- No coverage for Durable Medical Equipment. That means if you need something like a wheel chair there is no copay. A lot of DME items are big ticket items so this will mean you have to do a lot of comparison shopping before buying equipment. Make sure you buy from a supplier that sticks to Medicare's fee limits so you really are only stuck paying 20% of the cost.
- No coverage for experimental procedures.
- A blanket statement that they only cover what is in the plan documents for medical and hospital services. How do you get the document? You have to go to the Aetna website.
- No coverage for preventative benefits beyond Medicare at no additional cost. I honestly don't know what that means. A big part of my annual checkup is the blood work. Medicare doesn't cover those tests. IBM supplemental medical did. I don't know if Aetna Integration does.
I spent a great deal of time verifying that we had selected the right prescription drug plans. Although Medicare.gov had good planfinder tools it, I kept jumping from plan finder to formulary finder to compare plans to make sure I got a complete picture of the plans I was selecting. It took a lot of time.
It looks like Aetna is pushing the PPO plan pretty hard. I cannot emphasize enough that if you go that route you will have to use their doctor and hospital network to get the full benefit of the plan. If your doctors and hospital are already in the network then it is worth considering. Just remember, the participating health providers can decide to drop out any time during the year but you cannot change health plans until January 2013.
Oh, one more thing. If you are selecting a PDP do it soon as it is best to enroll via Medicare to be sure that your records are updated (versus enrolling via the private insurance company and having them notify Medicare). Medicare is advising on Medicare.gov that it takes up to 10 days to get the verification that you are enrolled. That means you will be close to the enrollment deadline when you get your verification if you enroll this week. Do it now!