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.
KR2 Medical Billing 