Do Aetna Medicare Advantage HMO and PPO plans have no out of pocket maximum?
Asked by: Mr. Wendell Hirthe III | Last update: September 29, 2025Score: 4.9/5 (7 votes)
Do Medicare Advantage plans have an out-of-pocket maximum?
In 2024, the out-of-pocket limit for Medicare Advantage plans may not exceed $8,850 for in-network services and $13,300 for in-network and out-of-network services combined. These out-of-pocket limits apply to Part A and B services only, and do not apply to Part D spending.
What counts towards out-of-pocket maximum Aetna?
Your out-of-network deductible ($100) counts toward your out-of-pocket limit. Your coinsurance ($120) counts toward your out-of-pocket limit. The extra amount the doctor can bill ($425) does not count toward your out-of-pocket limit.
What is the difference between Aetna HMO and Aetna PPO?
What is the main difference between the HMO-EPO plan and the PPO plan? The HMO-EPO plan only provides in-network coverage for services, except for urgent and emergent care which would be covered the same out-of-network as it would in-network. The PPO plan offers both in-network and out-of-network coverage.
What are the negatives of a Medicare Advantage PPO plan?
Disadvantages of Medicare Advantage plans can include difficulty switching out of the plans later, restrictions on care access, limited provider networks, and limitations on extra benefits.
PPO vs HMO: What's the Difference?
Why are people leaving Medicare Advantage plans?
Key takeaways: People leave Medicare Advantage plans because out-of-pocket costs vary between plans, network restrictions can cause frustration, prior authorization requests can delay care, and it can be difficult to use the additional benefits they provide.
What is the best medicare plan that covers everything for seniors?
Original Medicare with Medigap likely offers the most comprehensive coverage, but it may also be the most costly. A person can consider their income and how much they are able to spend before choosing a Medicare plan. Original Medicare with Medigap also offers a lot of flexibility when choosing a doctor or specialist.
Why do doctors prefer PPO over HMO?
HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.
Is Aetna Medicare Advantage a PPO or HMO?
Aetna® shines in Star Ratings with 88% of Medicare Advantage members in 4 out of 5-star plans or higher for 2025. Aetna Medicare is an HMO, PPO plan with a Medicare contract.
Is the Aetna PPO plan good?
PPO: The plan with the most freedom
But this plan lets you see specialists and out-of-network doctors without a referral. Copays and coinsurance for in-network doctors are low. If you know you'll need more health care in the coming year and you can afford higher premiums, a PPO is a good choice.
Do all insurances have out-of-pocket maximum?
Do all health plans have an out-of-pocket maximum? Plans that meet Affordable Care Act (ACA) standards are required to have out-of-pocket maximums. As the health insurance industry changes, there could be non-ACA plans that do not meet the same standards.
Why is Aetna so expensive?
Factors influencing Aetna insurance monthly costs
Plans with broader coverage and extensive benefits, such as lower deductibles, co-pays, and comprehensive services like dental and vision care, often come with higher monthly costs.
Why do doctors not like Medicare Advantage plans?
Across the country, provider grumbling about claim denials and onerous preapproval requirements by Advantage plans is crescendoing. Some hospitals and physician practices are so fed up they're refusing to accept the plans — even big ones like those offered by UnitedHealthcare and Humana.
Does everyone have to pay $170 a month for Medicare?
Most people pay no premiums for Part A. For Medicare Part B in 2025, most beneficiaries will pay $185 per month. Certain factors may require you to pay more or less than the standard Medicare Part B premium in 2025.
What is the biggest disadvantage of Medicare Advantage?
- Plans can also cost more overall than Original Medicare if you have complex medical needs. ...
- With some plans, you don't have any coverage if you use a doctor that isn't in the network.
Which is better a PPO or a HMO Advantage plan?
HMO plans typically have lower monthly premiums. You can also expect to pay less out of pocket. PPOs tend to have higher monthly premiums in exchange for the flexibility to use providers both in and out of network without a referral.
Is Aetna dropping Medicare Advantage plans?
You'll lose your current Aetna Medicare Advantage coverage. Beginning January 1, 2025, you'll only be covered by Original Medicare, which doesn't include additional benefits. That's why we encourage you to enroll in a new Aetna Medicare Advantage plan by December 31.
What is the downside to a PPO plan?
Cons of PPO Plans
Less Coordination: Without a primary care doctor managing your healthcare, there's less oversight, and it can be harder to keep track of your treatments and appointments.
What are three disadvantages of HMO?
- If you need specialized care, you will need a referral from your primary care physician to an in-network provider.
- Must see in-network providers for care-less flexibility than a PPO plan.
Why do people not like HMO plans?
On major disadvantage is that it is difficult to get any specialized care because the members must get a referral first. Any kind of care that is sought that is not a referral or an emergency is not covered.
Are there any 5 star Medicare Advantage plans?
"There isn't one Medicare Advantage plan that's the highest-rated; there are multiple plans that get an overall rating of 5 stars, which is the highest rating from CMS.
What are the 6 things Medicare doesn't cover?
- Eye exams (for prescription eyeglasses)
- Long-term care.
- Cosmetic surgery.
- Massage therapy.
- Routine physical exams.
- Hearing aids and exams for fitting them.
What is the best dental plan for seniors on Medicare?
“My top picks for Medicare Advantage dental insurance include UnitedHealthcare, Cigna, Aetna, Humana and Devoted Health. These companies provide notable dental coverage, and there are different advantages for each. It's important to consider the insurance that the dentists in your area accept and the coverage provided.