Understanding Medicare Advantage HMO plans

With ${company} Medicare Advantage HMO plans, you choose an in-network primary care provider (PCP). Your PCP works with you to help you get the right care at the right time so you can achieve your best health.

Woman with Aetna Medicare Advantage HMO plans hiking in a forest

How do Aetna Medicare Advantage HMO plans work?

A health maintenance organization (HMO) gives you access to a network of doctors and hospitals. Your plan requires you to use these network providers. Your HMO plan may also require you to get a referral from a PCP for hospital care and specialist visits. There are limited out-of-network benefits with an HMO plan.

Comparing Aetna Medicare Advantage plans

	Our Medicare Advantage HMO plans	Our Medicare Advantage HMO-POS plans	Our Medicare Advantage PPO plans
Preventative services covered	Yes	Yes	Yes
Requires you to use a network provider	Yes, unless it’s an emergency	Seeing out-of-network medical providers generally costs more.	No. But seeing out-of-network providers generally costs more.
Requires you to have a primary care provider (PCP)	Yes	Yes	Usually no PCP required
Requires referral to see a specialist	Varies by plan	Varies by plan	Varies by plan
Monthly premiums	Varies by plan, check your ZIP code for details	Varies by plan, check your ZIP code for details	Varies by plan, check your ZIP code for details
Medical deductible	Varies by plan, check your ZIP code for details	Varies by plan, check your ZIP code for details	Varies by plan, check your ZIP code for details
Limits what you pay out-of-pocket for covered medical care each year	Yes	Yes	Yes
Includes prescription drug (Rx) coverage	Varies by plan	Varies by plan	Varies by plan
Includes Rx mail-order benefit	Yes, if plan has Rx coverage	Yes, if plan has Rx coverage	Yes, if plan has Rx coverage
Dental, vision and hearing coverage	Yes (except for I-SNP)	Yes (except for I-SNP)	Yes (except for I-SNP)
ER and urgent care coverage worldwide	Yes	Yes	Yes
Fitness benefit	Yes, through SilverSneakers®	Yes, through SilverSneakers®	Yes, through SilverSneakers® except Institutional Special Needs Plans (I-SNP)
Over-the-counter (OTC) benefit	Varies by plan	Varies by plan	Varies by plan
Meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay)	Yes	Yes	Yes

Comparing Aetna Medicare Advantage plans

Our Medicare Advantage HMO plans
Preventative services covered	Yes
Requires you to use a network provider	Yes, unless it’s an emergency
Requires you to have a primary care provider (PCP)	Yes
Requires referral to see a specialist	Varies by plan
Monthly premiums	Varies by plan, check your ZIP code for details
Medical deductible	Varies by plan, check your ZIP code for details
Limits what you pay out-of-pocket for covered medical care each year	Yes
Includes prescription drug (Rx) coverage	Varies by plan
Includes Rx mail-order benefit	Yes, if plan has Rx coverage
Dental, vision and hearing coverage	Yes (except for I-SNP)
ER and urgent care coverage worldwide	Yes
Fitness benefit	Yes, through SilverSneakers®
Over-the-counter (OTC) benefit	Varies by plan
Meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay)	Yes

Our Medicare Advantage HMO-POS plans
Preventative services covered	Yes
Requires you to use a network provider	Seeing out-of-network medical providers generally costs more.
Requires you to have a primary care provider (PCP)	Yes
Requires referral to see a specialist	Varies by plan
Monthly premiums	Varies by plan, check your ZIP code for details
Medical deductible	Varies by plan, check your ZIP code for details
Limits what you pay out-of-pocket for covered medical care each year	Yes
Includes prescription drug (Rx) coverage	Varies by plan
Includes Rx mail-order benefit	Yes, if plan has Rx coverage
Dental, vision and hearing coverage	Yes (except for I-SNP)
ER and urgent care coverage worldwide	Yes
Fitness benefit	Yes, through SilverSneakers®
Over-the-counter (OTC) benefit	Varies by plan
Meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay)	Yes

Our Medicare Advantage PPO plans
Preventative services covered	Yes
Requires you to use a network provider	No. But seeing out-of-network providers generally costs more.
Requires you to have a primary care provider (PCP)	Usually no PCP required
Requires referral to see a specialist	Varies by plan
Monthly premiums	Varies by plan, check your ZIP code for details
Medical deductible	Varies by plan, check your ZIP code for details
Limits what you pay out-of-pocket for covered medical care each year	Yes
Includes prescription drug (Rx) coverage	Varies by plan
Includes Rx mail-order benefit	Yes, if plan has Rx coverage
Dental, vision and hearing coverage	Yes (except for I-SNP)
ER and urgent care coverage worldwide	Yes
Fitness benefit	Yes, through SilverSneakers® except Institutional Special Needs Plans (I-SNP)
Over-the-counter (OTC) benefit	Varies by plan
Meals-at-home program (meals delivered after an inpatient hospital or skilled nursing facility stay)	Yes

Medicare Advantage plans for every need

Aetna® Medicare offers you other Medicare Advantage plan options with monthly plan premiums as low as $0. We can help you find a plan that’s right for you.

${company} Medicare Advantage HMO-POS plans

With our HMO-POS plans, you can enjoy all the benefits of receiving medical care through a network provider. Our HMO-POS plans require you to use a network provider for medical care but provide you with flexibility to go to licensed dentists in or out of network for routine dental care.

Learn about HMO-POS plans

${company} Medicare Advantage PPO plans

With our preferred provider organization (PPO) plans, you can visit providers, in or out of network, who accept Medicare and ${company} plan terms. The freedom is yours.

Learn about PPO plans

${company} Medicare Advantage D-SNPs

Our Dual-eligible Special Needs Plan (D-SNP) is a type of Medicare Advantage plan, available to people living in our service area who have both Medicare and Medicaid. We can help you find out if you qualify.

Learn about D-SNPs

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Understanding Medicare Advantage HMO plans

How do Aetna Medicare Advantage HMO plans work?

Comparing Aetna Medicare Advantage plans