As the third-largest health insurer in the United States,1 Aetna serves up plenty of choices when it comes to Medicare health plans. This review contains all you need to know about Aetna Medicare, including pros and cons of choosing Aetna; details on Medicare Advantage, Supplement, and prescription drug coverage; and unique benefits you receive as a member.
The pros and cons of Aetna Medicare health plans
- Massive provider network: With Aetna’s Medicare Advantage plans, you get access to a network of doctors and facilities that span the country. Aetna’s global network includes 1.15 million doctors, specialists, and other health care physicians plus 5,667 hospitals.2
- Stellar Star Ratings: An impressive 91 percent of Aetna’s Advantage plans earned an overall rating of 4.0 out of 5.0 stars from Medicare’s Five-Star Quality Rating System.3* These star ratings can give you an idea of how well Medicare plans perform, from customer service to quality of care.
- Nationwide prescription coverage: Aetna’s Prescription Drug Plans (PDPs) are available in every state and Washington, DC.
- Medicare Advantage availability: You can’t buy Aetna Advantage plans in 12 states.
- No Private Fee-for-Service (PFFS) plans: These special Medicare Advantage plans, popular with some beneficiaries, are not available through Aetna.
- Clunky quote process: It’s not super intuitive to get an Aetna quote on its website, and finding a plan overview can be difficult.
Aetna’s Medicare health plan overview
Aetna sells all three major types of Medicare health plans. You can buy prescription coverage in every state, while Advantage plans are offered in all but a few areas.
- Medicare Advantage (Part C): These plans combine the benefits of Original Medicare Part A and Part B into one plan. Aetna’s Advantage plans also include free coverage for fitness memberships, and many include prescription, dental, and vision services.
- Medicare Supplement (Medigap): Aetna’s Medigap plans offer a menu of coverage options that help pay for some of the costs that Original Medicare doesn’t cover, like deductibles and copayments.
- Part D Prescription Drug Plans (PDPs): Aetna’s PDPs are offered nationwide, and if you keep Original Medicare but need coverage for prescription drugs, these PDPs may give you peace of mind that your medication costs won’t break the bank.
Aetna Medicare Advantage plans
Interested in an Aetna Advantage plan? We’re not surprised—Aetna offers some highly rated plans in 38 states and DC. In fact, 91 percent of Aetna’s Medicare Advantage beneficiaries are in a 4-star plan or better, based on Medicare’s 5-star rating.4* Medicare assigns higher ratings to plans that perform better in terms of customer service, quality of care, prescription drug prices, and more.
Essentially, Advantage plans are an alternative way to get your Part A and Part B benefits by packaging them into one plan sold by a private insurance company. Along with the Original Medicare benefits, which cover medical and hospital services, Advantage plans may offer extra benefits like dental services and hearing aid coverage. Most Aetna Advantage plans include prescription drug coverage, too.
When comparing Advantage plans, you’ll notice that Aetna’s plans are either Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans. HMO plans restrict your access to doctors, specialists, and hospitals to those that are part of Aetna’s provider network. PPO plans are typically more expensive than HMO plans because they have fewer provider restrictions.
- Aetna Medicare Plan (HMO):† Like with most HMOs, you must visit in-network doctors and providers with this plan, except in urgent or emergency situations. This plan is a good choice if you prefer low-premium plans and your providers participate with Aetna.
- Aetna Medicare Open Access Plan (HMO):† Unlike the previous HMO plan, the Open Access plan doesn’t require specialist referrals. However, you’re still restricted to in-network providers except for emergency or urgent care. This may be a good option if you want the freedom to choose your own specialist and don’t mind using Aetna’s provider network.
- Aetna Medicare Prime Plan (HMO):† Aetna’s Prime plans use tightly controlled, local provider networks to coordinate your care, which can save you in health care costs. You may want this plan if you have a chronic condition and need care from multiple providers but don’t mind choosing in-network providers.
- Aetna Medicare Plan (PPO):† Under PPO plans, you’re free to see any provider you’d like, but you might pay more to see out-of-network providers. This Aetna PPO plan could work well if you want the freedom to choose any doctor, specialist, or clinic.
