Where's the Advantage? Aetna Medicare Advantage Plans Out of Network in 2025

[DrQ]

Aetna Medicare Advantage Plans Out of Network in 2025​

Aetna MA Update

www.southwesternhealth.org

I'm glad we chose traditional Medicare with a supplement (Medigap). These plans are hawked so aggressively, but even if you select a PPO, you are going to pay through the nose.

I was getting some imaging done yesterday and the woman behind the desk was making call after call that they were no longer "in network" and would have to self pay or cancel.

 

[simpsontruckdriver]

As a former Medicare sales rep, the only "advantage" is saving healthcare money when you stay in network. On the other hand, anyone on an MAPD can switch one last time between now and March to another one (insurers can not market it) or drop to Medicare PFFS (Paid Fees For Service, aka traditional Medicare).

TS

 

[DrQ]

... On the other hand, anyone on an MAPD can switch one last time between now and March to another one (insurers can not market it) or drop to Medicare PFFS (Paid Fees For Service, aka traditional Medicare).

Yes, but unless you live in VERY few states, you cannot get a Medicare supplement without meeting underwriting requirements. If you can't meet those requirements, you have to pay the 20% out of pocket.

Aetna is still operating in the market, it is just that a BIG chunk if the providers are now "out of network". If they had pulled out of the market, then the victims could have qualified for acceptance under an SEP (Special Enrollment Period) without underwriting.

 

[emeryjre]

The Scripps Network in San Diego cancelled health services for 30K health care customers at the beginning of 2024
Certain Medicare advantage plans did not pay Scripps sufficient reimbursement to provide health care to these people
There will be fewer providers for advantage plans going forward (IMHO)
I pay a hefty monthly sum to Medicare and Blue Shield
I am in a situation where I can do this fortunately
I am seeing several friends beginning to struggle financially as costs continue to rise for medical care, property taxes, car and home owners insurance
Maybe the new administration will come through for us with the promises of lower costs