04/25/2022

Aetna Medicare Advantage Elite PPO Plans Deductibles-Out of Network

Since the start of 2022 I have seen that Aetna Medicare Advantage Elite PPO plans have a $1000 out of network deductible. I was under the assumption that as a MC Advantage plan patients would be "allowed" to see any provider who accepts medicare. With such a costly deductible it seems they are trying to dissuade their members from seeing out of network doctors. Are they allowed to apply such an onerous deductible?

Aetna and other Medicare Advantage Plans are within their right to apply a deductible for OON services. In comparison to many other plans in the NY/NJ Metro area or nationally (Medicare Advantage or commercial), a $1000 deductible for OON services is a low-cost burden in comparison to PPO plans that have a much higher OON deductible. Patients are encouraged to stay within their plan’s network to limit costs, however, The Aetna plan is allowing patients to see any provider they wish with the stipulation of that deductible.