Medicare Advantage/HMO Plans

Plans

100

The two plan groups offered

What is Individual and Group?

200

Individual Medicare Plan Types

What is 

• Aetna Medicare Advantage HMO (MA/MAPD)
• Aetna Medicare Advantage Open Access (MA/MAPD)
• Aetna Medicare Advantage PPO (MA/MAPD)
• Aetna Medicare Prescription Drug Plan (PDP)

300

Plans not offered for Individual

What is PPO ESA and Part B Only?

Routine/Preventive Care

100

Frequency limit for routine immunizations

What is no frequency limit?

200

Frequency limit for physical exams as of 2018

What is unlimited visits?

Features

100

HMO plan features

What is 

• Requires the member select a primary care physician
• Requires a referral to go to out-of-network doctors, specialists and hospitals.
• Precertification is required for select services
• Requires use of plan provider network
• Provides necessary and appropriate emergency care outside the network

200

Not required under HMO Open Access 

What is member not required to select a PCP?

Referrals/Precertification

100

T or F

HMO Open Access requires a referral to see a specialist, network doctor, or hospital.

What is FALSE?

200

Responsible for precertification

What is the PCP?

The Basics

100

Flat dollar amount member pays

What is Copay?

200

Excluded from OOP maximum

What is 

• Any dental optional supplemental benefit or dental discount
• Dental allowances
• Eyewear payments
• Hearing aid payments
• Part D drugs