Aetna Medicare Advantage Plans — 2017 Part C Plans Review

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Aetna Medicare Advantage Plans, 2017 Review

  • Over 3 million Medicare members1
  • Advantage monthly plan premiums as low as $0
  • Not sold nationwide

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If you’ve been looking for Medicare Advantage (Part C) online, you’ve likely seen the company name Aetna. As the nation’s third-largest insurance company with a history dating back to 1853,1 Aetna has become a mainstay of health coverage, including Medicare plans.

Today, 7% of the 19 million Part C enrollees are enrolled in an Aetna Medicare Advantage plan.2 We expect that percentage to grow, as nearly one in five of all new Advantage plans in 2017 were Aetna plans.3 One reason for the company’s sizable growth is its recent acquisition of Coventry Health Care. A proposed merger with Humana would have made the company an even larger powerhouse, but as of February, the merger isn’t in the cards.

Still, bigger doesn’t always mean better, so we want to give you an unbiased look at Aetna’s Medicare Advantage plans to help you decide if any of them are the right choice for you. We’ve done research to give you pros and cons, plan comparisons, overviews of special features and benefits, and more.

Aetna has a variety of Advantage plans available in most areas in the United States, and these plans include unique benefits for members, like coverage for free gym memberships. For these reasons, Aetna’s worth considering for your advantage plan needs.

Aetna has a variety of Advantage plans available in most areas in the United States, and these plans include unique benefits for members, like coverage for free gym memberships.

The pros and cons of Aetna Medicare Advantage

As with any Advantage plan, an Aetna Advantage plan offers the same coverage as Original Medicare Part A and Part B—with a few restrictions and some extra benefits thrown in. Some of these plans may restrict your access to doctors and health facilities, and many include dental, vision, and hearing services. Most also combine your insurance with Part D prescription drug coverage. Let’s look more closely at the pros and cons.

The pros

  • Eons of experience. Aetna’s been around since the mid-nineteenth century and has been paying Medicare claims since 1966.4 Aetna’s used its long history to continually improve its now-stellar customer service.
  • National footprint. Aetna sells Medicare Advantage (MA) and Medicare Advantage Prescription Drug Plans (MA-PDs) in 38 states and Washington, DC.5 With such a wide footprint, you’re likely to find an Aetna plan in your area.
  • No-cost wellness and fitness services. All of Aetna’s Advantage plans include access to Silver&Fit fitness programs, which help you maintain an active lifestyle. You also get no-cost access to a 24-hour nurse advice line for quick answers to your health questions.
  • Highly rated plans. On Medicare’s 5-star rating* system for plan quality, the company boasts “the highest percentage of Medicare members enrolled in plans rated 4 or higher overall stars among publicly traded companies.”6

The cons

  • Lack of specialized plans. Our searches didn’t turn up any Aetna Special Needs Plans (SNPs) or Private Fee for Service (PFFS) plans, but with plan availability changing over time and varying by location, you may have better luck in the future.
  • Hearing aid coverage limited to more expensive plans. Aetna sells some plans that include hearing aid coverage, but the benefit doesn’t come standard on its lowest premium Advantage plans like Aetna Medicare Premier (HMO) and Aetna Medicare Choice (PPO).

Aetna Medicare Advantage plan overview

Now we’d like to show you the nitty-gritty of Aetna’s Part C plans. The two key players here are HMOs and PPOs, which stand for Health Maintenance Organizations and Preferred Provider Organizations. We searched for Aetna plans in Harris County, Texas, to find specific summaries of benefits and costs. The plans available to you will vary depending on your location, so the information provided below is simply meant to give you an idea of what to expect when shopping for plans.

Aetna Medicare HMO

An Aetna HMO plan offers lower premium coverage with a set list of doctors and facilities. You’ll need to stay within Aetna’s provider network to receive care with HMO plans, but the good news is that Aetna’s network is huge and nationwide.§

Let’s look at an example of an Aetna HMO plan we found.

Aetna Medicare Premier Plan (HMO)†7 benefits**Cost/coverage
Monthly premium††$0
DeductibleNone
Out-of-pocket maximum$6,700
Primary care doctor visits$15 copayment
Specialist visits$40 copayment
Emergency room visits$75 copayment
X-rays and lab tests$0–$40 copayment or 20% coinsurance
Medical equipment20% coinsurance
Mental health visits$40 copayment
Dental coverage limitPlan pays up to $150 per year
Oral exams & cleanings$0 copayment
Dental fillingsNot covered
Medicare-covered and routine eye exams$0 copayment
Eyewear
(contacts, eyeglasses)
Plan pays up to $125 per year
Medicare-covered hearing exams$40 copayment
Routine hearing exams$0 copayment (one exam per year)
Hearing aidsNot covered
Prescription drug deductibleNone
Tier 1 drugs
(initial coverage phase)
$2
Tier 2 drugs
(initial coverage phase)
$5
Tier 3 drugs
(initial coverage phase)
$47
Tier 4 drugs
(initial coverage phase)
$100
Tier 5 drugs
(initial coverage phase)
33%
Fitness membershipFree membership at Silver&Fit facilities
Must see in-network providers?Yes
Specialist referrals required?Yes

