Information about Aetna’s Extended Service Area Plan

From the recent Retiree Matters newsletter, some information about Aetna’s Extended Service Area:

If you have experienced issues with some local health providers accepting the Aetna Medicare Advantage PPO plans, remember that the plan is an Extended Service Area or ESA plan. What this means is that you can see any doctor, even if they are outside the network, if they are eligible to receive Medicare payment and willing to accept your Aetna Medicare Advantage Plan. Here are some quick tips to keep in mind:

• If the provider you want to see accepts Medicare, but is not contracted with Aetna (non-participating or out-of-network), you can still use that provider because the provider is able to receive Medicare payment. Please visit our City website at
and click on the PPO Extended Service Area Flyer to see a document that you can print and give to your provider to assist with billing.
• Just always remember when selecting a provider, make sure they accept Medicare and are able to receive Medicare payment. If the provider is willing to bill Aetna, then you will not have to submit anything, but if the provider is not willing to bill Aetna and accepts Medicare, you will have to submit the claim to Aetna directly.
• If the provider does not accept Medicare, do not use that provider. If you decide to use a provider that does not accept Medicare, you will have to pay out of pocket and if you submit the claim to Aetna, it will not be reimbursed.

If there are any providers in particular you are interested in that do not accept the Aetna MA Plan, please notify Aetna by calling 1-800-338-4533 Monday through Friday, 8 a.m. to 9 p.m.


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