Tuesday, April 16, 2024

Aetna Medicare Advantage Vision Coverage

How Does Medicare Cover Vision Care And Eye Exams

Aetna 2021 Medicare Advantage Plans

Find Cheap Medicare Plans in Your Area

When it comes to vision care, Medicare Advantage plans generally offer lower costs and more coverage than Original Medicare. If you are shopping for a plan and need routine vision benefits like exams and eyewear, we recommend starting with Medicare Advantage options.

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Best Medicare Advantage Provider For Low Out

Medicare Advantage plans can be relatively low-cost, many with zero premiums. But the trade-off can come in the form of higher out-of-pocket costs. When evaluating the price of a plan, consider all the costs, not just the .

Pay special attention to the maximum out-of-pocket cost, which sets the cap on how much youll have to pay for covered services in a given year. To find the best plan with lower MOOPs, MoneyGeek looked at highly rated national carriers offering Medicare Advantage plans in at least 25 states and MOOPs in the bottom 75th percentile.

Based on those criteria, MoneyGeek identified Aetna Medicare as the best option.

Aetna Medicare

Aetna Medicare earns an average of 4.3 stars out of 5.0 in Medicare Star Ratings. More than two-thirds of Aetnas low MOOP plans have no monthly premium. Virtually all cover dental and vision care, and 100% offer hearing benefits.

Copayments, coinsurance and any other costs you pay before you satisfy your deductible all count toward the MOOP. But monthly premiums, drug costs and the cost of services provided by providers who dont participate with your health plan do not.

A low MOOP plan protects you from out-of-pocket costs, which can be high even with a $0 premium plan. Low premiums are often offset with higher deductibles, copayments and coinsurance. A lower MOOP will set the ceiling on your out-of-pocket costs.

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What To Expect From Aetna Vision Preferred Plan

With an Aetna Vision Preferred plan, your vision care is simple. You locate a provider, talk with them about scheduling an appointment and use your benefits to start saving.

There are thousands of providers across the country, including eye doctors in your neighborhood and inside your favorite retail chains. Many providers will offer you weekend and night-time hours.

Aetna Vision also offers you benefits for:

  • Gym memberships

If you are ready to find an Aetna Vision Provider follow these easy steps:

  • Search by Provider
  • Enter your 5-digit zip code and the search engine will take it from there.
  • Filters will narrow your results by listing the brands you recognize and love. It will also provide hours to choose from, the specific technology used by each provider, and more.
  • If you have a favorite eye-care provider, click on the search by name and zip code to look for a specific clinic.

When you choose an Aetna Vision preferred clinic within the network, you will enjoy added savings that include exclusive coupon offers and discounts. Our in-network providers, include LensCrafters, Ray-Ban, Glasses.com, ContactsDirect.com and Target Optical.

  • Glasses.com offers a unique kind of eye care. You can choose from green shipping and natural materials with your eye care. These options help you do your part in reducing climate change. We can offer a variety of lenses, including Blue light, transitions, and prescription sun. Our eyecare service is personalized to meet your needs.

Dental And Vision Insurance For Medicare Recipients

OPERS Health Care

If you need dental and vision coverage, you may choose Medicare Advantage Plans, which are also called âMA plansâ or âPart Câ, according to the Centers for Medicare and Medicaid Services. MA plans cover all the services that are covered by original Medicare, plus some additional services like vision and dental care. MA plans are offered by private companies that are approved by Medicare and they follow rules set by Medicare.

âEnrolling in a Medicare Advantage plan is how millions of older adults obtain dental coverage,â Christian Worstell, a Licensed Health Insurance Agent in Raleigh, NC, tells WebMD Connect to Care. âThese plans include all of the benefits covered by Original Medicare in addition to extra benefits like dental, vision, and hearing care, often for no monthly premium. It’s typically more affordable to enroll in a Medicare Advantage plan with dental coverage than it is to enroll in a stand-alone dental insurance plan.”

With MA plans, you may get covered for the following services which are not covered by original Medicare:

  • Fitness programs
  • Vision care services
  • Over-the-counter drugs

There are different kinds of Medicare Advantage Plans and you should compare the plans before you choose one. According to the Centers for Medicare and Medicaid Services, you can join one of the MA plans if:

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How Much Does Aetna Vision Coverage Cost

Your costs will depend on your ZIP code and the plan you choose whether it covers visits to out-of-network providers and whether there are in-network vision specialists.

You can compare premium rates and additional benefits using Medicares plan finder tool. Simply enter your ZIP code to compare the plans offered in your area.

Here are some 2021 sample costs for Aetna Medicare Advantage plans with vision coverage.

