Aetna Medicare Plans Review
Aetna offers a wide range of Medicare plans, including Medicare Advantage (Part C) plans and Part D prescription drug plans that are highly rated by the Centers for Medicare & Medicaid services. Aetna also offers Medicare Supplement (Medigap) plans that pay certain Medicare out-of-pocket costs.
Aetna is among the nation’s largest insurance providers and offers a diversity of Medicare plans including Medicare Advantage (Medicare Part C) plans, Medicare Part D prescription drug plans and Medicare Supplement Insurance (also called Medigap).
Aetna, a CVS Health company, was founded in 1853 in Hartford, CT, where it remains headquartered today. Aetna was bought by CVS in 2018 and is now a subsidiary company of CVS Health Corporation. Around 39 million people are insured by Aetna, including over 2.8 million Aetna Medicare Advantage plan beneficiaries.
Most Aetna Medicare Advantage Prescription Drug (MAPD) plan members are enrolled in a plan rated 4.5 stars or higher by Medicare in 2022.1
A Medicare Advantage plan from Aetna will cover all of the same benefits you’ll find in Medicare Part A and Medicare Part B. In addition, Aetna’s Medicare Advantage plans may also provide coverage for prescription drugs, dental, vision, hearing and other care not covered by Original Medicare.
Aetna’s Medicare Advantage plans may have some distinguishing features such as:
- A concierge service that helps plan members find local resources such as yard care and home maintenance, short-term caregiver respite care, community transportation and more
- Fitness program memberships such as SilverSneakers, which can include access to group fitness classes, mobile fitness instruction and local health facilities
- A 24-hour nurse hotline
- CVS Caremark Mail Service Pharmacy for home delivery of prescription medications (if the plan includes Part D prescription drug coverage)
- A Healthy Home Visit program that brings licensed clinicians to your doorstep
- Case management services
Aetna offers several types of Medicare Advantage plans. Plan availability and benefits can vary from one location to another, so you may not have access to each of the following types of Aetna Medicare plans or all of the benefits listed above.
Aetna Medicare HMO Plans
With an HMO Medicare plan, you typically choose a primary care physician (PCP) to help coordinate your care among other providers within the Aetna network. You may also be required to get a referral before you can see specialist providers for additional care.
Aetna HMO-POS Plans
These types of plans can give you some more flexibility than you might have with a traditional HMO plan. You may be able to see out-of-network providers for certain services while still benefiting from the coordinated care approach. You could potentially pay more out of pocket when you see providers outside of your plan network, however.
Aetna Medicare PPO Plans
PPO plans typically allow you to visit Medicare-approved providers in or out of the plan network, with no need to obtain referrals from your primary care doctor before you can see specialists. Your out-of-pocket costs could be higher when you visit a doctor who isn’t part of the plan network.
Aetna Dual Special Needs Plans
You may be able to enjoy extra benefits with an Aetna Dual Eligible Special Needs Plan (D-SNP) if you’re eligible for both Medicare and Medicaid and if an Aetna D-SNP is offered where you live. These plans offer all of your Original Medicare benefits but also include prescription drug coverage and allowances for over-the-counter (OTC) products.
Medicare Extra Help prescription drug cost assistance may also be available for beneficiaries who qualify.
Aetna D-SNP plans are available in 23 states:
- Alabama, California, Connecticut, Florida, Georgia, Iowa, Kansas, Kentucky, Louisiana, Maine, Michigan, Mississippi, Missouri, Nebraska, North Carolina, Nevada, New Jersey, New York, Ohio, Pennsylvania, Texas, Virginia, West Virginia
These plans aren’t available in every county of these states, however. Be sure to find out exactly which plans are offered where you live.
Medicare Part D plans cover prescription medications, which are not typically covered under Original Medicare. Some of Aetna’s Part D plans feature $0 deductibles or copayments, and mail delivery of drugs may also be available.
Aetna offers several Medicare Part D plans, though the plans available where you live may vary.
These plans feature monthly premiums that average just over $7 per month in 2022, which is the lowest national average premium for a Medicare Part D plan (PDP).
The Aetna SmartRx plan offers $0 deductibles for Tier 1 drugs, as well as $0 deductibles and $1 copays for up to a 30-day supplies of your medications at preferred retail pharmacies during your Part D initial coverage phase.
SilverScript Choice plans can offer a wide selection of generic and brand-name drugs, with $0 copays for Tier 1 and Tier 2 drugs. The average monthly premium is $30.64 in 2022, though the premium could be as low as $0 if you receive Medicare Extra Help.
These plans also offer free 90-day supplies of your Tier 1 medications and free standard mail delivery or pickup for Tier 1 drugs at preferred retail pharmacies.
These plans include Medicare donut hole gap coverage and $0 deductibles on all drug tiers, along with $0 copays for Tier 1 drugs. 30-day and 90-day supplies of your medications may also be available at preferred retail pharmacies or free standard mail delivery to your home.
SilverScript SmartRx (PDP)
SilverScript Choice (PDP)
SilverScript Plus (PDP)*
Average monthly premium
$30.64 (as low as $0 if you receive Extra Help)
Tier 1 drugs: $0
Tier 1 / Tier 2 drugs: $0
$0 on all tiers
* SilverScript Plus PDP is not available in Alaska
Aetna Medicare Formulary
A drug formulary is a list of all the drugs covered by a particular Medicare Part D plan.
Aetna makes it easy to search your plan drug formulary by drug name or see a complete list of covered drugs. The formulary also lists which tier the drug belongs to. The lower the tier, the less expensive the drug.
Medicare Supplement Insurance (Medigap) plans from Aetna help cover some of the out-of-pocket expenses that Original Medicare beneficiaries remain responsible for, such as deductibles, copayments and coinsurance.
