Aetna Medicare Advantage Review
While Aetna does not offer as many extra perks as other carriers, the company has a strong track record of maintaining competitive rates year over year. In addition, Aetna is committed to giving back to the communities it serves through volunteer work and financial support.
$0 premium and $0 deductible plans, including $0 deductible Part D coverage
Wide range of extra benefits including dental, vision, hearing, meal delivery, non-medical transportation, SilverSneakers, and 24/7 nurse hotline
Multiple plan options, including the Explorer plan that allows you to get in-network care at any Aetna facility nationwide
Nationwide provider network with access to CVS Health benefits
Limited plan options in some states
Not all plans include Part D prescription drug coverage
Not available in Alaska, Connecticut, Hawaii, Maine, Massachusetts, Washington, or the District of Columbia
Some plans charge an extra premium for supplemental benefits
About 39 million people choose Aetna for their Medicare coverage, making it the fourth largest Medicare Advantage provider in the country. Aetna is a highly respected name in the Medicare market. In fact, the company paid the country's first Medicare claim in 1966.
Aetna sells Medicare Advantage plans in 44 states. It offers four different plan types including the popular Explorer plan that lets members use their in-network benefits at any Aetna facility in the country. Aetna also offers a wide range of popular perks and extra benefits.
Who recommends Aetna?
Aetna is a leader in innovative health initiatives and insurance products. This is evidenced by the numerous awards and accolades it received, including the following:
Centers for Medicare and Medicaid Services (CMS) recognized Aetna for having 76 percent of Medicare Advantage members enrolled in a 4.5-star or higher plan, the highest percentage among publicly traded insurance companies.
J. D. Power & Associates awarded Aetna an Outstanding ranking four years in a row for providing excellent customer service.
FORTUNE Magazine named Aetna the most admired health insurance company for three years in a row, ranking it number one for Quality of Products and Services and Quality Management, and number two for Innovation.
The National Business Group on Health gave Aetna its Innovation in Reducing Health Disparities Award in recognition of Aetna's programs to reduce asthma complications among Hispanics and African Americans.
Center for Plain Language awarded Aetna top honors for its clear, easy-to-understand enrollment materials and its communications with Medicare Advantage members.
How do Aetna's Medicare Advantage plans work?
Aetna Medicare Advantage is private insurance. This means that Aetna determines plan benefits, premiums, and cost-sharing. It also means that Aetna, not Medicare, handles your insurance claims. You do still retain all your Medicare rights and protections if you choose an Aetna plan.
Some plans have a monthly premium in addition to your standard Part B premium, but most people enroll in a $0 premium HMO plan. You may have an annual medical deductible, depending on the plan. Unlike Original Medicare, which has separate deductibles for Part A and Part B, you only pay one deductible each year with Medicare Advantage.
Most plans include Part D prescription drug coverage with $0 copays for preferred generic drugs and no Part D deductible.
All Aetna Medicare Advantage plans include the SilverSneakers fitness program. Many cover routine vision, dental, and hearing care for no additional premium. Aetna also added some of the new expanded benefits approved by CMS in 2018. These benefits include home meal delivery, home health monitoring, non-medical transportation, and coverage for over-the-counter medications and devices.
All Aetna Medicare Advantage plans cap your out-of-pocket spending each year. CMS sets the annual maximum (which was $6,700 in 2020). The good news is that many Aetna plans set their spending cap below the government maximum.
What Medicare Advantage plans does Aetna offer?
Aetna offers the following four different plan options (plan types and specific benefits vary by location):
Aetna Medicare Advantage HMO
This is Aetna's value plan. In most areas, there are $0 premium, $0 deductible plans with low copays for primary care available. Although all HMO plans include prescription drug coverage, there is no separate Part D deductible. Most plans have $0 copayments for preferred generic drugs.
As with all HMOs, you need to choose a primary care doctor and receive all of your care from network providers. The only exception would be in the case of an emergency. You usually need referrals and prior authorization for specialist care and certain tests and procedures.
Most HMO plans include extra benefits such as dental, vision, and hearing services. Benefits such as meal delivery, transportation, and over-the-counter benefits are less common.
Aetna Medicare Advantage HMO-POS
This is a hybrid plan that offers HMO coverage when you see network providers, but gives you the flexibility to get care out-of-network. You may have to choose a primary care provider and get a referral for certain services.
There is usually a low monthly premium for HMO-POS plans. There is a chance that $0 premium plans may be available in your area. Deductibles range from $0 to $500, depending on the plan chosen. Most plans include Part D prescription drug coverage, as well as supplemental vision, dental, and hearing coverage. All plans include SilverSneakers.
Aetna Medicare Advantage Dual Special Needs Plan (DSNP)
Aetna's Special Needs plan is limited to people who are eligible for both Medicare and Medicaid. Most people who qualify pay no premiums or deductibles, and low or no copays for most services. Currently, it is only available in 14 states.
