Health insurance has become an important aspect of our lives. With the various offerings of numerous insurance providers on the market today, it’s crucial to make an informed choice that meets our unique needs. In this post, we delve into Aetna Medicare Solutions.
Aetna Health Insurance: A Brief Background
Aetna has carved its name in America’s insurance industry for more than a century and a half. It provides families, individuals, employers, and Medicare beneficiaries with a range of coverage options.
One of Aetna Health Insurance’s key features is its extensive network of healthcare providers. It has forged strategic alliances with a wide range of medical experts nationwide, such as specialists in diverse fields and other medical practitioners.
Aetna policyholders enjoy the privilege of availing themselves of exceptional healthcare services in a wide range of healthcare facilities.
Aetna also offers customized healthcare coverage options to satisfy the diverse needs of its clients. These include policies for individuals and families and employer-sponsored policies, as well as Medicare Advantage and Medicare prescription drug policies.
All these plans are developed for comprehensive coverage, encompassing preventive healthcare, hospitalization, consultations with specialists, and prescribed medications.
With the emergence of digital technology, Aetna has done its part to improve healthcare delivery. The company has made investments in innovative tools and resources to boost the customer experience, thus improving access to healthcare.
Policyholders of Aetna can manage their plans and access their health information online or through their mobile app. The app makes it easy to find doctors, estimate costs, and track claims, thereby helping to conveniently navigate their healthcare journey.
Aetna Medicare Solutions
Aetna Medicare Solutions aims to continuously improve its services by upgrading its system, thus making them more convenient and available for clients. The program boasts of providing premium benefits on par with those provided by other Medicare companies.
The plans’ coverage includes doctor’s consultations and hospital confinements, as well as services such as prescription drug expenses and other medical care. Additionally, there are benefits beyond hospital confinement.
Outside-hospital benefits are simple care that benefits everyone, such as dental care, eyewear, hearing aids, and even gym memberships for those fitness buffs.
Aetna provides its members with Medicare Solutions for individual and family health insurance plans. The Individual and Family Plan is the plan wherein health outcomes are achieved simultaneously.
Everyone feels their best, effortlessly and affordably, when they receive exceptional treatment from trustworthy professionals. The health plan fulfills clients’ needs by combining essential health benefits, such as prescription medications, maternity and newborn care, mental health services, and more.
Aetna Health Insurance: The Basics
To meet the various healthcare needs of individuals and families, Aetna Health Insurance provides a wide range of coverage options. Medicare, Medicaid, dental, vision, and supplemental insurance are included.
Medicare Advantage Plans
Aetna offers Medicare Advantage plans on top of the basic coverage of Medicare, the government-funded health insurance for individuals aged 65 and over. Medicare Advantage plans cover prescription medications, vision care, and dental services.
Medicaid-Managed Care Plans
Aetna collaborates with state and federal governments to provide Medicaid-managed care plans. Though this government-funded program affords healthcare services to low-income groups, the Aetna Medicaid-managed care plan affords qualified individuals access to high-quality medical care.
Dental Insurance
Dental insurance is an essential component of overall health coverage. Aetna offers dental plans to help individuals and families maintain their oral health. These plans typically cover preventive services like prophylaxis, X-rays, and restorative procedures such as fillings and root canals.
Vision Insurance
Similarly, Aetna also provides vision insurance to help individuals maintain good eye health. Vision plans often cover regular eye exams, prescription eyewear like glasses or contact lenses, and sometimes even discounts on LASIK procedures.
Supplemental Insurance Plans
Additionally, Aetna offers supplemental insurance plans that provide extra coverage for healthcare costs not covered by other insurance policies. These plans can help fill the gaps in coverage and include benefits like hospital indemnity coverage, critical illness coverage, and accident insurance.
Aetna Types of Plans
Aetna provides a variety of health insurance plans to cater to differing individuals’ needs. Two types of plans are available, the Health Maintenance Organization (HMO) and the Exclusive Provider Organization (EPO).
The HMO plan offers extensive medical coverage at a reduced cost. The enrollment process requires you to select a primary care physician (PCP) from its provider network. The PCP will be the point of contact for your healthcare needs and coordinate referrals to specialists when needed.
