Medicare approves private health insurance companies, such as Aetna, to offer Medicare Advantage plans. These are an alternative way to get Medicare benefits. Plans often include additional benefits such as hearing care.
Aetna’s Medicare Advantage plans are available across the United States. Many of the plans include hearing care coverage, such as annual routine hearing exams and hearing aid fitting. Some plans may also offer an annual allowance for hearing aid purchase.
Medicare Advantage plans offer the same basic coverage as original Medicare (Part A and Part B), together with some additional benefits, such as routine hearing services.
This article looks at the Aetna Medicare Advantage plans, including their hearing coverage. It also looks at eligibility and 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 began life in Hartford, CT, in 1853. They are now part of the CVS Health group.
The company estimate that 39 million people rely on them for healthcare, and the Aetna network includes 1.2 million healthcare personnel, 690,000 primary care doctors and specialists, and more than 5,700 hospitals.
Aetna provide medical, pharmacy and dental insurance plans, behavioral health services, Medicaid, and Medicare Advantage plans.
Medicare is a federal government health program. It is available to people aged 65 years and over, as well as some younger people with certain health conditions or disabilities.
Medicare has four parts, and each covers a different aspect of health care services:
- Part A covers inpatient hospital care.
- Part B covers outpatient medical care, including preventive care.
- Part C, or Medicare Advantage, combines the basic coverage of original Medicare (parts A and B), and it may include Part D.
- Part D is coverage for prescription drugs.
Medicare Advantage plan types
The various Medicare Advantage plans offer different levels of coverage, though they must all provide at least the same basic coverage as original Medicare (parts A and B).
The plans also offer additional benefits, such as prescription drug coverage and cover for dental, hearing, and vision care.
Medicare Advantage plan options include:
- Health Maintenance Organization (HMO) plans: Members have a network of preferred providers and must choose a primary care physician to manage their care and refer them to specialists.
- HMO Point-of-Service (HMO-POS) plans: These plans allow out-of-network care, but the member must pay more for services.
- Preferred Provider Organization (PPO) plans: Members also have a provider network but do not need to select a primary care doctor or request specialist referrals.
- Private Fee-for-Service (PFFS) plans: Beneficiaries will pay a fixed amount for care.
- Special Needs Plans (SNP): Providers tailor these plans to support people with specific circumstances, such as disabilities or chronic health conditions. Those who qualify for both Medicare and Medicaid can also access an SNP.
A person can use this online tool to compare Aetna Medicare Advantage plans by state, county, or ZIP code.
Aetna offer the following types of Medicare Advantage plan:
- Dual Eligible SNPs
Aetna Medicare Advantage plans offer the same basic coverage as original Medicare (parts A and B), including:
- inpatient stays in a hospital, clinic, or skilled nursing facility
- outpatient appointments
- laboratory and diagnostic tests
- preventive care and shots
- mental health services
- physical and occupational therapy
- durable medical equipment, such as oxygen equipment or crutches
- emergency care
- some transportation services
Medicare Advantage plans include supplementary benefits, which vary by plan. The extra coverage may include such items and services as:
- prescription drug coverage
- telehealth services
- routine hearing, vision, and dental care
- vision care
- podiatry, chiropractic, and diabetes services
- meal delivery services
The Centers for Medicare and Medicaid Services (CMS) use a star rating system to rate Medicare Advantage plans each year. The system uses a scale of 1 to 5 stars to measure the quality of the plans based on the following areas:
- preventive care to help people stay healthy
- management of chronic health conditions
- member experience
- customer service
The CMS awarded Aetna plans 4 out of 5 stars for their 2021 plans.
Unlike original Medicare, most Aetna Medicare Advantage plans include hearing care, such as checkups, exams, and hearing aids.
Plans provide hearing benefits through either the Aetna network or the direct member reimbursement (DMR) service.
Directly through an Aetna network
Network plans include total coverage for an annual routine hearing exam and hearing aid fitting. Plans may also cover hearing aid purchases.
Through the DMR service
DMR plans include total coverage for an annual hearing exam and hearing aid fitting if the provider is in-network. Plans may also cover hearing aid purchases.
DMR benefits provide an annual allowance so the member can visit any licensed hearing care provider in the U.S., providing they accept Medicare beneficiaries and have not opted out of original Medicare.
A person will pay the provider for the hearing services then send the itemized receipt to Aetna for reimbursement up to the allowance limit.
People can check their plan details in the Evidence of Coverage document.
Medicare Advantage plans, including Aetna plans, have several costs. These include the following:
- A monthly plan premium: This varies by location and plan. Aetna have some zero-cost premium plans, but, as with all Medicare Advantage plans, people must continue to pay the $148.50 premium in 2021 for original Medicare Part B, as well as the Part A premium, if applicable.
- Copays and coinsurance: When someone receives care, they pay a set amount as a copay or a coinsurance, which is a percentage cost.
- Deductible: People pay an amount out of pocket before their Aetna plan will cover any costs.
The table below shows some examples of Aetna Medicare Advantage plan costs in various locations.
|Location by zip code||Plan||Monthly premium||Hearing aid coverage||Annual in-network out-of-pocket limits|
|Medicare Eagle Plan (PPO)||$0||$1,250 per ear||$6,500|
|Medicare Platinum Plan (PPO)||$59||$1,250 per ear||$6,500|
|San Diego, CA|
|Medicare Plus Plan 2 (HMO)||$21||$2,500 per ear||$7,500|
A person can use the company’s online tool to check for Medicare Advantage plans that specifically include coverage for hearing aids, dental, or vision care.
Generally, if a person is eligible to enroll in original Medicare, they can also choose to get an Aetna Medicare Advantage plan — subject to the plan’s availability in their location.
People typically qualify for original Medicare if they are aged 65 years or older.
They may also qualify if they are younger and have received Social Security disability benefits for at least 24 months or receive a disability pension from the Railroad Retirement Board.
They may also qualify if they are younger than 65 years of age and have a diagnosis of end stage renal disease or amyotrophic lateral sclerosis.
Aetna offer many Medicare Advantage plan options, which typically include hearing coverage, including annual routine hearing exams, hearing aid fitting, and, in some cases, an amount toward hearing aid purchase.
Costs and covered services vary with Aetna plans. People can use the Medicare plan finder tool to find out costs and benefits by location.