Medicare Advantage plans are an alternative way for people to get Medicare parts A and B benefits. Most plans also provide coverage for prescription drugs.
Private companies such as Aetna offer Medicare Advantage plans throughout the country.
This article looks at the different Aetna Medicare Advantage plans available, benefits, availability, costs, and waivers.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Aetna are a healthcare benefits company that CVS Health acquired in 2018. They serve around 39 million people.
The Centers for Medicare and Medicaid Services gave Aetna 4.3 out of 5.0 stars for their Medicare Advantage Prescription Drug (MAPD) plans in the 2020 annual Star Ratings.
Aetna have a range of Medicare Advantage plans. The plans typically include prescription drug coverage and some additional benefits.
The following sections will outline their available plans in more detail.
Health Maintenance Organization plans
When someone joins a Health Maintenance Organization (HMO) plan, they choose an in-network primary care physician who coordinates their healthcare.
The primary care physician is a doctor who is the primary contact for all medical matters. If someone needs to see a specialist or requires a hospital visit, for example, the primary care physician needs to provide a referral.
Typically, members must use services from a specific network of doctors and healthcare facilities, unless in an emergency.
HMO plans have limited out-of-network benefits.
Aetna HMO plans require members to use a network of health services. Members must also select a primary care physician who provides referrals to see specialists.
Aetna HMO plan benefits include:
- prescription drug coverage and mail-order benefits
- dental, vision, and hearing cover
- worldwide emergency care cover
HMO Point of Service plans
Aetna’s Medicare Advantage HMO Point of Service (HMO-POS) plans also offer the benefits of coordinated care through a primary care physician.
Members have the flexibility to choose out-of-network providers for some services, though this is likely to be at a higher cost.
Aetna HMO-POS plans do not require a person to use in-network health services. In some plans, members will need to select a primary care physician.
Aetna HMO-POS plan benefits include:
- prescription drug coverage and mail-order benefits
- dental, vision, and hearing cover
- worldwide emergency care cover
Preferred Provider Organization plans
Aetna’s Medicare Preferred Provider Organization (PPO) plans allow members to visit any provider without a referral. When someone uses in-network services, they need not make a claim, and the cost is lower.
With some Aetna PPO plans, the member can choose a primary care physician. This can save on costs.
Aetna PPO plans do not require a person to use in-network health services or select a primary care physician.
Aetna PPO plan benefits include:
- prescription drug coverage and mail-order benefits
- dental, vision, and hearing cover
- worldwide emergency care cover
Aetna recently expanded their plan options. They now offer individual MAPD plans in 45 states, plus Washington, D.C.
Other new plans include:
- Prescription Drug Plan: There are two new individual plans, called SilverScript Choice and SilverScript Plus. Both plans have $0 tier 1 copay at select pharmacies. Standard tier 1 copay is $15.
- Dual Eligible Special Needs Plan (DSNP): A total of 14 states now offer DSNP plans for people who qualify for Medicare and Medicaid benefits.
- Medicare supplement: Aetna now offer options for Medicare supplement plans in 45 states. These plans allow people to customize their plans to suit their health needs.
- Group Medicare: This is available to businesses in all 50 states. It includes virtual behavioral healthcare via phone and video chat.
Most Aetna Medical Advantage plans offer a range of benefits, though these can vary by plan.
Benefits include:
- Dental, vision, and hearing: Free checkups, exams, eyeglasses, and hearing aids are available with in-network providers.
- Fitness benefits: Aetna members can use the Silver Sneakers fitness programs at any of the 16,000 gyms nationwide.
- Over-the-counter benefits: Members can get some nonprescription drugs and health products, such as vitamins and cold medications, directly from a pharmacy at no cost.
- Total health benefits: These include a 24-hour nurse hotline, free annual flu vaccinations, and prescription home delivery.
- Meals-at-home program: This offers meal delivery during someone’s recovery after a hospital stay. Aetna provides 14 meals per week.
- Resources For Living program: This is a helpline that gives members access to services and resources in their community, including help at home, caregiver support, social support, and other activities.
Aetna offer Medicare Advantage plans in all 50 states.
People can visit the Aetna website and enter their zip code to find out which plans Aetna offer in their area.
The costs of Aetna Medicare Advantage plans depend on someone’s circumstances and the plan they choose.
The table below outlines the approximate 2021 costs in Fairfield, Connecticut.
| PPO | HMO | HMO-POS | |
|---|---|---|---|
| Monthly premium | Varies by plan from $0–$99 | Varies by plan from $0–$99 | Varies by plan from $0–$28.20 |
| Medical deductible | Varies by plan from $0–$1,000 | Varies by plan from $0–$1,000 | From $0 |
| Limits out-of-pocket expenses | Yes | Yes | Yes |
The coinsurance and copay amounts vary with individual plans and the medical service.
Waivers for 2021
There is a waiver for individuals enrolled in a Medicare Advantage HMO.
The Commonwealth Fund waived the Medicare deductible for 2020 for people who change to the new Aetna Retired Employees Health Program Medicare Open Access PPO.
From January 1, 2021, the annual deductible applies.
This Medicare Advantage plan also has an open-access feature. Members will pay the same for any doctor or hospital, according to the listed costs. This gives them greater freedom of choice.
Aetna offer a range of Medicare Advantage plans, including HMO, HMO-POS, and PPO plans. These are available throughout the country, but people will need to check whether or not Aetna offer the plan they want in their location.
The plans offer the same coverage as original Medicare, as well as benefits such as dental and vision care.
Individuals can choose the plan that best suits their specific health needs and offers the best value for money.
We will update the 2021 costs as soon as possible after the Centers for Medicare and Medicaid Services (CMS) have released them.
We last updated the costs on this page on October 12, 2020