Aetna Medicare Assure Premier (HMO DSNP)

Aetna Medicare Assure Premier is a Medicare Advantage Health Maintenance Organization (HMO) plan designed specifically for individuals who qualify for both Medicare and Medicaid known as Dual Eligible Special Needs Plans (DSNPs). The plan combines the comprehensive coverage of Medicare with the additional benefits and costsaving features of Medicaid, all under one coordinated network.

Who Is Eligible?

• Residents of the plans service area (varies by state).
• Qualified for both Medicare Part A and Part B.
• Eligible for Medicaid benefits (or meet income/asset thresholds for Medicaid assistance).
• Usually must be 65 years or older, though some younger individuals with certain disabilities may qualify.

Key Benefits

Medical Coverage

• All services covered under Medicare Part A (hospital) and Part B (outpatient).
• Prescription drug coverage (Medicare Part D) with low or $0 copays for many formulary medications.
• Additional services not covered by Original Medicare, such as dental, vision, hearing aids, and routine foot care.
• Wellness programs, including gym memberships, nutrition counseling, and chronic disease management.

Cost Savings

• No monthly premium in most states Medicaid assistance usually covers the premium.
• Reduced or $0 copayments for doctor visits, hospital stays, and emergency services.
• Yearlong outofpocket maximum, providing financial protection against high medical expenses.

Care Coordination

• Dedicated care managers help members navigate appointments, medication management, and social services.
• Integrated electronic health records ensure primary care doctors, specialists, and pharmacists share uptodate information.
• Transportation assistance for medical appointments in many regions.

Network and Provider Access

Aetna Medicare Assure Premier operates as an HMO, meaning members must obtain most services through the plans network of doctors, hospitals, and pharmacies. Innetwork providers have been vetted for quality and costeffectiveness. Outofnetwork care is generally not covered except for emergencies.

Prescription Drug Coverage

The plans Part D formulary includes a broad range of generic and brandname drugs. Many medications are covered at $0 or $5 copays, especially for chronic conditions such as diabetes, hypertension, and mental health disorders. Members can use Aetnas mailorder pharmacy for maintenance drugs, often at lower cost.

Eligibility Verification & Enrollment

Individuals can enroll during the Medicare Initial Enrollment Period, the Annual Election Period (October1December15), or a Special Enrollment Period triggered by life events such as moving into the plans service area. Eligibility is verified through both Medicare and Medicaid data; a simple phone call or online portal can confirm qualification.

How to Get Started

Frequently Asked Questions

Do I need a separate Medicare Part D plan?

No. The Aetna Medicare Assure Premier plan includes Part D drug coverage as part of the overall benefit package.

What happens if I travel outside the plans service area?

Emergency services are covered nationwide. For routine care while traveling, you may need to pay outofpocket and seek reimbursement later.

Can I see a specialist without a referral?

Typically, a referral from your primary care physician is required for specialist visits, except for urgent care or emergency services.

Are there any annual limits on benefits?

The plan includes an outofpocket maximum, which varies by state but is usually lower than the standard Medicare Advantage maximum due to Medicaid contributions.

Comparing to Other Options

When choosing a Medicare Advantage plan, consider these factors:

• Costsharing. Dualeligible plans like Assure Premier often have the lowest outofpocket costs.
• Network size. HMO plans have smaller networks than PPOs, which may limit provider choice.
• Additional benefits. Look for dental, vision, hearing, and wellness programs that matter to you.

For many dualeligible members, the combination of reduced premiums, comprehensive coverage, and coordinated care makes Aetna Medicare Assure Premier a compelling choice.

Contact Information

For personalized assistance, call Aetnas Medicare DSNP helpline at 18003333888 or visit the Aetna Medicare website. Local Medicaid offices can also provide guidance on eligibility and enrollment steps.