Networks change. We verify your specific Aetna Medicare Advantage plan before your first visit; call with your member ID and we will confirm benefits, copay and any referral or authorization requirements.
Also appears on cards as: Aetna Medicare, Aetna Medicare HMO, Aetna Medicare PPO, Aetna Medicare Dual Complete, Aetna Medicare Eagle.
Aetna Medicare Advantage plans, offered by Aetna as part of CVS Health, are among the largest Medicare Advantage products in both Florida and South Carolina, with HMO, PPO and dual-eligible special needs plans available in most counties where Stedfast Psychiatry has offices. These plans replace Original Medicare's 20 percent coinsurance with fixed copays and typically cover outpatient psychiatry, medication management and psychotherapy for a mental health specialist copay, with no deductible on most plans. HMO members must use network providers but most Aetna Medicare plans do not require a primary care referral for behavioral health. PPO members can see out-of-network providers at a higher cost share. Behavioral health benefits are administered by Aetna directly rather than through a separate carve-out.
Telehealth mental health visits from home are typically covered at the same copay as office visits for members located in Florida or South Carolina during the appointment. For Deep TMS, Aetna Medicare Advantage must cover what Original Medicare covers, and it applies Medicare's criteria for severe major depressive disorder after failure of at least two antidepressants and a psychotherapy trial, with prior authorization required on most plans. Spravato is covered as a Part B drug with prior authorization, with documentation of treatment-resistant depression, a concurrent oral antidepressant and REMS-certified administration. Cost sharing for TMS sessions and for Spravato drug and monitoring is set by your plan and can be a copay or a percentage, so our staff verify your specific benefits before treatment begins.
What we check before your visit
- Whether your plan is in network at the office you chose and for telehealth
- Your copay or coinsurance for an evaluation and for follow-ups
- Whether a primary-care referral is required (common with HMO plans)
- Prior-authorization criteria for Deep TMS and Spravato, if those are being considered
Frequently asked questions
Does Stedfast Psychiatry accept Aetna Medicare Advantage?
Stedfast Psychiatry accepts many Aetna Medicare Advantage HMO, PPO and dual-eligible plans in Florida and South Carolina. Aetna offers several plan designs in each county, and networks differ among them, so confirm that your specific plan includes our office by calling the number on your card or asking our front desk to verify before scheduling.
What is the copay for a psychiatrist on Aetna Medicare Advantage?
Most Aetna Medicare Advantage plans charge a fixed copay for outpatient mental health specialist visits, with no deductible, and dual-eligible special needs plan members typically pay nothing. Telehealth visits usually carry the same copay. Your evidence of coverage lists the exact amount, and our staff can confirm it before your first appointment.
Do I need a referral to see a psychiatrist on an Aetna Medicare HMO?
Most Aetna Medicare Advantage HMO plans do not require a primary care referral for outpatient mental health visits, but a few plan designs do. Check your evidence of coverage or call Aetna. If a referral is required, your primary care office can usually send one electronically the same day, and we can help coordinate.
Does Aetna Medicare Advantage cover Deep TMS and Spravato?
Yes, under Medicare's criteria, with prior authorization required on most plans. TMS is covered for major depressive disorder after failure of at least two antidepressants and a psychotherapy trial. Spravato is covered for treatment-resistant depression with a concurrent oral antidepressant. Our team submits the request and confirms your per-session or per-dose cost share before scheduling.