Typically, HMO plans have lower out-of-pocket costs and require members to obtain referrals for specialist visits for certain procedures. Coverage is limited to in-network providers, except in emergencies.
The EPO plan offers a balance between cost and flexibility. Choosing a PCP isn’t required, as are specialist visits. However, similar to the HMO plan, coverage is limited to providers within the network.
The EPO plan is cost-effective compared to the HMO plan, yet the out-of-pocket cost is higher. What’s best about this plan is that the members enjoy the freedom to choose their healthcare provider while enjoying network discounts.
The beauty of the EPO plan is the member’s full flexibility. The member chooses a different healthcare provider for every service he avails of, and is not influenced by a PCP. He can choose which specialist to consult, provided it is within the network.
Aetna’s Focus on Quality Healthcare
As Aetna continues to boost its programs and operations, the organization has pushed for programs to continuously improve the delivery of quality healthcare.
Through strong collaboration with physicians and healthcare experts, the company gains knowledge and insights for improvements in its core services. Through constant interaction, they’re able to leverage their performance against that of other companies.
Through their relentless efforts, Aetna was able to achieve its goal. The clinical operations and programs are founded on well-established criteria, and they provide their members and physicians with the resources needed for decision-making.
To ensure the delivery of good services to their members, they set achievable targets throughout the journey. They analyze the members’ healthcare needs that may call for improvement, as well as measuring and monitoring against established criteria.
To enhance clinical care and service quality, Aetna develops enterprise-wide initiatives to improve member and community safety as well as ensure compliance with requirements, including those of sponsor plans, federal and state regulators, and accrediting organizations.
In detail, Aetna’s program to improve its services includes the following::
- Develop policies and goal-setting
- Conduct competitive checks to assess performance in the industry
- Maintain baseline data to set criteria and identify gaps for improvement.
- Probe members’ databases for needs analysis and demographics
- Review preventive and behavioral health services
- Revisit and analyze existing core products and services.
- Assess existing resources, such as logistics and manpower complements, to support new programs
- Address racial and ethnic disparities
- Implement programs to ensure successful outcomes
- Evaluate program effectiveness
- Study network provider accessibility
- Monitor services and benefits that are overused as well as underused.
- Perform credentialing activities
- Feedback system to assess member and provider satisfaction
Aetna gathered clinical data in 2021 and shared it with the NCQA Quality Compass to establish new objectives and enhance certain criteria. They solicited member and provider comments and improved their website and provider directory, as well as their online self-service alternatives.
Their Case Management and Disease Management program participants are highly satisfied and have recommended the curriculum. Aetna changed its app and provider directory to make it easier for members to locate telemedicine providers.
Aetna also enhanced its patient safety program, disseminated patient safety information via social media, and offered physicians tools on their secure provider website.
The quality improvement program of a corporation aims to improve the quality of life by bolstering behavioral healthcare and mental health. In 2021, the program achieved multiple goals, such as the following:
- Expand the provider network
- Launch MinuteClinic® HealthHUBTM pilots
- Create social media campaigns for LGBTQ and BIPOC youth
- Pilot new programs to manage addiction, depression, anxiety, and eating disorders
- Launch suicide prevention campaigns and programs
- Increase youth support for ages 12 to 25
A partnership has been set up between HealthHub, MinuteClinic, and Network to deploy licensed clinical social workers into stores to provide additional services, such as life coaching. Moreover, the organization founded the Aetna Institute of Quality for Autism.
Lastly, the organization is a Medicare solutions provider that regards NCQA accreditation as a means of demonstrating its dedication to enhancing the quality of care, access to treatment, and satisfaction of its clients.
Choose Aetna as your Medicare Solutions Provider
Aetna is a dynamic organization. It never stops seeking improvements and enhancements to the healthcare needs of its members. It never stops launching initiatives to continually improve every aspect of its operation.
Aetna is committed to fulfilling its goal of serving the best interests of everyone who chooses them as a Medicare provider.
Whether you’re currently an Aetna member or considering it for the first time, we at Omega Pediatrics will be glad to help you make an informed choice. We will shed light on how insurance providers, such as Aetna, can support your healthcare needs.
Book an appointment with Omega Pediatrics today! Aetna, as your Medicare provider, is a premium choice for quality healthcare to support you and your family.