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What Health Insurance Providers Does MedicareInsurance.com Work With?

What Health Insurance Providers Does MedicareInsurance.com Work With?

Posted on September 23, 2022 by Austin Lang

It’s Important To Have Options

There’s no one-size-fits-all when it comes to health insurance providers. People have different needs, and those needs (as well as the provider’s ability to fulfill them) change with time. 

Maybe you move out of your plan’s coverage area. Maybe your doctor renegotiates their contract and switches networks. Maybe you’re diagnosed with a condition that needs special care, and your existing Medicare insurance plan just doesn’t provide it.

Comparing your available insurance options is an essential part of maintaining your health, which is why we partner with a number of insurance providers across the country to find plans that might work for you.

Why Does My Health Insurance Provider Matter?

When it comes to benefits, insurance companies are competitive, especially the big names like. Aetna, Anthem, Humana, and Wellcare, which all offer similar benefits: vision care, dental care, prescription drugs, over-the-counter (OTC) discounts, fitness programs, etc. However, they differ in terms of how they offer those benefits.

For instance, Aetna is a subsidiary of CVS Health, owners of CVS Pharmacies. This means that their OTC benefit is integrated into participating CVS locations. Some locations even have a dedicated section for Medicare Advantage beneficiaries. 

Anthem and Humana, conversely, use a third-party service called Healthy Benefits+ to handle their OTC benefit. Rather than having a dedicated section in store, you can use their app to scan products at participating pharmacies (CVS included) to see if they’re covered. Both approaches achieve the same result, they’re just different. Some people might prefer the convenience of walking into a store and knowing which products are covered at a glance. Others might prefer the broader variety of locations that Healthy Benefits+ offers. It’s all a matter of preference.

The most significant difference between providers is their network. All insurance providers have a network of doctors, hospitals, pharmacies, and vendors with whom they’ve negotiated pricing. A doctor or similar entity is considered “in-network” when they have entered into a contract with a health insurance provider. This means they agree to charge a specific price for their services, and your insurer has agreed to pay a specific percentage of that cost. 

Doctors who have not made this agreement are considered ‘out-of-network’, meaning the insurance company will need to negotiate pricing with them after you or your doctor submits a claim. This can be expensive, which is why some insurance plans don’t allow you to seek out-of-network care except during an emergency.

There are three types of Medicare Advantage plan you’re likely to encounter:

 

  • Health Maintenance Organization (HMO) plans limit you to a specific network of healthcare providers, resulting in lower costs for you and your insurer. Some plans are considered point-of-service (HMO-POS) plans, which allow you to seek out-of-network care in certain circumstances, typically for dentistry and vision.
  • Preferred Provider Organization (PPO) plans allow you to seek out care at any provider who accepts insurance, though you’ll need to pay extra if they are out-of-network. You can still see in-network providers for a lower cost, however.
  • Special Needs Plans (SNP) are similar to HMOs, except their networks are built around treating a specific need. There are three types of SNP:
    • Chronic Condition SNP (C-SNP): An SNP whose network and benefits center around treating a specific condition, like diabetes or heart disease.
    • Institutional SNP (I-SNP): An SNP designed to provide care for people in nursing homes and similar institutions. In addition to general care, they also cover medical services you receive while staying at the participating institution. 
    • Dual Eligible SNP (D-SNP): An SNP designed for people eligible for both Medicare and Medicaid. A D-SNPs network consists of providers who accept insurance from both programs, and is designed to coordinate your benefits to maximize coverage.

The type of plans and benefits a given health insurance provider offers depend on your geographic location. For instance, people in remote areas are less likely to receive meal delivery as a benefit, but might find more plans offering telehealth services. It’s the result of a complex, ever-changing combination of factors. 

The point is, no single provider is objectively better than any of the others.  Their size, network, and benefits offered in your area may differ, but those differences can change drastically over time, so don’t rule one out just because it’s not a good fit for you right now.  Also, occasionally we’ll mention benefits and programs offered by providers. This does not mean that benefit is exclusive to that provider, nor does it mean plans we offer will provide that benefit. 

Check with a MedicareInsurance.com licensed insurance agent or use our free quoting tool to see what benefits may be available in your area.

