What Is Aetna Medicare
What is Aetna Medicare? It’s a Medicare Advantage program that provides an alternative to Original Medicare, encompassing a variety of plan options to meet different health needs. With Aetna Medicare, beneficiaries can access medical, hospital, and prescription drug coverage.
This straightforward guide will walk you through what Aetna Medicare offers this year, how it functions, and what you need to know if you’re considering enrolling.
Key Takeaways
- Aetna Medicare offers a variety of Advantage plans, including HMO, PPO, SNP, and D-SNP designed to suit diverse health requirements, with added potential benefits such as dental, vision, and hearing care.
- The Aetna Medicare Advantage plans cover both Medicare Parts A and B, and their costs are determined by factors like plan type, location, and individual health needs, with plan premiums influenced by various factors.
- In addition to Medicare Advantage plans, Aetna also provides Medicare Supplement plans to cover gaps in Original Medicare and standalone Prescription Drug Plans with varied monthly premiums, accommodating different prescription needs and budgets.
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Aetna Medicare: An Overview
Aetna’s Medicare Advantage plans, offered within Medicare Part C, provide a broad array of health plan alternatives to Medicare beneficiaries. As a crucial component of Aetna Medicare, the Advantage plan may offer comprehensive nationwide coverage for doctors’ visits, hospitalization, and prescription drugs within a single policy.
The comprehensive range of Medicare plans offered by Aetna sets it apart from its competitors. Aetna presents an array of plans, each expertly designed to accommodate unique health needs and preferences.
Aetna Medicare Advantage plans offer more than just health benefits; they offer peace of mind and the assurance of being in good hands.
Aetna’s History and Presence in the Medicare Market
Founded in 1853, Aetna carries a longstanding legacy in the insurance industry, including its subsidiary, Aetna Life Insurance Company. Since 1966, Aetna has catered to Medicare beneficiaries, affirming its commitment to offer reliable and affordable healthcare solutions to those eligible.
With an annual clientele of nearly 11 million Medicare beneficiaries, Aetna has a substantial presence in the Medicare and Medicaid services market.
The coverage of 87% of its Medicare Advantage members underscores Aetna’s substantial presence in the Medicare market. As a prominent member of the Aetna group of companies, Aetna continues to build on its legacy of providing high-quality healthcare solutions.
Types of Aetna Medicare Plans
Aetna offers a diverse selection of Medicare plans, encompassing HMO, PPO, SNP, and D-SNP options, along with coordinated Medicare and Medicaid plans. The primary categories of Aetna Medicare Advantage plans include HMO, PPO, HMO-POS, and D-SNP plans, each specifically designed to cater to individual preferences and needs.
Aetna’s Medicare Advantage plans, under a Medicare contract, include coverage of Medicare Parts A and B, added benefits like a low deductible, and extensive prescription coverage. Notably, the Aetna Medicare-Medicaid plan is designed to offer coordinated Medicare and Medicaid benefits for individuals who are eligible for both programs.
Aetna Medicare Advantage Plan Benefits
Aetna Medicare Advantage plans may incorporate additional benefits, enriching the comprehensive healthcare experience. In addition to coverage for Medicare Parts A and B, these plans may offer:
- Dental care
- Vision care
- Hearing care
The added potential benefits mean that subscribers get more than just basic medical coverage; they get a total package that caters to their overall well-being.
Prescription Drug Coverage
Aetna Medicare Advantage plans offer comprehensive medical and pharmacy benefits, which encompass prescription drug coverage. This ensures that subscribers have access to necessary medications without the burden of excessive out-of-pocket costs.
Upon reaching out-of-pocket drug costs, subscribers move out of the coverage gap and are only required to pay 25 percent of the cost for both generic and brand-name drugs. This phase persists until the annual out-of-pocket drug cost is reached.
Members can access their prescription drug coverage by logging in to their member website, where they can find coverage details, formulary information, and estimate drug costs.
