Aetna Medicare Assure Plan (HMO DSNP)

Plan Overview

The Aetna Medicare Assure Plan is a Medicare Advantage Health Maintenance Organization (HMO) Dual Eligible Special Needs Program (DSNP). It is designed for individuals who qualify for both Medicare PartA/PartB and Medicaid (or a staterun equivalent). The plan combines the coverage of Medicare with extra benefits and costsaving features that are often unavailable in standard Medicare Advantage plans.

By integrating Medicaid resources, the Assure Plan can lower outof pocket costs, simplify prescription drug coverage, and provide coordinated care through a network of vetted providers. It is available in many states, and the exact service area varies by county.

Eligibility Requirements

To enroll in the Aetna Medicare Assure HMO DSNP, you must meet the following criteria:

• Be enrolled in Medicare PartA and PartB.
• Qualify for full Medicaid benefits (or a statespecific equivalent such as a Qualified Medicare Beneficiary (QMB) status).
• Live in a service area where the plan is offered.
• Not be enrolled in any other Medicare Advantage plan.

Note: Dualeligible individuals often receive a separate enrollment notice from their state Medicaid agency. That notice will include a special enrollment period (SEP) that allows you to join the Aetna Medicare Assure Plan even outside the regular Medicare enrollment windows.

Key Benefits & Services

The Assure Plan bundles traditional Medicare benefits with several additional services tailored for dualeligible members:

• Medical Coverage Hospital (PartA), medical services (PartB), and specialist visitsall provided through an HMO network.
• Prescription Drug Coverage (PartD) A comprehensive formulary with low copays for generic drugs and preferred brandname medicines.
• Zero or Minimal Premiums Most members pay $0 monthly premium; some states may charge a small amount.
• Low Copayments & Coinsurance Typical officevisit copays range from $0$5, and hospital stays often have $0$10 daily coinsurance.
• Care Coordination A dedicated care manager helps schedule appointments, manage chronic conditions, and connect you with community resources.
• Dental, Vision, & Hearing Preventive dental cleanings, annual eye exams, and hearing aid coverage are included.
• Wellness Programs Free fitness classes, nutrition counseling, and smokingcessation support.
• Transportation Services Nonemergency medical transportation (NEMT) for eligible members.
• Telehealth Access to virtual visits with primary care physicians and specialists at no extra cost.

Costs & OutofPocket Limits

Because the plan leverages Medicaid funding, costs are generally lower than standard Medicare Advantage plans. The typical cost structure is:

• Monthly Premium $0 in most states (some may have a small statedetermined premium).
• Annual OutofPocket Maximum $2,850 for medical services (including PartB) and $5,100 for prescription drugs, though many members never reach these limits because Medicaid often covers the remainder.
• Copays $0$5 for primary care, $5$10 for specialists, $0 for most preventive services.
• Prescription Drug Cost $0$10 copays for generics, $5$20 for preferred brand drugs, and $10$30 for nonpreferred brands.

If you have limited income or qualify for extra Medicaid assistance, many of these amounts may be reduced further or eliminated entirely.

How to Enroll

1. Confirm Eligibility Verify that you are enrolled in both Medicare and Medicaid.
2. Check Availability Use the Aetna website or call 1800AETNAMED (18002386263) to confirm that the Assure Plan is offered in your county.
3. Gather Documentation Have your Medicare card, Medicaid ID, and a recent proof of address ready.
4. Enroll Online Visit Aetnas Medicare Assure page and follow the Enroll Now prompts.
5. Enroll by Phone Call the tollfree number above and speak with a licensed enrollment specialist.
6. Complete Paper Application If you prefer, request a paper application by phone; return it with the required signatures.

After enrollment, you will receive a member ID card in the mail within 710 business days. Your care manager will reach out within 48 hours to discuss your health goals and set up any needed appointments.

Frequently Asked Questions

What is the difference between an HMO DSNP and a regular Medicare Advantage plan?

An HMO DSNP is specifically tailored for dualeligible beneficiaries. It integrates Medicaid benefits, often eliminating premiums and reducing copays, while a regular Medicare Advantage plan does not have this builtin Medicaid support.

Can I see any doctor I want?

The Assure Plan requires you to use doctors, hospitals, and specialists that are part of Aetnas HMO network. Outofnetwork care is generally not covered except in emergencies.

Do I need to enroll in a separate PartD prescription plan?

No. Prescription drug coverage is included as part of the plans Medicare Advantage benefits.

What if I move to a new state?

Coverage depends on whether the Assure Plan is offered in the new state. If it is, you can transfer your enrollment during the Medicare annual enrollment period or through a special enrollment period triggered by the move.