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Aetna Medicare Advantage Plans Fact Sheet and FAQs

  • After careful evaluation and discussion with Aetna, Hendrick Medical Center and Hendrick Medical Center South in Abilene, and Hendrick Medical Center Brownwood, are out-of-network with Aetna Medicare Advantage plans (“Aetna MA”), effective 2/15/2025. These hospitals will remain contracted with Aetna for its commercial insurance and ASO plans.
  • Hendrick Clinic and Hendrick Anesthesia Network will remain in-network for Aetna Medicare Advantage plans.
  • Even though Hendrick will now be out-of-network with Aetna MA plans, Aetna’s MA plan members still have the option to choose Hendrick for services.
  • When Aetna MA plan members who reside in Hendrick Health’s Abilene market area choose to receive services from Hendrick in Abilene as an out-of-network provider, Aetna is expected to approve and pay those member’s claims to Hendrick at 100% of traditional Medicare benefit levels.
  • When Aetna MA plan members who reside in Hendrick Health’s Brownwood market area choose Hendrick Medical Center in Brownwood as an out-of-network provider, it is possible that Aetna may re-direct those members to a nearby in-network rural hospital. If an Aetna MA plan member requires services that Hendrick Medical Center Brownwood can provide but the in-network rural hospital to which the member is referred cannot, Hendrick Medical Center Brownwood will request authorization from the Aetna MA plan on behalf of Aetna MA members who want to receive their care at Hendrick Medical Center Brownwood, and Hendrick expects those authorizations to be provided.
  • All Aetna MA plans are required to provide coverage for a range of medical facilities and specialties to members within a reasonable distance and travel time from their homes. When those facilities and/or specialties aren’t available in the community, Medicare rules direct plans to allow services to be performed at a Medicare beneficiary’s closer local hospital, even if that hospital isn’t in-network. Hendrick will work with Aetna MA plans to ensure services are available to Aetna MA plan members according to these Medicare requirements.

Key Take-Aways:

  • Affected Aetna MA plan members have the option to choose Hendrick Health for healthcare services that they need, particularly if those services are not available at the in-network facility.
  • Hendrick will work with Aetna MA plans, and Aetna MA plan members living in the Hendrick Medical Center Abilene market area to allow members to receive services at the facility they choose.
  • Hendrick will help Aetna MA plan members living in the Hendrick Medical Center Brownwood market area to arrange authorization for their hospital services, if those members choose Hendrick Medical Center Brownwood for services - particularly if those services are not available at the in-network rural facility to which the member is referred by Aetna.
  • Should Aetna MA patients living in the Hendrick Health market area choose to receive services from Hendrick, those members won’t owe Hendrick more than the amounts that their cost-sharing obligations would be under traditional Medicare.

FAQs

Q: Why has Hendrick become out-of-network with my Aetna MA plan?

A: Hendrick determined that Aetna MA does not consistently follow Medicare rules relating to admission criteria and to providing transitional care ordered by patients’ doctors, and this practice can lead to delays or denials in the provision of care that Medicare enrollees would be entitled to receive under traditional Medicare.

Q: My notice from Aetna states that I won’t be able to use Hendrick Health after 2/15/2025, or that Aetna won’t pay for my care. Why is your message different?

A: Medicare rules limit how far a MA plan can re-direct their members to receive care. Most Aetna MA plan members reside in Hendrick Medical Center’s Abilene market area and aren’t required to travel away from their local hospital provider. Aetna MA plans may re-direct others to small rural hospitals, but those small rural hospitals may not provide the level of services found with Hendrick hospitals, and Hendrick expects that Aetna will authorize Hendrick services upon request for members who still wish to receive services at Hendrick. Hendrick will work with Aetna MA plans for authorization of services.

Q: How do Aetna MA medical decisions affect hospital stays?

A: Aetna MA plans may disagree with doctors’ orders for a member’s admission to the hospital as an inpatient. Aetna MA plans also may take longer than expected to approve transitional care, causing inpatient stays to exceed stays that might occur if the member was enrolled in traditional Medicare.

Q: How are Aetna MA plan members affected by their MA plan’s medical decisions?

A: When an Aetna MA plan disagrees with doctors’ orders for certain services, it may prevent those members from receiving the Medicare benefits they’re entitled to or require the member to appeal the Aetna MA plan decision.

Q: How can I be sure I’m not affected by Hendrick hospitals having an out-of-network status with my Aetna MA plan?

A: Hendrick will not hold Aetna MA plan members who reside in the Hendrick Health market area responsible for more than the amounts they would have to pay under traditional Medicare.