Breaking Down Aetna Medicare Advantage Plans

• Medicare Advantage (MA) plans are known as supplemental plans to Original Medicare for they work to cover the gaps in standard Medicare coverage.

• Aetna is known as the fourth-largest Medicare Advantage plan provider in the nation and is an affiliate of CVS Health.

• Aetna offers a wide range of plan types such as HMOs, PPOs, HMO-POSs, etc.

• Additional benefits such as fitness memberships, vision coverage, meal delivery coverage, and more are covered by most Aetna MA plans.

Medicare Advantage plans, otherwise known as ​“Medicare Part C” or ​“MA Plans,” are considered Medicare supplement plans. MA plans work to fill the coverage gaps in Original Medicare by wrapping Part A, Part B, and Part D insurance into one plan alongside potential coverage for dental, hearing, and vision. Medicare Advantage plans are offered through private insurance companies that have contracts with the Federal Medicare Program. Any individual that’s eligible for Original Medicare is also eligible to enroll in a MA plan. However, while Original Medicare does not require plan renewal after initial enrollment, MA plans may change annually inciting plan changes for various enrollees.

Note: To learn more about Medicare Advantage plans, visit this source.

Aetna is considered the fourth-largest provider of MA plans in the nation with over 2.9 million Medicare beneficiaries enrolled in an Aetna MA plan. Aetna health insurance provides MA coverage to individuals in 46 states plus Washington D.C. Since 2018, Aetna has been known as a CVS Health company, allowing beneficiaries to receive the same in-network coverage at CVS walk-in clinics or MinuteClinics.

To speak with a licensed insurance agent from Aetna’s Medicare Advantage team, contact 1–855-335‑1407 anytime from 8 a.m. to 8 p.m. seven days a week.

Note: To learn more about the Aetna health insurance company, visit this source.

Aetna supports a wide array of Medicare Advantage plan types from HMO plans to PPO plans to D‑SNPs, and more. Most Aetna MA plan types include Part D (prescription drug) coverage.

Health Maintenance Organization (HMO) Plans

HMO plans are known for being cost-effective and convenient as they require a provider to have a primary care physician (PCP). This primary care physician works to coordinate a holistic healthcare experience for the patient; they guide the patient’s health and wellness by coordinating the patient’s care and various providers. The downside to this plan is that all care must be done in-network, otherwise, enrollees may face high costs. Not to mention, referrals are required if patients wish to see a different provider or specialist.

Note: To learn more about HMO plans, visit this source. To find an Aetna HMO plan near you, visit this source.

Preferred Provider Organization (PPO) Plans

PPO plans are also known to be cost-friendly and popular as they provide a patient with more flexibility over their care. A PCP is not required with this plan, nor are referrals or in-network coverage. However, it should be noted that out-of-network providers may be more expensive.

Note: To learn more about PPO plans, visit this source. To find an Aetna PPO plan near you, visit this source.

Health Maintenance Organization Point of Service (HMO-POS) Plans

HMO-POS plans are very similar to HMO plans as they require individuals to have a primary care provider (PCP) and are cost-efficient. However, they often provide greater flexibility when it comes to getting referrals for specialists or seeing providers that are out-of-network.

Note: To learn more about HMO-POS plans, visit this source. To find an Aetna HMO-POS plan near you, visit this source.

Dual-Eligible Special Needs Plans (D‑SNPs)

SNPs are Medicare Advantage plans that cover individuals with specific diseases or illnesses. The benefits, providers, and drug coverage provided with this plan are uniquely tailored to the individuals being treated and covered under a special needs plan. In most cases, a PCP is necessary along with referrals for other providers or specialists.

Aetna provides Dual-Eligible SNPs for those eligible for both Medicare and Medicaid. 

Note: To learn more about SNPs, visit this source or this source. To find an Aetna D‑SNP near you, visit this source.

Beneficiaries enrolled in an Aetna Medicare Advantage plan are also eligible for a plethora of additional benefits including but not limited to:

• Dental Coverage: Most Aetna MA plans provide coverage for necessary dental procedures or annual preventive visits.

