Your Aetna Answers

Frequently Asked Questions

About Medicare

Here are frequently asked questions about Medicare. To see an answer, simply click on that question.

1. I can’t find the name “Aetna Medicare^SM Plan (HMO)” “Aetna Open^SM Plan (PFFS),” “Aetna Medicare Open^SM Plan” or “Aetna Medicare Rx^SM Plan” on my open enrollment package that my company uses. Is it the same plan?
2. I already have a Medicare supplement plan. Why should I change?
3. When I join an Aetna Medicare Advantage Plan do I lose my Medicare coverage?
4. What is a PCP?
5. After I join an Aetna Medicare Rx Plan, will there be someone to call if I need help?
6. How does Medicare Part D fit in?
7. Can I get medications filled when I’m traveling or when I am away from home?
8. What happens if my doctor does not recognize the Aetna Medicare Open Plan?
9. What is a private fee-for-service plan?
10. Who qualifies for assistance with prescription drug costs? How can I find out more and apply for help?
11. What is creditable coverage?

1. I can’t find the name “Aetna Medicare^SM Plan (HMO)” “Aetna Medicare^SM Plan (PPO),” “Aetna Medicare Open^SM Plan (PFFS)” or “Aetna Medicare Rx^SM Plan” on my open enrollment package that my company uses. Is it the same plan?

   It’s possible that your company refers to the plans by different names. Please refer to the open enrollment materials provided to you by your former employer.

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2. I already have a Medicare supplement plan. Why should I change?

   You will usually get more benefits, and you will often pay a lower monthly plan premium, with an Aetna Medicare Advantage Plan. Also, many Aetna Medicare Advantage Plans include Part D coverage so you have the coverage you need in one plan.

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3. When I join an Aetna Medicare Advantage Plan do I lose my Medicare coverage?

   No. You get the same or better coverage, plus additional benefits. You must still be entitled to Medicare Part A and continue to pay your Part B premium.*

   * Unless you are eligible for the Aetna Medicare Open Plan (Part B only) offered by your former employer.

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4. What is a PCP?

   A PCP is a primary care doctor you choose from our network to provide your routine and preventive care. With the Aetna Golden Medicare Plan, you must select a PCP to get coverage. You don't need to choose a PCP for Aetna (PPO) Plan or Aetna Medicare (PFFS) Plan.

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5. After I join an Aetna Medicare (PDP) Plan, will there be someone to call if I need help?

   Yes. Trained Aetna Medicare specialists are available to assist our members. So, whether you need information about your coverage, a drug formulary, or a pharmacy, we can answer your questions.

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6. How does Medicare Part D fit in?

   Here’s an overview of what the Original Medicare Plan includes:

   • Part A: The hospital insurance program; the part of the Medicare plan that pays for inpatient hospital, skilled nursing facility, home health care, and hospice care.
   • Part B: Coverage for physician, outpatient and preventive services.
   • Part C: Includes Medicare Advantage Plans (such as HMOs, PPOs and PFFS plans) that provide Part A and B benefits to enrollees, as well as offering optional Medicare prescription drug benefits.
   • Part D: The Medicare prescription drug benefit that started in 2006 offered through private insurers.
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7. Can I get medications filled when I’m traveling or when I am away from home?

   Yes. You can get covered prescriptions filled at any network pharmacy in the United States. In fact, our network includes 60,000 participating pharmacies nationwide where you can purchase medications. You can also use the prescription mail order service.

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8. What happens if my doctor does not recognize the Aetna Medicare (PFFS) Plan?

   Most providers who participate with Original Medicare should accept the Aetna Medicare (PFFS) Plan. Ask your doctor to visit the website www.aetna.com and look for the Provider PFFS section for more information including the Terms and Conditions of Participation for the Aetna Medicare (PFFS) Plan. The provider website and phone number will be listed on the back of your ID card. If your doctor or hospital does not agree to accept our payment terms and conditions, they may not provide health care services to you, except in emergencies.

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9. What is a private fee-for-service plan?

   It is a Medicare Advantage Plan that provides you with those services covered by the Original Medicare Plan and more. These plans are offered by private insurance companies, like Aetna, through a contract with the federal government and include a plan premium for medical coverage. You can choose a provider you want to see as long as they are eligible to receive payment from Medicare, agree to treat you for covered services, and accept the Aetna Medicare Open Plan Terms and Conditions of Participation. This allows you flexibility with your care. The Aetna Medicare (PFFS) Plan is also known as a Medicare Advantage Private Fee-for-Service plan.

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10. Who qualifies for assistance with prescription drug costs? How can I find out more and apply for help?

    Eligibility for financial help is based on guidelines set by the federal government. You can apply for extra help through the Social Security Administration or a State Medical Assistance Office. Remember, the amount of help received depends on income and resources, and is determined by the federal government.

    If you think you qualify for help, call the Social Security Administration at 1-800-772-1213 (TTY/TDD 1-800-325-0778). You may also visit www.socialsecurity.gov. The Social Security Administration's application process provides the quickest decision. You can also go to a local Medicaid office and apply.

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11. What is creditable coverage?

    Creditable coverage is Prescription Drug Coverage that is on average at least as good as that offered under the Medicare standard Part D plan. If you have Pharmacy coverage as a member of a group plan through your former employer and that coverage is not a Part D plan, you will be notified whether the plan is creditable, or not.

    If you don't join a Medicare drug plan when you are first eligible for Medicare Part A and/or B and you go without creditable prescription drug coverage for 63 continuous days or more, you may have to pay a late-enrollment penalty to join a Part D plan later.

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