered by your plan, refer to the grid in Chapter 4 of your EOC.

You’ll receive a new EOC electronically each year, usually around September. While the EOC can be lengthy, it contains detailed information about your plan’s benefits. Be sure you review it. And keep it at home or saved to your computer in case you need to refer to it throughout the year.

You will also receive an Annual Notice of Change (ANOC) each year. The ANOC includes a table with a summary of changes to your plan’s costs and benefits for next year. The ANOC is sent by mail or email and typically arrives in September. You’ll use it to begin reviewing your Medicare benefits for the next year. The new year’s plan details become available during the Annual Enrollment Period starting in October. We recommend reviewing this document as soon as you receive it. Then you can ask questions and get personal assistance from our Member Services team. The telephone number is on your member ID card.


Get the most out of added benefits

Medicare Advantage plans often include more benefits and services than Original Medicare. You’ll want to learn the details of each benefit and how to get the most value from it. The most common extra benefits in Medicare Advantage plans include dental, vision and hearing services and an allowance for certain over-the-counter (OTC) items, though some plans provide other benefits and services.

Dental benefits to make you smile: Oral health contributes to your overall health, so it’s important to continue caring for your teeth. Dental benefits are part of most Aetna Medicare Advantage plans and cover routine dental exams and cleanings.

Your plan may require you to see a dental provider in network. You can search the Aetna online provider directory to find a dental provider. With some plans, you may be allowed to use any dentist you want and get reimbursed for costs up to your plan’s coverage amount. Read your plan’s EOC for details.

Although many Aetna Medicare Advantage plans already include dental coverage in their plan benefits, some of our Medicare Advantage plans offer optional dental coverage that you can buy for an extra monthly premium.

Vision benefits worth looking into: Vision services are designed to help you continue doing the things you love to do. Even if your eyesight is fine, it’s a good idea to schedule a routine eye exam. Not only can these regular check-ins ensure everything is working as it should, but they also may spot potential health issues earlier. And help you avoid serious complications.

All Aetna Medicare Advantage plans cover an annual routine eye exam at no extra cost, and most also include an annual allowance that can be used to purchase prescription eyewear.

With some plans, you can see any eye doctor within a network of providers. For direct member reimbursement (DMR) plans, there are no network requirements, and you are reimbursed for covered services up to the coverage limit.

Listen up! Hearing benefits to improve your quality of life: Enjoying your favorite song. Listening to ocean waves. Giggling over your grandchild’s latest knock-knock joke. Hearing helps us savor life’s moments. To keep your hearing in tip-top shape, use the hearing benefits available through your Medicare Advantage plan. Most plans cover an annual hearing check and, if you need one, a fitting for a hearing aid at no added cost. Your plan may also include coverage toward the purchase of hearing aids.

Depending on your plan, you may be required to see a provider who’s in network. With DMR plans, there are no network requirements, and you are reimbursed for approved services up to an annual limit.

Extra benefits that may surprise you: You may have even more benefits you can use to help care for your overall health. All Aetna Medicare Advantage plans offer fitness programs at no extra cost, and many offer an allowance for certain over-the-counter products such as hand sanitizer or cold medicine. Some plans may also include coverage when you travel or transportation to doctor’s appointments, the pharmacy and more. Review your EOC to discover the benefits included in your plan.

Whether it's providing a network of trusted doctors, pharmacies and hospitals, or a menu of additional benefits and services, Medicare Advantage plans can help take care of the whole you.

See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. The provider and/or pharmacy network may change at any time. You will receive notice when necessary.


About the author

Bonnie Vengrow is a journalist based in NYC who has written for Parents, Prevention, Rodale’s Organic Life, Good Housekeeping and others. She’s never met a hiking trail she doesn’t like and is currently working on perfecting her headstand in yoga class.

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