Costs Associated with Aetna Medicare Advantage Plans
Most Aetna Medicare Advantage plans necessitate the Medicare Part B premium payment alongside the plan’s cost.
The pricing of Aetna Medicare Advantage plans is influenced by various factors including location, plan type, and individual health requirements. Understanding these factors is crucial, as they can substantially influence the total cost of the plan.
Factors Influencing Plan Costs
The key factors that impact the pricing of Aetna Medicare Advantage Plans include the selected plan type (HMO or PPO), geographical location, and the individual’s unique health requirements. Generally, HMO plans are more affordable compared to other types.
The variation in costs across different locations is influenced by the availability of healthcare services and providers in each county, which directly affects the pricing of plans.
The cost of Aetna Medicare Advantage Plans is also influenced by individual health needs, with medical care costs increasing based on factors such as copayments and out-of-pocket expenses tailored to the individual’s health needs.
Comparing Costs Across Plans
The prices of Aetna Medicare Advantage plans fluctuate according to the type of plan. For example:
- The HMO-POS plan may have a low monthly premium
- Copays for primary care and specialist visits can range.
The expenses related to Aetna Medicare Advantage Plans can be affected by multiple factors such as:
- The chosen plan type
- An individual’s health requirements
- The healthcare provider network
- The specific aspects of copays and prescription drug coverage
For instance, the monthly premium for certain Aetna Medicare Advantage plans may start low, and they have an out-of-pocket maximum. Copays can range from for primary care visits to specialist visits, and even offer low costs for Tier 1 prescription drugs under specific plans.
Navigating the Aetna Medicare Website
Aetna Medicare offers various tools to aid in the selection of an appropriate plan. These include a plan comparison tool, online resources for locating network pharmacies, managing potential benefits coverage, and tools focused on promoting healthier living.
The ‘Find Provider’ page on the Aetna Medicare website can be utilized to locate in-network providers. This allows you to search for network doctors, pharmacies, dentists, and hospitals in your local area.
The form on Aetna’s official website can be used to inquire about your application status and wait for their response. Alternatively, you can log in to the secure Aetna Medicare member website to access a range of features and pertinent information.
Finding a Suitable Plan
The Aetna Medicare website features a plan comparison tool, allowing users to juxtapose different Medicare Advantage plans and their offerings. When choosing a plan on the Aetna Medicare website, a user should take into account factors such as:
- The availability of potential extra benefits like vision, dental, and hearing coverage
- Their personal health goals
- The different Medicare coverage options
- Any upfront costs associated with the plans.
Locating In-Network Providers
The ‘Find Provider’ page on the Aetna Medicare website can be accessed to locate in-network providers and verify coverage for doctors and prescriptions. Aetna Medicare’s network encompasses a range of providers including doctors, pharmacies, dentists, and hospitals. The list of in-network providers undergoes regular updates, with changes implemented six days a week.
Certain Aetna Medicare plans do not provide out of network services, unless in emergency cases, therefore it is crucial to confirm the details of your plan.
Enrolling in an Aetna Medicare Advantage Plan
Individuals who are 65 years of age or older or have a qualifying disability and receive Social Security Disability may meet the eligibility requirements for an Aetna Medicare Advantage Plan. Moreover, those who are dually enrolled in Medicare and Medicaid may qualify for Aetna’s dual-eligible Special Needs Plan (D-SNP).
The annual enrollment window for Aetna Medicare Advantage Plans spans from January 1 to March 31. Within this period, individuals currently enrolled in a Medicare Advantage plan have the opportunity to make a one-time choice to transition to an Aetna Medicare Advantage Plan.
For enrollment in an Aetna Medicare Advantage Plan, proof of age, employment history, and citizenship or permanent resident status may be required.
Eligibility Requirements
Medicare Part A and Part B constitute the two components of the fee-for-service health insurance program. Enrollment in both parts is a prerequisite for eligibility for Aetna Medicare Advantage Plans. Residing within the plan’s service area is a fundamental eligibility requirement for Aetna Medicare Advantage Plans.
