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Aetna Medicare Advantage PPO plan

Keeping your doctors

New York Teacher

Aetna has an extensive network of 1.2 million doctors, but you do not have to use Aetna-network providers to be covered. You can see any Medicare-approved provider who is willing to bill Aetna.

"As long as the provider accepts traditional Medicare, there is really no difference in the member experience when seeing a doctor in network or out of network," said UFT Welfare Fund Executive Director Geof Sorkin. "It's the same benefits and same cost share. The retiree is not going to be penalized for going out of network."

Aetna will reimburse the doctor at the same rate as traditional Medicare. The copay stays the same.

Aetna also has high rates of hospital participation. In the New York City metro area, for example, the only large hospital that is out of network is Stony Brook, but it has no issues seeing Aetna members out of network.

About 96% of doctors who take GHI Senior Care are either already in Aetna's network or accept payment from Aetna. Aetna is reaching out to the remaining 4% of GHI Senior Care providers who do not have a billing history with Aetna to get even more to come on board before Sept. 1.

To ensure a smooth transition come September, we encourage you to go now to the Aetna plan's website, to see if your doctors or preferred hospital are in Aetna's network.

If they are not in the network or you have any questions, call the Aetna Member Services hotline at 855-648-0389. The company will reach out to your provider, explain how the new plan works and encourage the provider to either join the network or set up billing with Aetna.

Aetna will also contact doctors to make sure they are aware of the prescription drug changes.

"The beauty of the Aetna plan is that it is an open formulary. All medications are covered, and it has the same cost as GHI Senior Care," Sorkin said. "There are no exceptions."

Related Topics: Health Benefits