Posted in Insurance, My services, Training, Updates

Aetna: New Medicare Advantage Plans in North Carolina, South Carolina and Tennessee- 01/01/2021

As of 01/01/2021- there are 2 new HMO plans that will be available in NC, SC and Tennessee: These plans are Aetna Medicare ValueSM Plan (HMO) and Aetna Medicare Value Plus Plan (HMO)

These plans will require to choose a PCP. However, they will NOT require a referral to see a specialist. This information will be on the member cards, as indicated by the red arrow below:

The following is the list of the plan types:

Supplemental Benefits: NOT all plans will have these available

  • Dental (preventive and comprehensive)
  • Over-the-counter (OTC)
  • Hearing Aids
  • Post hospital discharge meal delivery
  • Telehealth

Additional Information:

  • All members must select a primary care physician.
  • There is no referral requirement for specialty care.
  • Participating providers can submit pre-authorization requests through our provider portal, or they can also fax the request or call it in to the Provider Service Center.
  • These plans include pharmacy Part D coverage.

Note: No out-of-network benefits exist for these plans unless the member follows the approval process. They can start this process by contacting Member Services directly.

Author:

My name is Kate Patskovska, CPB. I am an Independent Medical Biller CPB (AAPC) and an owner of KR2 Medical Billing. KR2 Medical Billing is a full service Consulting/Medical Billing Business that is dedicated to educating, consulting, and overall improving the "financial health" of your medical practice.

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