Aetna Medicare Advantage FAQs

What happened?  

Southwestern Health Resources, the network for care provided through Texas Health, UT Southwestern Medical Center, and more than 7,000 primary care physicians, specialists, and other providers in North Texas, made a good-faith effort to negotiate a new Medicare Advantage contract with Aetna. Still, Aetna declined to accept our proposed fair terms and decided to leave us out of its network. The reimbursement rates Aetna offered would not cover the rising costs of providing quality care to our patients.  

Since we did not reach an agreement with Aetna to stay in its Medicare Advantage network, your Texas Health, UT Southwestern, and affiliated doctors will be out of network as of Jan. 1, 2025.

Our top priority now is ensuring you can continue to access the physicians, clinicians and facilities you know and trust. You have an important opportunity to change your Medicare Advantage plan from Jan. 1 to March 31, 2025, to avoid any possible interruptions in accessing care. You can also switch to traditional Medicare and obtain a Part D plan during this time.  For more information, click here for the Understanding Medicare Advantage Enrollment Periods fact sheet. 

Why did this happen? 

Contract negotiations are a normal part of business and most of the time are resolved with no disruption to patient care. We are letting you know that we did not agree on a new contract and we will be out of network for Aetna Medicare Advantage health plans after Dec. 31, 2024. Therefore, we want to remind you that from Jan. 1 to March 31, 2025, you can select a new health plan to help you keep your current doctors. 

Fair rate adjustments are essential for maintaining the high standards of care you deserve. Your health and well-being are our top priorities, and we are committed to ensuring that you receive the best possible care. Southwestern Health Resources, UT Southwestern Medical Center, Texas Health, and our 7,000+ doctors want to ensure your providers in network so you can maintain your relationships with your doctors.

When does the contract with Aetna end? 

The current contract with Aetna runs through Dec. 31, 2024. The period from Jan. 1 to March 31, 2025, allows you to choose a different Medicare Advantage plan or traditional Medicare and obtain a Part D plan to keep your UT Southwestern, Texas Health, and other Southwestern Health Resources doctors and facilities in network in 2025. 

Which Aetna Medicare Advantage health plans are affected? 

Most Aetna Medicare Advantage plans are out of network as of Jan. 1, 2025. 

However, some plans may have out-of-network benefits. 

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.  

HMO, HMO-POS and PPO plans will have greater out of pocket costs starting Jan. 1, 2025. If you have this type of plan and wish to keep your doctor, consider changing to a plan with in-network benefits. If you have questions, you should call your benefits department to verify out-of-network responsibility.

Which hospitals and facilities are impacted?  

Aetna’s decision to exclude us from its network affects access to 31 hospital locations and 650 outpatient facilities. Our network, the largest in North Texas, includes five of the ten top-ranked hospitals in Dallas-Fort Worth (DFW), notably William P. Clements Jr. University Hospital, which is the No. 1 hospital in the DFW for the eighth consecutive year and ranks among the nation’s top hospitals for care in 11 specialties – the most of any hospital in Texas, according to U.S. News & World Report. 

Which providers are impacted? 

Aetna’s decision to exclude us from its network affects all UT Southwestern Medical Center and Texas Health providers and more than 7,000 affiliated doctors, specialists, and other healthcare providers.    

I have an Aetna Medicare Advantage health plan. What does this mean for me? 

You won't have in-network access to Texas Health, UT Southwestern and affiliated providers as of Jan. 1, 2025. These doctors and other healthcare providers will be out of network starting Jan. 1, 2025, which will mean significantly higher out-of-pocket costs.  

Our top priority now is ensuring our patients have continued access to the physicians, clinicians and facilities they know and trust. You have an important opportunity to change your Medicare Advantage plan from Jan. 1 to March 31, 2025, to avoid any possible interruptions in accessing care. You can also switch to traditional Medicare and obtain a Part D plan during this time. For more information, click here for the Understanding Medicare Advantage Enrollment Periods fact sheet.

Be aware that some Aetna MA plans have out-of-network benefits. Patients with a PPO ESA plan can continue using Texas Health and UT Southwestern hospitals and providers. You will pay the same as if your provider or hospital were in-network. 

HMO, HMO-POS and PPO plans will have greater out of pocket costs starting Jan. 1, 2025. If you have this type of plan and wish to keep your doctor, consider changing to a plan with in-network benefits. If you have questions, you should call your benefits department to verify out-of-network responsibility.

Texas Health and UT Southwestern emergency rooms will remain accessible regardless of our contract status with Aetna. Transition of Care (also known as Continuity of Care) benefits may be available to some patients if the treating provider reasonably believes discontinuing care could cause harm. Some examples of circumstances that may be eligible for Transition of Care include treatment for a disability, acute condition or a life-threatening illness.  

It is important to note that Transition of Care benefits are applied per a patient's benefit plan. For assistance with questions regarding transition of care options, call the number on your Aetna member ID card for customer service. You must also submit a Transition of Care form to Aetna to request a temporary extension of in-network coverage. You have 90 days from when you received a letter from Aetna about our out-of-network status to make this request, and the form requires your provider's approval.  

How can I protect my in-network access to Southwestern Health Resources’ provider network in 2025? 

Switching to one of the plans listed below will help you keep your primary care doctor and continue accessing UT Southwestern, Texas Health and other doctors and hospitals in our network. The list shows all the Medicare Advantage plans that will let you stay connected to the top care in North Texas.

^{*Contracts with no expiration date are evergreen, meaning they don’t have definitive termination dates.} 

Medicare Plan Finder 

The Medicare Plan Finder is an online resource that helps you view and compare all available drug and health plan choices. To find and compare available plans in your area, visit the Medicare Plan Finder at www.medicare.gov/plan-compare and search by ZIP code. You can also log in to your www.mymedicare.gov account for personalized results.

1-800-MEDICARE 

The Medicare Call Center can help you with specific questions about coverage, billing, claims, medical records, expenses, etc. Call 1-800-MEDICARE (1-800-633-4227). TTY users can call 1-877-486-2048.