• Vision Coverage: Most Aetna MA plans provide coverage for routine eye examinations and prescription eyewear such as glasses or contact lenses.

• Hearing Coverage: Aetna has paired with NationsHearing to provide better coverage for hearing exams and the purchasing of hearing aids.

• Fitness Memberships: Most MA plans provide fitness memberships through the SilverSneakers health and wellness program. This program gives MA beneficiaries access to thousands of gyms nationwide, virtual health and wellness workshops, nutrition classes, and more.

• Telehealth Benefits: All Aetna MA plans will provide coverage for virtual primary care, urgent care, behavioral health care, and specialty care visits.

• Prescription Mail Order Discounts: Save money through Aetna’s convenient prescription mail order service that allows individuals to order their medications in bulk for less cost.

• 24 Hour Nurse Line: Aetna ensures all questions and concerns are answered by providing their beneficiaries with a 24-hour hotline connection to trained nurses and providers.

• Over-the-Counter (OTC) Drug Discounts: Aetna’s Medicare Advantage plans link beneficiaries with an array of discounts on OTC medications.

• Meal Delivery Programs: For patients that are in recovery or require in-home care, Aetna provides them with coverage for meal delivery programs.

Note: To learn more about the additional benefits included in Aetna’s Medicare Advantage plans, visit this source.

A variety of factors are included when considering the cost of any MA plan such as monthly premiums, deductibles, out-of-pocket costs, copayments, and coinsurance. The cost of one’s Aetna Medicare Advantage plan is dependent on where one lives, which plan one chooses, and what one’s specific health needs are. 

In 2022, Aetna is expanding its $0‑premium plans to approximately 84% of their Medicare Advantage beneficiaries. Regardless of specific Aetna plan costs, all MA plan beneficiaries are required to pay their Part B premium which is projected to be approximately $158.50 per month in 2022. 

Note: To learn more about costs associated with Aetna’s Medicare Part C plans, visit this source. To learn more about Aetna’s plan changes in 2022, visit this source.

In order to enroll in an MA plan through Aetna, a CVS Health company, one should use Aetna’s search tool to find local plans and tips for enrollment. Any eligible Medicare beneficiary is able to enroll in an MA plan during their Medicare annual enrollment period otherwise known as the initial enrollment period (IEP), switch their plan during the open enrollment period (OEP), or enroll in an MA plan during the general enrollment period (GEP). The dates for these enrollment periods are as follows:

Initial Enrollment Period

The initial enrollment period spans a total of seven months and is the same as Original Medicare’s IEP. These seven months include three months prior to an individual’s 65^th birthday, the month of one’s 65^th birthday, and the three months following one’s 65^th birthday. 

Open Enrollment Period

October 15^th to December 7^th is considered Medicare’s OEP and it allows beneficiaries to switch their current plan, e.g., switch from Original Medicare to an MA plan, switch from one MA plan to another, etc.

General Enrollment Period

The GEP for Medicare Advantage spans from April 1^st to June 31^st and is an additional timeframe for eligible individuals to register for a MA plan.

Note: To learn more about Medicare Advantage’s enrollment periods, visit this source.

Before choosing a Medicare Advantage plan, one should use the government’s Medicare Advantage plan comparison tool to evaluate and compare plans. Things to consider before deciding on the best supplemental Medicare plan:

Cost:

• How much are they willing to spend monthly on a premium?

• What do they want their deductible to look like?

Coverage:

• Will their prescriptions be covered under this plan?

• Is additional coverage offered for services such as dental, vision, or hearing?

• Will their current doctors or specialists be covered?

Convenience:

• Where is their insurance office in case they need assistance?

• Does their insurance provide transportation to and from healthcare appointments if needed?

Note: Oak Street Health provides transportation to and from healthcare appointments for patients that need assistance. They also have providers that are trained and willing to guide patients through their insurance benefits whenever needed.