Furthermore, moving out of the service area qualifies individuals for a Special Enrollment Period (SEP).
However, individuals under the age of 65 do not qualify for Aetna Medicare Advantage Plans.
Enrollment Periods
The Special Enrollment Periods in Aetna Medicare Advantage Plans encompass the following:
- Initial Coverage Election Period (ICEP), commencing three months prior to enrollment in both Parts A and B
- Marriage
- Loss of coverage due to divorce
- Loss of Medicaid eligibility
- Exhaustion of COBRA coverage
- Enrollment in Part A and/or Part B due to exceptional circumstances
- Eligibility for a special enrollment period for individuals working and able to delay their Medicare benefits
These factors may lead to the initiation of a Special Enrollment Period for Aetna Medicare Advantage plans.
Aetna’s Medicare Supplement and Prescription Drug Plans
In addition to its comprehensive Medicare Advantage plans, Aetna also offers Medicare Supplement plans and standalone Prescription Drug Plans. Aetna’s Medicare Supplement plans include benefits like Part A hospice care coinsurance or copayment, unrestricted nationwide provider options, 12-month rate protection, and lifetime benefit stability.
Aetna offers three unique Medicare Part D Prescription Drug Plan options.
Aetna’s prescription drug plans provide coverage for a range of prescriptions, such as outpatient drugs, vaccines, and certain medical supplies. The costs for Aetna’s Prescription Drug Plans can vary, with some plans having low monthly premiums.
Keep in mind, the costs of employer plans and offered subsidies can also influence the total expenses.
Medicare Supplement Plans
Original Medicare fails to cover most vision, dental, and hearing services, along with certain medical services like plastic surgery, podiatry, and chiropractic care. Aetna’s Medicare Supplement Plan is designed to fill certain coverage gaps in Original Medicare, such as deductibles, copayments, and coinsurance. It is accessible to individuals enrolled in Medicare Part A and Part B.
Aetna provides a range of Medicare Supplement plans, also known as Aetna Medicare Plan options, including the following Medicare Plan choices:
- Plan A
- Plan B
- Plan F
- Plan G
- Plan N
Plan F offers comprehensive coverage, covering 100% of expenses not covered by Medicare. The pricing structures for Aetna Medicare Supplement plans are determined by the specific plan and location. Annual premiums can range, while monthly premiums may vary.
Standalone Prescription Drug Plans
Beneficiaries can choose to enroll directly in Aetna’s Standalone Medicare Part D plan or opt for a Medicare Advantage plan that includes prescription drug coverage.
In order to qualify for Aetna’s Standalone Prescription Drug Plans, individuals need to be enrolled in Medicare Part A and/or Medicare Part B. These plans are a great option for those seeking additional coverage for their medications, vaccines, and medical supplies.
Summary
Aetna Medicare offers a range of comprehensive healthcare plans, catering to diverse needs and preferences. From its Medicare Advantage plans to Medicare Supplement and standalone Prescription Drug Plans, Aetna is committed to enhancing the overall healthcare experience of its subscribers.
With an array of potential benefits and a user-friendly website, Aetna makes the process of choosing and managing your healthcare plan easier than ever.
Frequently Asked Questions
→ Is Aetna Medicare the same as Medicare?
No, Aetna Medicare is a Medicare Advantage plan run by a private insurance company, including potential additional benefits compared to Original Medicare.
→ Does Aetna cover what Medicare doesn’t?
Yes, Aetna Medicare Advantage plans may provide coverage for things not covered by Original Medicare, which may include routine vision, dental, hearing care, and prescription drugs taken at home.
→ What is included in the Aetna Medicare Advantage plan?
The Aetna Medicare Advantage plan includes nationwide coverage for doctors, hospitalization, and prescription drugs, all in one comprehensive plan.
ZRN Health & Financial Services, LLC, a Texas limited liability company
Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.