Aetna offer Medicare Advantage plans across the United States, and many plans include routine vision coverage. They may also cover eye exams, eyeglasses, frames, and contact lenses.
Medicare Advantage plans and original Medicare (Part A and Part B) offer beneficiaries equal coverage levels. Commonly, Medicare Advantage plans provide additional benefits, such as routine vision services.
This article explores Aetna Medicare Advantage plans, including their vision care 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 started life in 1853, in Hartford, CT. They are now part of the CVS Health group. The company’s health insurance plans and services include Medicare plans, pharmacy and dental plans, and other programs and services.
Aetna have 1.2 million healthcare personnel, 690,000 doctors and specialists, and more than 5,700 hospitals in their network. They serve more than 39 million people.
Medicare is a federal government health plan for people aged 65 years and over. That said, younger people can also enroll in Medicare if they have certain disabilities or health conditions.
Medicare’s four parts cover different aspects of healthcare and services:
- Part A of original Medicare covers inpatient hospital care.
- Part B of original Medicare covers outpatient medical care, including preventive care.
- Part C, or Medicare Advantage, combines the benefits of original Medicare and may also include Part D.
- Part D is optional prescription drug coverage for people enrolled in original Medicare.
Medicare Advantage plan types
Medicare Advantage plans may include various types of plan, offering different levels of coverage and availability. The list below looks at these in more detail.
- Health Maintenance Organization (HMO) plans use a network of healthcare providers, and people can choose a primary care physician to coordinate their care and issue specialists’ referrals.
- Health Maintenance Organization Point-of-Service (HMO-POS) plans allow members to use out-of-network care at a higher cost.
- Preferred Provider Organization (PPO) plans also use a provider network, but members do not need to select a primary care doctor or require specialist referrals.
- Private Fee-For-Service plans have members who pay an agreed amount for care.
- Special Needs Plans (SNPs) are for people with specific disabilities or chronic health conditions or those who have Medicare and Medicaid.
People can find out which Medicare Advantage plans are available in their area by using the government’s plan finder tool.
Aetna offer several types of Medicare Advantage plan that provide different coverage levels, though they may not offer every plan in every location. Also, plan features and benefits may vary by service area.
Aetna offer the following Medicare Advantage plans:
- HMO plans
- HMO-POS plans
- PPO plans
- Dual Eligible SNPs
All the Aetna Medicare Advantage plans provide the same basic coverage as original Medicare, including:
- inpatient stays
- outpatient appointments
- diagnostic tests
- preventive care and vaccinations
- mental health services
- physical and occupational therapy
- durable medical equipment, such as blood testing strips or walking frames
- emergency and urgent care
- some transportation services
Aetna also provide additional coverage that may include the following:
- Part D prescription drug coverage
- Silver Sneakers wellness program
- telehealth services
- routine hearing, vision, and dental care
- podiatry and chiropractic services
- meal delivery services
Star ratings
Each year, the Centers for Medicare and Medicaid Services rate Medicare Advantage plans using the star rating system. Plans can score from 1 to 5 stars based on the following:
- preventive care
- management of chronic health conditions
- beneficiary experience
- complaints and customer service
Aetna Medicare Advantage plans have an overall weighted average of 4 out of 5 for their 2021 plans.
Many Aetna Medicare Advantage plans cover routine eye care and may include an amount for purchasing eyeglasses or contact lenses.
Aetna offer vision care through a network plan or by direct member reimbursement (DMR).
Directly through an Aetna network
Individuals enrolled in the company’s network plans are entitled to one annual routine vision exam with a provider in that network. The plans also provide an annual allowance to purchase eyewear.
DMR benefit
DMR plans provide an annual allowance for eyeglasses or contact lenses.
The plans do not limit a person to using an in-network provider, so individuals can visit any licensed vision care provider in the U.S., providing they accept Medicare.
A person will pay the provider when they receive their vision care services and then send an itemized receipt to Aetna for reimbursement.
People can find more detailed plan information in the company’s Evidence of Coverage.
Costs for Aetna Medicare Advantage plans may include monthly premiums, deductibles, copays, and coinsurance. Other factors affecting costs for 2021 include where a person lives and possibly their age.
The table below shows a few examples of premium costs, together with the annual eyewear coverage allowance and maximum out-of-pocket costs.
| Area and zip code | Plan | Premium | Annual eyewear coverage | In-network maximum annual out-of-pocket costs |
|---|---|---|---|---|
| King County, WA Zip 98101 | Medicare Platinum Plus Plan (HMO) | $37 | $300 | $7,000 |
| Charlotte, NC Zip 28105 | Medicare Premium Plan (PPO) | $0 | $100 | $7,000 |
| Dallas, TX Zip 75001 | Medicare Eagle Plan (PPO) | $0 | $400 | $5,000 |
| New York City, NY Zip 10001 | Medicare Value Plan (PPO) | $22 | $150 | $11,300 |
People can find costs and other details for all plans within their zip code on the Aetna Medicare website.
To join an Aetna Medicare Advantage plan, a person must qualify for original Medicare (parts A and B), and the plan must be available in their location.
Most people qualify for original Medicare when they reach age 65 years of age. Younger people may also qualify if they have received 24 months of Social Security disability benefits, a disability pension from the Railroad Retirement Board, or a diagnosis of end stage renal disease or amyotrophic lateral sclerosis.
Medicare Advantage plans provide a bundled alternative to original Medicare (Part A and Part B). Aetna offer a range of Medicare Advantage plans, which usually include an annual routine vision test and an amount toward eyewear purchases.
Costs and benefits vary among the different Aetna Medicare Advantage plans.