Which Houston Hospitals Take Aetna Medicare Advantage Plans

How to learn about a Houston hospital accepts your Aetna Medicare Advantage plan

Whether a Houston hospital accepts your Aetna Medicare Advantage plan depends on which specific plan you have and which hospital you want to use. Aetna offers multiple Medicare Advantage plans in the Houston area, and each one has its own network of hospitals and doctors. The fastest way to know for certain is to call the hospital's billing department directly, or to check your plan documents or the Aetna member website before you go.

Large Houston hospitals like Memorial Hermann, Houston Methodist, and Texas Children's Hospital are in-network for many Aetna Medicare Advantage plans, but not all of them. Some Aetna plans are HMO plans, which means you can only use hospitals in their network without paying extra out of pocket. Others are PPO plans, which let you go to out-of-network hospitals but charge you more. Knowing which type of plan you have makes a real difference in what you will owe.

Key Takeaways

Call the hospital's billing department or your Aetna plan member services line to confirm whether a specific Houston hospital is in your plan's network before you schedule care.
Aetna Medicare Advantage plans in Houston include both HMO and PPO options, and each plan has a different hospital network.
Your plan documents and the Aetna member website both show which hospitals are in-network for your specific plan.
If a hospital is out-of-network, you will pay more, and HMO plans may require you to get a referral from your primary care doctor first.

How to check your plan's hospital network

Start by looking at the documents you received when you joined your Aetna Medicare Advantage plan. Your plan materials should include a provider directory or a list of in-network hospitals. If you cannot find the paper copy, log into your Aetna member account online at aetna.com or call the member services number on the back of your insurance card.

When you call Aetna member services, have the name of the hospital ready and ask whether it is in-network for your specific plan. The representative can also tell you whether you need a referral from your primary care doctor before you go, and what your out-of-pocket costs will be. This takes about five minutes and removes the guesswork.

You can also search the Aetna website directly. Go to aetna.com, sign in, and use the "Find Care and Costs" tool to search for hospitals by name or location. The tool will show you which hospitals are in-network and what your estimated costs would be for common procedures.

Major Houston hospitals and Aetna Medicare Advantage coverage

Memorial Hermann Health System, which includes Memorial Hermann-Texas Medical Center and multiple other locations across Houston, is in-network for many Aetna Medicare Advantage plans. However, not every Aetna plan in Houston includes every Memorial Hermann facility, so you still need to check your specific plan.

Houston Methodist, another large system with multiple hospitals in the Houston area, is also in-network for many Aetna plans. Texas Children's Hospital, Baylor College of Medicine, and UT Health Houston are commonly in-network as well, but again, this depends on which Aetna plan you have.

Smaller or specialty hospitals may not be in-network for your plan, or may be in-network for some Aetna plans but not others. This is why calling ahead or checking your plan documents is so important — you cannot assume that a well-known hospital is covered by your plan.

What happens if your hospital is out-of-network

If you go to a hospital that is not in your plan's network, you will pay more out of pocket. With an HMO plan, you may have to pay the full bill yourself unless it was an emergency. With a PPO plan, your insurance will still help pay, but you will owe a higher copay or coinsurance than you would at an in-network hospital.

In an emergency, most Aetna Medicare Advantage plans will cover the cost at any hospital, whether it is in-network or not. If you are not sure whether your situation counts as an emergency, call Aetna member services or go to the nearest hospital and let them know you have Aetna Medicare Advantage — the hospital can contact Aetna to confirm coverage.

Referrals and prior approval for hospital care

If you have an HMO plan, you usually need a referral from your primary care doctor before you can go to a hospital for non-emergency care. Your doctor sends the referral to the hospital, and the hospital confirms that your plan covers the procedure. This step can take a few days, so plan ahead if you can.

Some procedures also require prior approval from Aetna before you go to the hospital. Your doctor's office usually handles this, but you can also call Aetna member services to ask whether a specific procedure needs approval. Getting approval in advance protects you from surprise bills and makes sure the hospital knows your insurance will pay.

What to do if a hospital says it does not take your plan

If a hospital tells you it does not accept your Aetna Medicare Advantage plan, ask them to check again or provide that information in writing. Sometimes hospitals have outdated information about which plans they accept. You can also call Aetna member services to confirm whether that hospital is truly out-of-network or whether there is a billing issue the hospital needs to resolve.

If the hospital is genuinely out-of-network and you need care, ask whether you can transfer to an in-network hospital, or ask the hospital what your out-of-pocket cost would be. Some hospitals will work with you on payment if you explain your situation. You can also file a complaint with Aetna if you believe the hospital should be in-network but is refusing to bill your plan.

Frequently Asked Questions

Can I use any Houston hospital with my Aetna Medicare Advantage plan?

No. Each Aetna Medicare Advantage plan has its own network of hospitals. You can use in-network hospitals with lower out-of-pocket costs. Out-of-network hospitals charge you more, and HMO plans may not cover them at all except in emergencies. Check your plan documents or call Aetna to confirm which hospitals are in your network.

Do I need a referral to go to a Houston hospital?

It depends on your plan type. HMO plans usually require a referral from your primary care doctor for non-emergency hospital care. PPO plans typically do not require a referral. Call your doctor's office or Aetna member services to find out whether you need one before you schedule.

What should I do if I need emergency care at a hospital that is out-of-network?

Go to the nearest hospital. Most Aetna Medicare Advantage plans cover emergency care at any hospital, in-network or not. Tell the hospital you have Aetna Medicare Advantage, and they can contact Aetna to confirm coverage while you are being treated.

How do I find out my out-of-pocket costs before I go to the hospital?

Call Aetna member services with the name of the hospital and the procedure you need. They can give you an estimate of your copay or coinsurance. You can also use the "Find Care and Costs" tool on the Aetna website if you are logged into your account.

What if the hospital will not accept my Aetna Medicare Advantage plan?

Ask the hospital to verify your plan information, or call Aetna member services to confirm whether the hospital is in-network. If the hospital is in-network but refusing to bill your plan, ask for the issue in writing and contact Aetna to file a complaint. If the hospital is out-of-network, ask what your costs would be or whether you can transfer to an in-network facility.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.