Aetna Medicare Insurance Review

Aetna Medicare Insurance Review
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Aetna Medicare Insurance Review

Aetna Medicare Insurance Review
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Aetna is one of the largest and oldest Medicare health insurance providers in the U.S. 

Along with their other health insurance products, Aetna provides Medicare Advantage health insurance to more than 2.9 million Medicare beneficiaries in 46 states and Washington DC.

Find out about Aetna’s Medicare services and products and how the company performed in 2021.

Aetna Review 

Aetna, or Aetna Health Inc., is the third-largest for-profit Medicare insurance company and famously paid the first Medicare claim back in 1966.

Aetna is known for its variety of plans and value for money. In 2021 they offered Medicare Advantage, Medicare Supplement Insurance, and Part D plans across the U.S.

Their plans include benefits such as vision, dental, and hearing coverage, prescription drug home deliveries, and nationwide coverage for any medical provider that accepts Medicare.

The company also has extensive experience with Medicare and constantly improves its member benefits year on year. 

From fitness perks to over-the-counter benefits, their wide variety of health extras makes them a leading provider of supplemental Medicare insurance plans that help cover Medicare’s costs.

Benefits of Aetna

✅ One of the oldest health insurance providers in the U.S.

✅ Part of CVS Health, which runs the largest pharmacy chain in the U.S.

✅ They allow their members to see any medical provider that accepts Medicare.

✅ Widely known and trusted by millions of Americans.

✅ They offer many low-cost and $0.00 deductible plans.

✅ They have Medicare plans in all states and Washington DC.

Shortcomings of Aetna

❌ Aetna health insurance doesn’t currently offer PFFS (Private Fee-For-Service) or MSA (Medical Savings Account) plans. 

❌ They only offer select extra benefits, such as Companion benefits (members can get people to visit them) and Healthy Foods debit cards (members can use this card to purchase healthy foods), in specific locations.

Terms you need to know -

Deductibles are costs you will pay for your medical tests, items, and services before your Medicare policy covers your expenses. 

Coinsurance payments are expenses that patients must cover for medical treatment, services, and items. These are different for Medicare Parts A and B and can either be a percentage of the cost or a fixed amount.

Copayments or copays are amounts that Medicare beneficiaries pay for medical services, tests, or items. These amounts are set by your health insurance company and can range between $1.00 and a few hundred dollars.

Out-of-pocket expenses are the costs that your health insurance doesn’t cover, which you will have to pay for. Deductibles, copayments, and coinsurance are examples of out-of-pocket expenses.

What Is Aetna’s Medicare Star Rating?

Aetna’s overall weighted star rating (2021): ⭐⭐⭐

Here’s what the different star ratings mean:

(No stars): New Plan

⭐: Poor

⭐⭐: Below average 

⭐⭐⭐: Average 

⭐⭐⭐⭐: Good 

⭐⭐⭐⭐⭐: Excellent 

The Medicare star rating system applies to Medicare Advantage providers, Medicare Advantage plans, and Part D  Prescription Drug Plans. 

Aetna’s overall performance was rated as 4 stars in 2021, while the average star rating for 2021 was 4.06.

But this is the overall rating of the company. Individual plans also have ratings, and many Aetna policies are rated four stars and above. 

In 2021, 87% of Aetna’s Medicare Advantage-Prescription Drug (MA-PD) members were on a plan rated 4.5 stars or higher. 

You can check a plan’s star rating on the Medicare website.

What Are Medicare Star Ratings?

The Centers for Medicare and Medicaid (CMS) uses a star rating system to measure the performance of Medicare Advantage and Part D plans. The aim is to make it easy for buyers to compare the quality of the health plans on offer.

Overall star ratings score health insurance providers that offer Medicare Advantage and Part D prescription drug plans.

  • The rating for Medicare Part C considers 28 different factors.
  • The rating for Medicare Part D considers 12 factors. 
  • The rating for Medicare Advantage Plans with Part D coverage considers 38 factors. 