DSNPs differ from regular SNPs in that they include extra benefits for vision, dental, hearing, and personalized care coordination. They also cover over-the-counter medications and devices. Some even cover alternative therapies like acupuncture. Yet another perk is that most members are eligible for a free Lifeline phone and cellular service.
Aetna Medicare Advantage PPO
With a PPO plan, you can see any provider that accepts Medicare and the terms of your Aetna plan. If you use network providers, you pay much less out of pocket, but if you decide to go outside your network, your coinsurance can be as high as 50 percent. You don't need a primary care physician or referrals for specialist care with Aetna's PPOs.
Most plans have a monthly premium and annual deductible, which can be as high as $1,800 with some plans. PPOs usually include Part D prescription drug coverage, as well as coverage for routine vision, dental, and hearing care. Benefits for meal delivery and transportation are less common.
The Explorer plan (EPO) is a variation of Aetna's standard PPO. With the Explorer plan, you pay in-network copays if you get care from an Aetna facility anywhere in the country. You're not restricted to your plan's service area, which makes the EPO a popular choice for frequent travelers and dual residents. This option is currently available in 28 states.
How do Aetna Medicare Advantage plans compare to other insurance providers?
CMS recognized Aetna for having the most enrollees in a plan that was rated 4.5 stars or higher. Medicare star ratings measure plan quality across a number of factors, including cost, quality of care, customer satisfaction, and patient safety.
Aetna also gets an A+ rating from the Better Business Bureau, although J .D. Power and Associates showed a slightly higher than average number of complaints in a 2020 survey. A. M. Best gives Aetna an excellent rating for financial stability.
Aetna has a large nationwide health network with over 700,000 primary care doctors and specialists and 5,700 hospitals. As part of the CVS Health family, Aetna members have access to the largest pharmacy network in the country. In addition to low network copays, plan members have access to walk-in immunizations and vaccines with no out-of-pocket costs.
Some plans even offer plan members no-cost health screenings, wellness services, and routine health care at CVS MinuteClinics.
What makes Aetna's Medicare plans stand out?
Aetna has one of the largest health networks in the country. With its widespread network and broad range of Medicare Advantage plans, Aetna gives you maximum flexibility to find coverage that meets your unique needs.
Aetna also offers plans at every price point, including $0 premium and $0 deductible value plans for budget-conscious buyers. Beneficiaries who value choice over cost can choose a PPO plan that gives them the freedom to use any provider that accepts Medicare anywhere in the country.
The CVS Health connection means Aetna members have high-quality prescription drug coverage and a robust mail-order pharmacy. Most plans have over 3,800 covered medications in their formulary.
How does pricing work with Aetna, and can I get any discounts?
If you enroll in an Aetna Medicare Advantage plan, you must continue to pay your Part B premium, which is $144.60 in 2020. Most people pay no additional premium for their Aetna plan.
If you don't choose a $0 premium plan, HMOs and HMO-POS plans are usually the most economical options. According to Aetna, HMO-POS premiums range from $0 to $33 per month and HMOs between $0 and $178 per month in 2020.
PPO plans are usually the most expensive, although $0 premium plans are available in some locations. PPO premiums range between $0 and $214 per month in 2020.
Keep in mind most Aetna plans include Part D. This means your plan premium includes both your health and prescription drug coverage. With most PPO plans, you pay no extra premium for supplemental benefits like vision, dental, and hearing care.
How do I know if I'm eligible to enroll in an Aetna plan?
Anyone who is eligible for Medicare and enrolled in Part A and Part B can enroll in any Aetna plan sold in their service area. You can't be turned down for a preexisting condition, and you can't be charged a higher premium because of your health status.
Aetna plans aren't available in the following states:
The District of Columbia
You can enroll in an Aetna plan during your Medicare Initial Enrollment Period, which starts three months before your 65th birthday and lasts for seven months total. If you get Medicare due to a qualifying disability, you can enroll in an Aetna Medicare Advantage plan as soon as you are eligible for Medicare.
If you're currently enrolled in Original Medicare, you can switch to an Aetna plan during the Annual Election Period (October 15 through December 7 each year). If you're currently a member of a Medicare Advantage plan, you can switch to Aetna during the Medicare Advantage Open Enrollment Period (January 1 through March 31 each year).
Choosing the right Medicare plan is one of the most important decisions you'll make. It's essential to consider your health needs, lifestyle, and budget to find the best fit. Your State Health Insurance Assistance Program can be a helpful resource. The Medicare Plan Finder tool is a great place to research available plans. You can also contact a licensed Medicare broker for detailed information about local plans and provider networks to help you make an informed decision.
Explorer benefits package
Aetna's "Explorer" benefit provides coverage at any facility in the country.
72% of Aetna enrollees have a $0 monthly premium.
Highly rated plans
CMS recognized Aetna for having the most enrolles in a plan that was rated 4.5 stars or higher.
By: Sheila Olson
Sheila has over two decades of experience writing about Medicare, health, and personal finance. Her work has been featured on sites such as Investopedia, The Motley Fool, and Boomer Benefits. Sheila holds a MPH (Master of Public Health) from Northern Arizona University.