A Quick Guide to Aetna Medicare Plans
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Does Aetna Offer Medicare Insurance?
Aetna is one of the largest insurers in the private Medicare insurance market, offering plans in all 50 states. They are also one of the oldest insurance companies in the U.S.
Aetna offers Medicare Advantage (Part C) plans, Medicare Supplement (Medigap) plans, and prescription drug (Part D) plans.
What Medicare Plans Does Aetna Offer?
Aetna serves Medicare-eligible Americans with both Medicare Advantage and Medicare Supplement insurance plans. In previous years, Aetna had a large presence in the prescription drug plan market. However, they sold this part of their business to WellCare in 2018.
Aetna Medicare Supplement Insurance Plans
Aetna is one of the premier providers of Medicare Supplement insurance plans. Also known as Medigap plans, Aetna issues these policies to help Medicare enrollees pay for some of the costs incurred under Original Medicare.
These costs include:
Part A deductible ($1,408 for 2020)
Part B deductible ($198 for 2020)
Part B coinsurance (20% of the cost for every Part B service or procedure)
Part B excess charges
With Original Medicare alone, you must pay for these costs out-of-pocket, and there is no limit to how much you could pay in a year. These costs are often referred to as "gaps" in your coverage. Medigap policies are issued in 10 standardized plans (A, B, C, D, F, G, K, L, M and N), with each plan covering a different mix of the Original Medicare coverage gaps.
One of the most popular Medigap plans is Plan G. With Plan G, you get coverage for:
100% of the Part A deductible
Emergency coverage outside the US
100% coverage of Part B excess charges
100% coverage of Part B coinsurance
With Plan G, all you are responsible for is the Part B deductible, which is $198. This means that you only are responsible for paying for the first $198 of Part B services. Plan G covers every other Medicare-approved expense for the rest of the year.
Aetna Medigap insurance ratings are among the highest available, which means that you can count on them to pay claims when you need that help the most.
With an Aetna Medicare Supplement insurance plan, you have maximum flexibility when it comes time to see a doctor. You can see any doctor in the nation, as long as they accept Medicare patients. You also do not need a referral.
Aetna Medicare Advantage Plans
Aetna also offers Medicare Advantage plans, which serve as an alternative to Original Medicare. In 2020, Aetna had the third highest number of Medicare Advantage enrollees of any private insurance company, providing plan coverage to approximately 11% of nationwide beneficiaries.
Medicare Advantage plans are required by law to cover everything that Original Medicare covers. They are also required to have an annual out-of-pocket maximum spending cap. In this way, you are protected from the danger of incurring high out-of-pocket costs for Medicare services.
In late 2019 Aetna announced that it an effort to keep healthcare costs affordable, it would be providing access to $0 monthly premium plans for an estimated 77% of its members.
In addition to covering Part A and B services, Aetna Medicare Advantage plans offer extra benefits. Extra benefits vary by state and county, but can include:
- Prescription drug coverage
Vision coverage — eye exams, lenses, and sometimes frames
- Dental coverage
Hearing coverage — exams, and sometimes discounted hearing aids
Transportation coverage — rides to and from medical appointments
SilverSneakers® fitness membership — free or discounted access to gyms
Emergency coverage for international
Ask a Nurse 24/7
- Resources for Living® — a concierge service for local resources in your area
Medicare Advantage plans are similar to health insurance coverage that you have probably had as an employee. Specifically, you pay small copayments or coinsurance for every procedure or service you receive. Some Medicare Advantage plans have an annual deductible, but many do not.
Some Aetna plans are Health Maintenance Organizations (HMOs). HMOs have a network of approved doctors and facilities from which you are required to receive services. Any services outside of these approved networks are not covered.
Aetna also offers Preferred Provider Organization (PPO) plans. With a PPO, the plan has a network of doctors and facilities that you can access for preferred (lower) pricing. If you receive treatments outside the preferred network, the plan will still cover you, but you can expect to pay higher prices. Aetna Medicare PPO plans are among the most popular Medicare Advantage plans available across the country.
Who Is Eligible for Aetna Medicare Plans?
In order to be eligible for an Aetna Medicare plan, you must first be enrolled in Original Medicare. The requirements for Original Medicare are based upon the following criteria:
Citizenship or residence status
Age, disability, or health
Citizenship or Residence Status
You must be a US citizen or permanent legal resident in order to enroll in Medicare. If you are a permanent legal resident, you must have resided in the US for at least five consecutive years.
Age, Disability, or Health
Most Americans qualify for Original Medicare upon turning 65. This is known as "aging into Medicare". Note that you do not have to retire, or start receiving Social Security income, in order to join Medicare. If you meet the other requirements, you can join at age 65.
You can also become eligible if you are disabled. You gain eligibility if you have received Social Security Disability payments or Railroad Retirement Board disability payments for 24 consecutive months. Your enrollment in Medicare is automatic after the 24th month, regardless of your specific age.
The third way that Americans enter Medicare is due to certain health diagnoses. Regardless of your age, you are eligible for Original Medicare, assuming that you meet the citizenship or residence requirements, if you are diagnosed with either:
End-stage renal disease (ESRD), or
ALS (Lou Gehrig's disease)
If you have either of these two conditions, there is a waiting period of up to five months, after which your enrollment in Medicare is automatic.
As long as you meet the citizenship or legal resident requirement, you can receive Part A without paying a premium. In order to qualify, you must have paid payroll taxes for a minimum of 10 years. You pay payroll taxes when you work as an employee of a company, or when you pay self-employment taxes.
Generally, if you qualify for Social Security, you will qualify for premium-free Part A. If you do not work for a long enough duration of time to qualify on your own, you can also qualify if your spouse met the requirement. This can be true even if your spouse has passed away, or if you are divorced.
If you do not qualify for premium-free Part A, you can still choose to enroll and pay for coverage. The Part A premium is $458 per month in 2020. This amount may be lower if you have some work history, but have worked less than 10 full years.
Once you are enrolled in Original Medicare, it is important to always pay your Part B premium. You must be enrolled in both Part A and B in order to participate in any of Aetna's Medicare insurance programs.
How to Choose an Aetna Medicare Plan
Researching the ins and outs of Medicare will set you up for success to get the most out of your coverage.
If you are concerned about incurring high out-of-pocket costs with Original Medicare, you may want to consider adding additional coverage. An Aetna Medicare plan could protect you from such expenses, and it may also provide you with extra benefits.
Joseph Arroyo is a licensed Medicare insurance agent who lives in Hilton Head, South Carolina. Arroyo is certified to sell Medicare products including Medicare Supplement insurance, Medicare Advantage, and prescription drug plans.