Aetna

Aetna is one of the oldest insurance providers in the nation, tracing their origins all the way back to the 1800s! In fact, they had their start as a fire insurance company: the name Aetna comes from Mount Etna, one of the most active volcanoes on Earth! Today, they’re focused entirely on health insurance — offering individual, employer-backed, and Medicare Advantage plans to customers across the United States. 

Aetna offers four broad types of Medicare Advantage plan: HMO, HMO-POS, PPO, and D-SNP They also offer Medicare Part D prescription drug plans, and Medicare Supplement Insurance (Medigap) in certain states.

Benefits vary from plan to plan, but many Aetna plans offer prescription drug benefits, vision, hearing, and dental services, meal delivery, and fitness benefits through SilverSneakers. As we mentioned above, many plans offer an OTC benefit directly through CVS Pharmacies, allowing you to walk into a participating location and select eligible items directly off the shelf. 

Most of these are CVS branded items, which unfortunately means Target locations with CVS Pharmacies won’t accept this benefit, as they only carry Target branded generics. Even if you don’t live near a CVS, you can still enjoy your OTC benefit through their online portal, and can find in-network providers in all 50 states.

Anthem (Elevance Health)

No matter your state, you’re probably familiar with the iconic Blue Cross and Blue Shield. You might have even encountered them as far away as Uruguay! The Blue Cross Blue Shield Association (BCBSA) is a federation of 35 separate insurance companies that operate under the same banner across the United States and beyond. Anthem, which is currently rebranding as Elevance Health, is one of its most prominent members, operating in fifteen states. 

Anthem offers HMOs, PPOs, and various SNPs, including ones aimed at treating chronic conditions and providing care for people in institutional settings. They also offer Part D and Medigap coverage. Like Aetna, their plans often include benefits like prescription drug coverage, vision, hearing, and dental services, meal delivery, and SilverSneakers access. 

A unique benefit of choosing Anthem is access to the BCBSA network. Although most BCBSA plans are local, many providers who accept Anthem will also accept other plans with the BCBSA branding. 

The reverse is also true: if you have a BCBSA plan from a local provider like Florida Blue (which is not owned by Anthem), you can use your insurance at providers who accept Anthem. This isn’t a guarantee, as network sizes and benefits will always vary from plan to plan, and your insurance may not be accepted in all areas. However, it is still something to keep in mind.

Humana

Humana is one of the nation’s largest providers of Medicare Advantage plans. You can find Humana plans and providers in all 50 states. Like Aetna and Anthem, they offer HMOs and PPOs with many of the common Medicare Advantage benefits, like prescription drug coverage and vision care. They also offer SNPs in select states, and can even provide Part D and Medigap coverage.

One of Humana’s claims to fame is its extensive pharmacy network, offering reduced copayments and deductibles when you fill prescriptions at major retailers like Walmart, Costco, and Albertsons. Their least expensive Medicare Part D plan is even named after Walmart, though you’re not limited to using it there. Humana also operates CenterWell Pharmacies, a dedicated mail-order service available exclusively to Humana customers.

Wellcare

Unlike the other providers on this list, Wellcare focuses exclusively on Medicaid and Medicare plans. This makes them one of the smaller providers on this list, but also means that all of their resources are focused on Medicare and Medicaid. 

Most of their plans are relatively straightforward, with names like “No Premium” and “Giveback”, so you know exactly what you’re getting at a glance. No “Gold Select Ultra Choice Premium plans” here. Of course, you’ll also know what’s being offered at a glance if you use our free quoting tool, but it’s a nice sentiment regardless. 

This “Keep-it-Simple” doesn’t mean you’ll be lacking in benefits, however. Wellcare offers similar benefits to the other providers on this list, including SilverSneakers, OTC benefits, and telehealth services. They also offer discounts on certain medical alert systems, adding extra peace of mind for those living alone.

There’s So Much More

In addition to the big four, we also offer plans from regional and local providers, which can offer surprising benefits. If you’re curious about what options are available in your area, take a moment to explore nearby healthcare providers, then give us a call at (800) 950-0608. 

One of our licensed insurance agents will be happy to help you find a plan that fits your needs, no matter what they are.

About the Author

Austin Lang

Austin is dedicated to breaking down complex topics, like Medicare, in a way that's easy to understand. He graduated with an M.A. from Florida Atlantic University in 2018.

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