Data effective 07/27/2017. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

Aetna Medicare PPO

Aetna PPO plans normally cost more than HMOs, but they usually offer more coverage and a wider selection of providers. Although you’ll probably pay less if you see doctors within Aetna’s network, you have the option to see most any provider with a PPO plan.

Here’s an example of an Aetna PPO plan in Texas.

Aetna Medicare Choice Plan (PPO)†8 benefits**Cost/coverage
Monthly premium††$19
DeductibleNone
Out-of-pocket maximum, in-network$6,000
Out-of-pocket maximum,
combined in- and out-of-network
$10,000
Out-of-network medical services45% coinsurance for most services
Primary care doctor visits
(in-network)
$15 copayment
Specialist visits
(in-network)
$35 copayment
Emergency room visits$75 copayment
X-rays and lab tests
(in-network)
$0-$35 copayment or 20% coinsurance
Medical equipment
(in-network)
20% coinsurance
Mental health visits
(in-network)
$40 copayment
Dental coverage limits
(in-network)
Plan pays up to $150 per year
Oral exams & cleanings
(in-network)
$0 copayment
Dental fillings
(in-network)
Not covered
Medicare-covered and routine eye exams
(in-network)
$0 copayment
Eyewear
(contacts, eyeglasses)
Plan pays up to $125 per year
Medicare-covered hearing exams
(in-network)
$35 copayment
Routine hearing exams
(in-network)
$0 copayment (one exam per year)
Hearing aidsNot covered
Prescription drug deductibleNone
Tier 1 drugs
(initial coverage phase)
$2
Tier 2 drugs
(initial coverage phase)
$5
Tier 3 drugs
(initial coverage phase)
$47
Tier 4 drugs
(initial coverage phase)
$100
Tier 5 drugs
(initial coverage phase)
33%
Fitness membershipFree membership at Silver&Fit facilities
Must see in-network providers?No
Specialist referrals required?No

Data effective 07/27/2017. This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums, and/or copayments/coinsurance may change on January 1 of each year.

The perks of being an Aetna member

An asset of Advantage plans is that you often get special benefits that you don’t get with Original Medicare—and Aetna’s plans are no exception.

  • Fitness membership. With every Aetna Advantage plan we found, you get free coverage for a Silver&Fit fitness program membership. This program helps older adults stay well through specialized exercise classes and resources.
  • Nurse advice hotline. Aetna also has a 24-hour nurse advice line. You can call any time to speak with a registered nurse who will discuss your health concerns with you and direct you to the appropriate health care provider.

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Where and how to get Aetna Medicare Advantage

Aetna sells Medicare Advantage in 36 states plus DC. But you’re out of luck if you live in one of the following states where doesn’t offer coverage: Alaska, Hawaii, Idaho, Massachusetts, Minnesota, Montana, New Hampshire, North Dakota, Oregon, Rhode Island, or Vermont.

If you’re ready to start shopping, you have a couple of options:

  • Talk to a licensed sales agent. Lucky for you, MedicareHealthPlans works with some great agents who can talk to you about your options and even get you a quote for free. Click here to get started.
  • Visit Aetna’s Medicare website.
  • Search Medicare.gov for plans in your area.

Sources

1Aetna Inc., “Aetna History
2Kaiser Family Foundation, “Medicare Advantage 2017 Spotlight: Enrollment Market Update
3Kaiser Family Foundation, “Medicare Advantage Plans in 2017: Short-term Outlook Is Stable
4Aetna Inc., “Aetna History
5Aetna Inc., “Aetna Urges Medicare Beneficiaries to Shop and Save for 2017—Before December 7
6Aetna Inc., “Aetna Urges Medicare Beneficiaries to Shop and Save for 2017—Before December 7
7Aetna Inc., “Summary of Benefits, Aetna Medicare Premier Plan (HMO), H4523, Plan 015

8Aetna Inc., “Summary of Benefits, Aetna Medicare Choice Plan (PPO), H5521, Plan 060

Disclaimers

*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.

Aetna Medicare Premier Plan is an HMO with a Medicare contract. Aetna Medicare Choice Plan is a PPO with a Medicare contract. Enrollment in these plans depends on contract renewal.

This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov

§ The provider network may change at any time. You will receive notice when necessary.

** This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year.

†† You must continue to pay your Part B premium.

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