Aetna Medicare Premier Plan (H0628-003) Exiting Some Ohio Counties for 2025: What You Need to Know

If you’re a Medicare beneficiary in Ohio enrolled in Aetna’s Medicare Advantage Plan H0628-003, you may have recently received some news that could affect your healthcare in 2025. Aetna has announced that it will be discontinuing Plan H0628-003 in several Ohio counties, meaning beneficiaries will need to select a new Medicare plan during the Annual Enrollment Period (AEP) or risk losing their coverage.

This change can be a source of confusion and concern for many, but with the right information, you can make an informed decision about your healthcare for the upcoming year. Here’s everything you need to know about Aetna Medicare Advantage Plan H0628-003 exiting certain Ohio counties and what your next steps should be.

What Counties Are Affected by Aetna’s Exit?

Aetna has decided to withdraw its H0628-003 Medicare Advantage plan from a number of counties across Ohio. While the company hasn’t completely pulled out of the state, it’s important to check whether your county is among those affected. Counties impacted by this decision include Adams, Brown, Butler, Champaign, Clinton, Darke, Greene, Highland, Logan, Preble and Shelby.

If you live in one of these counties, it’s crucial to take action during the Medicare Annual Enrollment Period (AEP), which runs from October 15 through December 7, to ensure you have coverage for 2025.

Why Is Aetna Exiting These Counties?

Aetna, like other Medicare Advantage providers, periodically reviews its plan offerings to assess financial viability, provider networks, and coverage quality. There can be many reasons why an insurer decides to exit a specific market, such as changes in network provider availability, plan profitability, or regulatory concerns.

Aetna hasn’t disclosed the exact reasons for discontinuing Plan H0628-003 in these Ohio counties, but it’s not uncommon for Medicare Advantage providers to adjust their plan portfolios to better align with their overall business strategy or changes in healthcare costs.

What Does This Mean for You?

If you are enrolled in Plan H0628-003 in one of the affected counties, your coverage will not automatically roll over to another Aetna plan. This means that starting in 2025, you will no longer be covered under this specific plan. However, you have several options to ensure you maintain Medicare coverage:

1. Enroll in Another Aetna Medicare Advantage Plan
   Aetna will likely offer other Medicare Advantage plans in your area, though the exact benefits and costs may differ from your current plan. Be sure to carefully review these plans to determine if they meet your healthcare needs.

2. Switch to a Different Medicare Advantage Plan
   There are many Medicare Advantage plans offered by other insurers in Ohio. During AEP, you can compare plan options from different providers to find one that best suits your needs. Consider factors like provider networks, prescription drug coverage, and additional benefits like dental, vision, or hearing coverage.

3. Return to Original Medicare
   If you don’t find a Medicare Advantage plan that fits your needs, you also have the option to return to Original Medicare (Part A and Part B). Keep in mind that Original Medicare doesn’t cover everything, and you might want to consider adding a Part D plan for prescription drug coverage or a Medigap (Medicare Supplement) plan to help cover out-of-pocket costs like deductibles and coinsurance.

4. Consider a Medicare Advantage Special Needs Plan (SNP)
   If you have specific healthcare needs, such as a chronic condition, you may qualify for a Medicare Advantage Special Needs Plan (SNP). These plans are tailored to individuals with certain conditions and often provide more specialized care and additional benefits.

   

Steps to Take During AEP

1. Review Your Options
   The first thing you should do is review your options for 2025. Make sure you compare premiums, out-of-pocket costs, and network restrictions to find the best fit for your healthcare needs.

2. Consider Your Prescription Drug Coverage
   One of the key components of any Medicare Advantage plan is prescription drug coverage. If you have medications you take regularly, make sure any plan you consider offers comprehensive drug coverage and includes your medications in its formulary at an affordable price.

3. Check Provider Networks
   If you have doctors, specialists, or healthcare providers you prefer, ensure they are included in the network of any new plan you’re considering. Medicare Advantage plans can have limited provider networks, so it’s important to verify that your providers are still available under your new plan.

4. Verify Additional Benefits
   Many Medicare Advantage plans offer additional benefits like dental, vision, hearing, and wellness programs. If these benefits are important to you, make sure the plan you choose provides them. Keep in mind that not all Medicare Advantage plans offer the same level of extras, so compare plans carefully.

5. Submit Your Application During AEP
   Once you’ve selected the plan that’s right for you, be sure to enroll before the Annual Enrollment Period ends on December 7. Failure to do so could leave you without coverage in 2025, or you may face delays and penalties if you try to enroll later.