HMO - Aetna Medicare

Aetna is the brand name used for products and
services provided by one or more of the Aetna
group of subsidiary companies (Aetna).
The benefit information provided herein is a brief
summary, not a comprehensive description of
benefits. For more information contact the plan.
Limitations, copayments, and restrictions may
apply. Benefits, formulary, pharmacy network,
premium and/or copayments/coinsurance may
change on January 1, 2012.
In general, beneficiaries must use network
pharmacies to access their prescription drug
benefit, except in non-routine circumstances.
Pharmacy clinical programs such as prior
authorization, step therapy, and quantity limits
may apply to your prescription drug coverage.
For the Aetna Medicare PPO plan: Higher costs
may apply for out-of-network services.
Precertification, or prior approval of coverage, is
requested for certain services. Providers must be
licensed and eligible to receive payment under
the federal Medicare program.
This material is for informational purposes only.
Not all health services are covered. See plan
documents for a complete description of benefits,
exclusions, limitations and conditions of coverage.
Plan features and availability may vary by location
and are subject to change. Aetna receives rebates
from drug manufacturers that may be taken
into account in determining Aetna’s Preferred
Drug List. Rebates do not reduce the amount a
member pays the pharmacy for covered
prescriptions. Providers are independent
contractors and are not agents of Aetna. Provider
participation may change without notice. Aetna
does not provide care or guarantee access to
health services.
Providers who have been duly recognized by the
NCQA Recognition Programs are annotated in the
provider listings section of this directory. Aetna is
committed to Accreditation by the National
Committee for Quality Assurance (NCQA) as a
means of demonstrating a commitment to
continuous quality improvement and meeting
customer expectations. A complete listing of
health plans and their NCQA accreditation status
can be found on the NCQA website located at
http://www.ncqa.org/tabid/142/Default.aspx.
To refine your search, we suggest you search
these areas: Managed Behavioral Healthcare
Organizations – for behavioral health
accreditation; Credentials Verification
Organizations – for credentialing certification;
Managed Care Organizations - for HMO and PPO
health plan accreditation; Recognition Directory -
for physicians recognized by NCQA in the areas
of heart/stroke care, diabetes care, back pain and
systematic processes; Physician and Hospital
Certification (PHQ) that evaluates how health
plans measure and report the quality and cost of
physicians and hospitals.
For up-to-date provider network information,
please visit our DocFind ® directory at
www.aetnamedicare.com.
Important Note: Please begin using this directory
to locate Aetna Medicare (HMO) (PPO) providers
in your area on January 1, 2011. Some of the
health care providers listed in this directory will
not participate in the Aetna Medicare (HMO)
(PPO) network until January 1, 2011. In the
meantime, if you need help finding Aetna
Medicare (HMO) (PPO) providers in your area
prior to January 1, 2011 or you have any
questions, you can get the most up-to-date
information by visiting www.aetnamedicare.com
or calling our Customer Service Department at
1-800-282-5366, 8 am to 8 pm, 7 days a week.
TTY/TDD users should call 1-888-760-4748.
A Medicare Advantage organization with a Medicare contract
27.01.121-A (3/11) MDH/MDP
©2010 Aetna Inc.