Aetna Medicare Premier 1 $140 $11,300
Aetna Medicare Premier 2 $199
Houston, TX Aetna Medicare Prime Plan $0
Aetna Medicare Eagle Plan $0
Aetna Medicare Value Plan $0
Phoenix, Aetna Medicare Prime Plan $0
Aetna Medicare Platinum Plan $0
Aetna Medicare Platinum Plan $59

What Is Prior Authorization And When Do You Need It

Certain network health care services, such as hospitalization or outpatient surgery, require prior authorization from $ Medicare. This means that $ Medicare must approve the service before the plan will cover it. Check your Evidence of Coverage for a list of services that require prior authorization.

If you need services that require prior authorization, have the network provider contact us. The provider is responsible for getting prior authorization from $ Medicare before treating you.

Some plans include an out-of-network benefit. If yours does and you decide to receive covered services from an out-of-network provider, ask the provider to contact us for prior authorization for those services.

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Aetna Plan Options And Costs

Aetna offers a select number of Medicare Supplement plans. Although the company does not have the full suite of Medigap policies, its prices are extremely competitive when looking at the market as a whole. It is important to note that what each Supplement plan covers is standardized across the nation and across each company. This means, for example, that Medicare Supplement Plan A from Aetna will cover the same services as Plan A from AARP/UnitedHealthcare. We have outlined what each plan covers below:

Plan A

Youll notice that Aetna only offers plans A, B, F, G and N for Medicare Supplement. This means that if you are looking for one of the other policies available , then you will need to find a different Medigap insurer. This is especially important to notice since Plan F is no longer available to new enrollees in Medicare, making Plan G a great overall choice for most individuals that want complete coverage.

Aetna Medicare Advantage At A Glance

2023 Aetna MAPD Sales Presentation
  • Plan options: Aetna offers four main types of Medicare Advantage plans: HMO, PPO, HMO-POS and D-SNP plans.
  • Provider network: Aetna allows you to search for providers in your area by ZIP code and coverage needs.
  • Average monthly premium: Many plans charge $0 for a monthly premium, although exact plans and costs depend on your location.

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How Can I Get Dental And Vision Coverage With Medicare

Original Medicare provides very limited dental and vision coverage, which may not fulfill your requirements. If you need better coverage, you may find that a Medicare Advantage Plan is your best option. These plans are offered by many private companies and each one has a different set of benefits. Read on to find out more about getting your dental and vision services covered with Medicare.

What Vision Services May Be Covered By An Aetna Medicare Plan

If you enroll in an Aetna Medicare Advantage plan that includes vision coverage, the plan may cover:

  • Annual eye exams

The costs associated with vision benefits may be included as part of your plans premiums or as an Optional Supplemental Benefit, which means you would pay an additional premium.

If your plan covers vision, the benefits may be available to you as either an allowance or via a provider network.

A plan allowance allows you to see any licensed vision care provider. You pay the provider for their services and submit a receipt to your plan for reimbursement up to the allowance amount.

A plan network requires you to see a vision care provider who is a part of the plan network to receive covered services.

Aetna Medicare Advantage plans cover all of the benefits and services that are covered by Medicare Part A and Part B. Aetna Medicare Advantage plans may also provide additional benefits such as coverage for:

  • Prescription drugs

1 Freed M, et al. . Medicare Advantage in 2022: Enrollment Update and Key Trends. Kaiser Family Foundation. .

2 According to internal data from TZ Insurance Solutions in 2021.

Not all plans or products are available in all markets. Additional plans may be available in your service area.

The purpose of this communication is the solicitation of insurance. Contact will be made by an insurance agent/producer or insurance company.

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Medicare Advantage Plan Types

Medicare Advantage plans may include various types of plan, offering different levels of coverage and availability. The list below looks at these in more detail.

  • Health Maintenance Organization plans use a network of healthcare providers, and people can choose a primary care physician to coordinate their care and issue specialists referrals.
  • Health Maintenance Organization Point-of-Service plans allow members to use out-of-network care at a higher cost.
  • Preferred Provider Organization plans also use a provider network, but members do not need to select a primary care doctor or require specialist referrals.
  • Private Fee-For-Service plans have members who pay an agreed amount for care.
  • Special Needs Plans are for people with specific disabilities or chronic health conditions or those who have Medicare and Medicaid.

People can find out which Medicare Advantage plans are available in their area by using the governments plan finder tool.

  • meal delivery services

Know Everything Your Vision Plan Covers

OPERS Health Care

Depending on your plan, Aetna Vision Preferred vision insurance generally includes:*

  • One eye exam per year with $0 co-pay

  • Standard prescription eyeglass lenses at a member cost of $0 to $25 with a frames allowance ranging from $130 to $300

  • OR a contact lens allowance from $130 to $150 per calendar year

  • Eyeglass lens extras typically require an additional co-pay. For example: Lenses with an anti-reflective coating or made with an above-standard material are usually less than a $100 co-pay. Progressive lenses cost anywhere from $0 to $135

That means if you use your Aetna Vision plan to help pay for prescription contact lenses and want to also buy a pair of eyeglass lenses during the same 12-month period, your allowance will only cover the first type of eyewear purchased .

