Aetna Medicare Plan HMO Connecticut
Aetna Medicare Plan HMO Connecticut is a Medicare Advantage Plan (MAPD). This plan is offered in Fairfield, New Haven, and New London counties. Aetna refers to this plan as the Shoreline plan. They also offer a similar version of it called “inland”. The inland plan includes Hartford, Litchfield and Tolland counties. The Aetna Medicare Plan HMO Connecticut is an HMO plan. Members must use in network providers (except for emergency and urgent care). If you choose to use an out of network provider in an non emergency or urgent care situation, there will be no coverage at all. Medicare A and B will not provide the standard 80% part B coverage when going out of network on a Medicare Advantage plan.
In addition to a $6,700 maximum out-of-pocket contribution (for medical expenses only), this Aetna plan is a $0 premium offering and requires referrals to see specialists. You only need to obtain a referral once per specialist each calendar year. The plan features very low co-pays for a $0 premium plan. With a $10 primary doctors copay and a $40 specialist copay. Most other co-pays are also low compared to other plans offered in the same market such as a $600 inpatient hospital co-pay and a $150 major radiology copay (basically means MRI’s, CAT and PET scans).
The prescription drug plan (included with benefits of plan)
is one of the few that does not have a deductible on tier 3, 4 and 5 drugs. Overall, this is a solid plan with a large national network of providers that can be accessed anywhere in the country. The one benefit that should be noted with this plan is the fact that it does have an annual deductible of $1,000 for some services such as Inpatient hospital, major radiology, Outpatient surgery, ambulance and some other services. A plan summary has been provided below for review.