- Aetna Medicare Prime Plan (PPO):† Finally, the PPO Prime Plan offers an extra emphasis on connecting you with local providers who will coordinate your care—like with the HMO Prime plan—plus, you can see any provider you choose. If you don’t mind paying more in monthly premiums and want total provider flexibility, this might be the right plan for you.
Learn more details about these options, including plan summaries and comparisons, in our Aetna Medicare Advantage 2017 review.
Aetna Medicare Supplement plans
Unlike Advantage plans, which replace Original Medicare’s hospital and insurance coverage, Aetna Supplement (Medigap) plans are designed to help beneficiaries enrolled in Part A and Part B cover some of the expenses they are left with after Medicare coverage.
Supplement plans are standardized across the country, meaning that the benefits for each plan type are identical no matter which company you buy a plan from or where you live (with the exception of Massachusetts, Minnesota, and Wisconsin, which standardize Medigap plans differently).
Although Aetna offers Supplement plans in most areas, you can’t buy one if you live in Alaska, Connecticut, Hawaii, Maine, Massachusetts, Washington, or DC.
Which Medigap plans can you buy from Aetna? Our research found that in most states, Aetna sells plans A, B, F, G, and N.5 To find out which benefits each plan covers, check the chart below.
For an in-depth comparison of Aetna’s Medigap offerings, check out our review of Aetna Medicare Supplement plans.
The perks of being an Aetna member
As an Aetna Medicare member, you’ll enjoy the following unique features and benefits.
Nurse advice line
As a member, you can call Aetna’s Ask a Nurse 24/7 hotline any time of day to discuss your health concerns. You’ll speak with a registered nurse who will help you understand and manage acute or chronic conditions, determine where to seek care, and more.
Mail-order prescription drugs
Aetna helps you fill your prescriptions more easily with its mail-order pharmacy program, Aetna Rx Home Delivery. Check to see if your prescriptions can be delivered right to your doorstep or another chosen location.
Advantage plan fitness membership
Aetna Medicare Advantage plans include access to the Silver&Fit fitness programs. By enrolling, you get free coverage for a membership at any participating gym, which will have equipment and classes you can use to stay fit and well.
Convenient customer service and tools
Find Aetna customer service information easily by visiting aetnamedicare.com. Look for the specific phone numbers for the type of coverage you have as well as email addresses and operational hours.
Aetna also offers several online tools for beneficiaries. You can view your coverage and benefits, check claims, pay bills, change plans, and find forms all from Aetna’s secure member website.
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Or speak to a licensed insurance agent at 855-802-1206
Learn more about Aetna Medicare
We’ve got even more Aetna Medicare health plan details for you. From Medigap to Advantage, check out the links below to find what you’re looking for.
If you’re ready to shop and compare plans, start by visiting aetnamedicare.com, or call 1-888-247-1051 (TTY: 711). They are available Monday through Friday, 8 a.m. to 8 p.m.
A note about the Aetna name
Just because you see a plan without the Aetna name attached to it doesn’t mean Aetna is not selling it. The insurer sells Advantage plans under the Aetna brand name, Coventry, and the following brands:
- Aetna Health & Life Insurance Company
- Aetna Life Insurance Company
- American Continental Insurance Company
- Continental Life Insurance Company of Brentwood, TN
*Medicare evaluates plans based on a 5-star rating system. Star Ratings are calculated each year and may change from one year to the next.
†The Aetna Medicare Plan, Aetna Medicare Open Access Plan, and Aetna Medicare Prime Plan are HMOs with Medicare contracts. The Aetna Medicare Plan and Aetna Medicare Prime Plan are PPOs with Medicare contracts. Enrollment in these plans depends on contract renewal.
‡You must continue to pay your Part B premium.
1US News & World Report, “Aetna’s Fourth-Quarter Earnings Surged 38 Percent in a Performance that Trumped Analyst Estimates, but the Health Insurer Issued Initial Guidance for the New Year that Fell Short of Wall Street Expectations”
2Aetna Inc., “Aetna Facts”
3Aetna Inc., “CMS Star Ratings”
4Aetna Inc., “CMS Star Ratings”
5Aetna Inc., “Medicare Supplement Insurance Plans”