After you enroll in an Aetna Vision Preferred plan, youll receive a welcome packet in the mail. The packet includes your member ID card, information about your plan and a list of local in-network providers. Once you have your member ID, you can use your ID number to register an account on the Aetna Vision website.

After you create your account, you can log in and access your vision plan documents online. Review them carefully to ensure you get the most out of your benefits.

*Coverage depends on your individual plan. Please see your vision insurance member documents to determine your specific benefits.

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Information For California Members Only

$ contracts with provider organizations called an Independent Practice Association or a Physician-Hospital Organization . An IPA/PHO is an association of independent providers. It may include hospitals, primary care doctors and specialist doctors, who together provide health care services.

$ uses several IPAs to provide you with health care services. You may choose a primary care physician associated with an IPA/PHO. If you do, theyll refer you for health care services and specialist care within their IPA/PHO.

Available Medicare Advantage Plans

Aetna offers several kinds of Medicare Advantage plans, and they vary in structure, costs and benefits. Most plans offer dental, vision and hearing benefits as well as fitness benefits through SilverSneakers.

In general, Aetna offers Medicare Advantage prescription drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage plans without drug coverage. The company has expanded its Medicare Advantage plan for veterans Aetna Medicare Eagle to 42 states in 2023. The plan is designed to complement the health care coverage veterans receive from the VA.

Aetna is also introducing the Aetna Medicare Longevity Plan in Pennsylvania in 2023. This is an Institutional Special Needs Plan, which is meant for members who live in nursing homes.

Plan availability may vary by county. Other plan offerings may include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor to see a specialist, and out-of-network benefits are usually limited.

HMO point-of-service plans give you a bit more flexibility than traditional HMO plans. While you do have a primary doctor and you may still need a referral, you have more freedom to see out-of-network providers, although youll pay more for out-of-network care.

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Do Aetnas Medicare Advantage Plans Include Vision Coverage

Some of Aetnaâs Medicare Advantage plans cover routine vision services. These may include eye exams, glasses, frames, contact lenses, and more. Different Aetna plans have different levels of vision coverage some may not have routine vision coverage.

Did you know that many of Aetnaâs Medicare Advantage plans include prescription drug coverage? Thatâs right â thatâs in addition to the Medicare Part A and Part B benefits you get through a Medicare Advantage plan. You get all Part A and Part B benefits except for hospice care, which Medicare coverage still provides to you directly instead of through the plan.

With a Medicare Advantage plan from Aetna , you might also get additional benefits beyond Part A and Part B. You already know about prescription drug coverage and vision coverage, but did you know some plans may offer routine dental or hearing benefits? Remember that benefits beyond Part A and Part B vary among plans.

When you have an Aetna Medicare Advantage plan , hereâs something you need to know. You still continue to pay your monthly Medicare Part B premium, as well as any premium your Medicare Advantage plan might charge. Some plans may have premiums as low as $0.

Are Video Visits With An Eye Doctor Online Covered By Aetna

How Medicare can help you stay connected to what matters most

Most insurers provide coverage for video visits at the same cost as in-person visits. You can search on Zocdoc specifically for Eye Doctors who accept Aetna for video visits by selecting your carrier and plan from the drop-down menu at the top of the page. We recommend you check with your insurance carrier directly to confirm your coverage and out of pocket costs for video visits.

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Does Medicare Cover Eye Exams

While Medicare doesn’t cover routine vision exams, you can get eye checkups for certain medical concerns.

Medicare will pay for regular tests if you’re at risk for or have been diagnosed with diabetes, glaucoma or macular degeneration. If you don’t have these conditions and are on Original Medicare, you’ll pay the full price for a routine eye exam, which is between $170 and $200, on average.

Does Medicare Cover Dental And Vision

Medicare Interactive notes that Original Medicare does not cover most dental services that you primarily need for good maintenance of your oral health, including:

  • Routine checkups
  • Tooth extractions

If you undergo any of these dental procedures, you’ll typically have to bear the full cost of the treatment unless you have private dental coverage.

Although Medicare does not pay for dental health services which you need primarily for the good health of your teeth, it does cover a limited number of dental procedures that are essential for your general health, or which are required for the success of another medicare-covered health service. For example, it may cover:

  • Examination of your oral cavity in the hospital before a kidney transplant
  • Dental treatment required before radiation therapy for oral cancer.
  • Reconstruction of the jaw bone after the removal of a facial tumor.
  • Surgery to rectify fractures of the face or jaw
  • An oral examination before valve replacement in the heart.
  • Dental splints and wiring that may be necessary after jaw surgery

One important point to note here is that Medicare will cover these initial dental services, but it will not pay for any follow-up dental care after the treatment or procedure has been completed.

âMedicare also does not cover regular eye exams for contact lenses or glasses. However, if you have a chronic eye condition like cataracts or glaucoma, Medicare does cover certain eye care services, such as:

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