Aetna Medicare Advantage plans match the coverage of original Medicare and offer additional benefits, including dental care.
Some plans cover preventive care, and others extend coverage to comprehensive care, such as fillings and extractions.
Medicare is a federal government program, and people can access Medicare benefits through either original Medicare or a Medicare Advantage plan from a private insurance company, such as Aetna.
This article discusses Aetna Medicare Advantage plans and dental care coverage. It also looks at eligibility for Aetna plans and some of the costs.
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 provide medical, prescription drug, and dental insurance plans, including Medigap and Medicare Advantage plans. The company’s Advantage plans include:
- Health Maintenance Organization (HMO) plans
- Health Maintenance Organization Point-of-Service (HMO-POS) plans
- Preferred Provider Organization (PPO) plans
- Dual Special Needs Plans (D-SNPs)
The Aetna network comprises 1.2 million healthcare personnel, more than 700,000 primary care doctors and specialists, and more than 5,700 hospitals.
Each year, the Centers for Medicare & Medicaid Services (CMS) rate Medicare Advantage plans using a star rating system. Based on quality and customer satisfaction, the CMS award a rating from 1 to 5 stars. They awarded Aetna’s 2021 plans an average of 4.0 out of 5.0 stars.
Medicare is a federal government health program with four parts. It is available to people aged 65 years and over, as well as younger people with disabilities or specific health conditions.
Each of the Medicare parts covers a different aspect of healthcare services:
- Part A covers inpatient hospital care.
- Part B covers outpatient medical care, including preventive care.
- Part C, also called Medicare Advantage, combines the basic coverage of Part A and Part B (original Medicare) and may include Part D.
- Part D is coverage for prescription drugs.
Aetna Medicare Advantage plans offer additional benefits that original Medicare does not provide. These benefits may include coverage for dental care, including:
- teeth cleaning, scaling, and polishing
- simple extractions
- denture or bite adjustments
- radiography (X-rays)
- advice on oral hygiene and diet
The specific details of each plan vary, and some plans are more comprehensive than others. People can check with their plan’s Evidence of Coverage for the details of dental coverage. The Medicare plan finder can also help a person get more information about Advantage plans.
If an Aetna Medicare Advantage plan provides dental benefits, the plan’s monthly premium may cover the cost of these services. In other cases, a person may need to purchase an optional supplemental benefit and pay an additional monthly premium.
Aetna also offer a stand-alone dental direct plan, which offers preventive care with zero out-of-pocket costs.
Aetna Advantage plans provide dental benefits through either the Aetna network or direct member reimbursement (DMR). This online tool can help a person find providers that accept their Advantage plan.
Directly through an Aetna network
With a network plan, the member must use an approved dentist from a named network who has a contract with Aetna.
The company’s in-network plans cover the total cost for preventive care, which includes oral exams, dental cleanings, and radiography. Some Aetna Advantage plans include extensive services, such as fillings and extractions.
Through direct member reimbursement benefit
If an Aetna Medicare Advantage plan offers dental coverage through DMR, a person pays upfront when they get the dental care and then submits an itemized receipt. Aetna provide forms that the person needs to complete, and the company then reimburse the amount up to the plan allowance.
People can use any licensed dental care provider in the United States for Aetna-approved services, providing that the provider accepts Medicare.
DMR plans include coverage for most preventive care and other comprehensive services.
All Medicare Advantage plans, including Aetna’s offerings, have associated costs. These include:
- Monthly plan premium: Aetna plan premiums begin at $0 but may cost more depending on coverage, location, and a person’s details. A person must also pay the premiums for Medicare Part A (if applicable) and Part B. The monthly Part B premium for 2021 is $148.50.
- Copays and coinsurance: Each time someone receives a healthcare service, they pay an amount. A copay is a fixed amount, such as $20, whereas a coinsurance is a percentage of the total cost of the service.
- Deductible: This is the amount that a plan member must pay out-of-pocket before their plan begins to pay its share.
Plan costs vary. For example, the Aetna Medicare Value HMO Plan has the following associated costs for 2021:
- $0 monthly premium
- oral exams — $0 copay (two visits every year)
- teeth cleanings — $0 copay (two visits every year)
- dental X-rays — $0 copay
The plan has a separate deductible for certain types of services, including dental care. For comprehensive dental services from in-network providers, the deductible is $50. Until the beneficiary has paid the deductible amount, they must pay the full cost. After that, the costs will be:
- nonroutine services — 20% coinsurance
- restorative services — 20–50% coinsurance
- endodontics, periodontics, and extractions — 20% coinsurance
The plan pays up to $2,000 annually for dental services. An individual must pay any amount above this limit for the dental care they receive.
Aetna also offer a discount card that provides savings of 15% to 50% off the cost of many dental services.
To join an Aetna Medicare Advantage plan, people must qualify for enrollment in original Medicare.
Generally, U.S. citizens or permanent legal residents meet the requirements for original Medicare when they reach the age of 65 years. A person may also qualify if they are under 65 years of age and, for the last 2 years, have received Social Security disability benefits or a disability pension from the Railroad Retirement Board.
If someone has end stage renal disease or amyotrophic lateral sclerosis, they may also qualify for enrollment, although they may need to select an SNP. These plans cater specifically to people with certain health conditions.
There are various enrollment periods during which people can join, change, or cancel their Medicare plans, including Advantage plans.
Aetna Medicare Advantage plans provide benefits that original Medicare does not. These typically include some level of dental coverage, including twice-yearly oral health exams, teeth cleaning, and X-rays, if necessary.
The level of dental coverage and the associated costs vary among Aetna plans.