These plans are accepted anywhere your Medicare Part A and Part B coverage is, so your Aetna plan can go wherever you do.
It’s important to note that Medicare Advantage plans and Medicare Supplement plans are very different, and you cannot have a Medicare Advantage plan and a Medicare Supplement plan at the same time.
Aetna offers seven different Medicare Supplement Insurance plans, though plan availability may vary where you live.
Aetna Plan A
Plan A is the most basic Medigap plan and provides coverage for Medicare Part A and Part B coinsurance, Part A hospice care coinsurance and copayments and the first three pints of blood needed for a blood transfusion. Be careful not to confuse Plan A with Medicare Part A, which is your inpatient hospital care insurance.
Aetna Plan B
Plan B offers all of the same benefits as Plan A in addition to full coverage of the Medicare Part A deductible. Medicare Plan B should not be confused with Medicare Part B, which covers your outpatient medical care and doctor’s services.
Aetna Plan D
Plan D includes all of the same coverage as Plan B while also adding coverage for skilled nursing facility coinsurance and foreign travel emergency care. Plan D should not be confused with Medicare Part D, which is Medicare prescription drug coverage.
Aetna Plan C
Plan C provides all of the benefits found in Plan D in addition to covering the Medicare Part B deductible. Plan C is only available to those who became eligible for Medicare prior to January 1, 2020. If you became eligible for Medicare before that date, you may be able to enroll in Plan C if it’s available where you live. Plan C should also not be confused with Medicare Part C, which is another term for Medicare Advantage plans.
Aetna Plan G
Plan G includes all of the same coverage found in Plan D in addition to offering coverage for Medicare Part B excess charges. Plan G is one of the most popular Medigap plans available and offers the most coverage of any type of Medigap plan, except for Plan F.
Aetna Plan F
Plan F has identical coverage to Plan G but also covers the Medicare Part B deductible. Plan F is the only Medigap plan to offer coverage in all nine Medigap benefit areas. Like Plan C, Plan F is only available to those who became eligible for Medicare prior to Jan. 1, 2020.
Aetna Plan N
Plan N covers the same costs as Plan D, but Plan N requires a $20 copayment for some doctor’s office visits and a $50 copayment for emergency room visits that do not result in admission for inpatient hospital care.
Every year, the Centers for Medicare and Medicaid Services (CMS) rates all Medicare Advantage and Medicare Part D plans according to a five-star scoring system. You can review Aetna Medicare Star Ratings by state and by plan to compare the relative quality of plans that are available.
The majority of Aetna Medicare Advantage Prescription Drug (MAPD) plan members are enrolled in a plan rated 4.5 stars out of 5 or higher in 2022.
Credit rating agency AM Best issued a Financial Strength Rating of “A” (Excellent) to CVS Health Corporation’s Aetna subsidiaries.
As one of the largest insurance companies in the U.S., Aetna boasts a vast nationwide network of health care providers. No matter where you go, an Aetna doctor or pharmacy won’t be far.
You can use the Aetna Find a doctor search tool to find Aetna providers near you are part of Aetna plan networks and to see if your favorite doctor or nearest pharmacy is part of an Aetna plan network.
About 1.2 million health care providers belong to Aetna health care networks, including over 700,000 primary care doctors and specialists and over 5,700 hospitals.
Many Aetna Medicare Advantage plans cover vision care and eyeglasses. You may also be able to find vision benefits from a standalone Aetna policy.
If your Aetna plan offers vision and eyewear benefits, your plan may cover the following services and items from vision providers within the plan network:
- Routine eye exams
- Prescription glasses or contacts, with an annual allowance that can be used toward the cost of eyewear
Some plans may feature an annual allowance for vision care and eyewear, called a direct member reimbursement (DMR). Plan members who have DMR coverage for their vision care get the yearly allowance for glasses and contacts and they can submit documentation to their plan carrier and will get reimbursed when they pay up front and receive covered vision care.
Like vision, dental benefits are included in most Aetna Medicare Advantage plans. And like Aetna vision coverage, you can also get dental benefits through a standalone dental plan with Aetna.
Depending on your specific Aetna Medicare Advantage plan, you may have coverage for certain types of dental care form a network of dentists in your area.
These types of Aetna dental coverage typically cover 100% of the costs for preventive care such as:
- Routine teeth exams
- Routine teeth cleanings
- Dental X-rays
- Teeth extractions
The frequency of how often these services are covered by your plan throughout the year may vary depending on the plan you have.
Some plans may feature an annual direct member reimbursement allowance for dental care. If your plan features DMR, you may be able to use your Aetna dental plan to pay for services like the ones listed above at any dentist in the U.S. who accepts Medicare.
Does Aetna Medicare Cover SilverSneakers?
SilverSneakers is a fitness program designed specifically for older adults and is offered at thousands of gyms and community centers all over the U.S. Many of Aetna’s Medicare Advantage plans include membership to SilverSneakers at no extra charge.
Aetna offers Medicare Advantage plans in 49 states and the District of Columbia.
Aetna Medicare Part D and Medigap plans may be found parts of every state and Washington, D.C.
Current Aetna Medicare Supplement Insurance plan members can call the Aetna Medigap Customer Service phone number at 1-888-624-6290 (TTY 711).
If you're looking to compare Aetna Medicare Supplement plans available where you live, you can compare Aetna Medigap plans online or call a licensed agent for help comparing plans.
For help with Aetna Medicare Advantage plans both with and without drug coverage, you can call to speak with a licensed insurance agent. You can also compare plans in your local area online for free, with no obligation to enroll.
Aetna contact options for current members using email, requesting a call back and more.
1 Every year, Medicare evaluates plans on a 5-star rating system. http://www.aetnamedicare.com/en/compare-plans-enroll/star-ratings.html.