Aetna Medicare Advantage PPO Extended Service Area (ESA)
The Exchange’s benefits team is aware of communications to Exchange retirees stating providers will no longer accept Aetna Medicare Advantage after the first of the year. If you are notified that your doctor or hospital is no longer accepting Aetna, please note that this change does not impact Exchange retirees. While these messages have become an increasingly routine part of end-of-year negotiations between healthcare providers and insurance companies, Exchange retirees are largely unaffected as the Aetna Medicare Advantage PPO Extended Service Area allows beneficiaries to see any provider of their choice. Specifically, there is no difference regarding out-of-pocket costs for Exchange retirees receiving in-network or out-of-network care when seeing providers that are (1) eligible to receive payment under Medicare and (2) willing to bill and accept payment from Aetna.
Any confusion is typically quickly resolved by informing the healthcare provider that you are covered by the Aetna Extended Service Area plan, which pays for out-of-network medical care and provides the same benefits as original Medicare and more including many preventive services. If necessary, you may also share Aetna’s “For Your Doctor” information sheet, available here.
If you have any questions, please contact Aetna by calling the number on the back of your insurance card and pressing 1 for Medicare Advantage or reach out to your Exchange Benefits team at Benefits@aafes.com or 800-519-3381.
Reminder: If the medical provider refuses to bill Aetna as an out-of-network provider, email Exchange Benefits, Benefits@aafes.com, with the provider information. The Benefits team will reach out to Aetna for assistance.
HQ Exchange Benefits Team
Handout for your medical provider
Update – Texas Health Resources and UTSW
We have some new information for all retirees with the Aetna Medicare Advantage Plan (PPO) Extended Service Area (ESA) relating to Texas Health Resources and UT Southwestern Medical Center.
For reference, Texas Health Resources and UTSW are part of an integrated health care network, Southwestern Health Resources. Information regarding this network can be reviewed at https://utswmed.org/why-utsw/southwestern-health-resources/.
Here’s the news, according to the Southwestern Health Resources website, https://www.southwesternhealth.org/aetna-ma-faqs, under “Which Aetna Medicare Advantage health plans are affected?” please note the following information:
If you have a PPO ESA plan, you can continue using Texas Health and UT Southwestern hospitals and providers. You’ll pay the same as if your provider or hospital were in-network.
The MAPD plan for retirees 65 and over is a PPO ESA plan! Based on this information on their own website, you will be able to see any Texas Health and UT Southwestern hospital and providers. There is no change in what you pay.
If you have any difficulty with a particular provider, please refer to the website referenced above. If needed, you can also utilize the provider handout previously referenced that can be found at https://www.aetnamedicare.com/documents/group/dodnaf/2024/24-DOD-0014_Provider_Flyer_for_Online_V3.pdf.
After providing the website information and/or the provider handout, if you continue to have an issue regarding coverage, please provide all pertinent information to HQ Benefits at benefits@aafes.com.
Update – Aetna Contract Negotiations – Baylor Scott and White
Per HQ Benefits, Aetna has reached a new 3-year agreement with Baylor Scott and White Health System effective July 1, 2026. Baylor Scott and While System will continue to participate in Aetna’s network with no disruption.
Previously HQ Benefits had advised that contract negotiations between Aetna and Baylor Scott and While had been extended to July 1, 2026, hence the commencement date of the new agreement. This is great news for any pre-65 retiree utilizing Baylor Scott and White as the system will stay in-network. For those in the MAPD plan, while access would have remained given the Extended Service aspect of the plan, there should be no issues with medical providers continuing to bill Aetna without any action on your part.