The CMS rates health insurance companies and their plans on:

  1. How the health insurance provider keeps their beneficiaries healthy (for example, preventive services and other health benefits).
  2. How they manage long-term or chronic conditions.
  3. Their members’ experience (overall customer satisfaction).
  4. Member complaints (complaints submitted and if members are leaving the health plan).
  5. The plan’s overall customer service (call center services, processes insurance claims and appeals, and enrollments).

Other Third-Party Ratings of Aetna

Aetna received positive reviews from three third-party companies that looked at its performance in 2021. These companies provide ratings of Medicare health insurance providers in the U.S. based on customer satisfaction, reviews, and finances.

Consumer Affairs

Consumer Affairs, a private nonprofit, gave Aetna 3.9 out of 5 stars in their overall satisfaction ranking, with most people rating the company either 4 or 5 stars.

Consumer Affairs’ overall satisfaction ranking score is based on a scale of 1 to 5 and looks at user submissions over the past 12 months. At the time of publishing Aetna’s score was calculated from 1,577 submissions.

While their rating is a good way of finding out what members think, the site doesn’t separately score plans and may give a limited view of the company’s performance.

J.D. Power

The 2021 J.D. Power Medicare Advantage Study rates customer satisfaction among the ten largest Medicare Advantage providers in the U.S by surveying 3,359 members of Medicare Advantage plans across the U.S. 

The study looks at:

  1. Coverage and Benefits

  2. Provider Choice

  3. Cost

  4. Customer Service

  5. Information and Communication

  6. Billing and Payment

The consumer insights and advisory firm JD Power scored Aetna 795 out of 1,000, ranking it 7th overall in this year’s report.

2021 U.S. Medicare Advantage Study

Here’s how Aetna performed in comparison to other Medicare providers in JD Power 2021 U.S. Medicare Advantage Study.

AM Best 

The AM Best Credit Rating is an independent, objective opinion about business financial strengths and weaknesses. Here’s what their different ratings mean:

Best's Financial Strength Rating Scale

AM Best gave Aetna Health Inc. a financial strength rating of A (excellent). The company also stated that Aetna has a stable financial position and long-term outlook.

How Does Aetna Compare to Other Health Insurance Providers?

Aetna vs UnitedHealthcare

Aetna is the third-largest for-profit provider of Medicare insurance in the U.S., while UnitedHealthcare is the biggest, with around 27% of the market.

JD Power ranked Aetna and UnitedHealthcare equally in their 2021 Medicare Advantage Study. Both companies received 795 out of 1,000 for overall customer satisfaction.

Aetna received an overall 4-star rating for its services, and UnitedHealthcare scored 3.5 stars. However, it is essential to check how plans in your area are rated before you choose.

Both companies offer great benefits on their Medicare Advantage, Prescription Drug, and Supplement Insurance plans and received excellent ratings from AM Best for their financial stability.

Aetna vs Kaiser Permanente

Kaiser Permanente received a 5-star rating in 2021, which is higher than Aetna’s 3-star overall score.

Kaiser Permanente has around 12.5 million Medicare members, while Aetna has nearly 9.8 million Medicare members.

However, Kaiser Permanente is only available in Hawaii, Washington, Oregon, California, Colorado, Maryland, Virginia, Georgia and Washington DC, while Aetna offers different Medicare insurance products in all 50 states and Washington DC.

Depending on where you live, Aetna may be the more affordable option as they offer more low-cost plan options than Kaiser Permanente.

Medicare Advantage Plans Offered by Aetna

Medicare Advantage plans are private health care plans for Medicare. These health insurance plans offer the same coverage as Original Medicare but often provide additional vision, dental, and hearing insurance.

Aetna offered four types of Medicare Advantage plans in 2021:

There Are Five Main Types of Medicare Advantage Policies

HMO Plans

Health Maintenance Organization (HMO) plans provide health insurance via a specific network of healthcare providers. You’re only covered for service in-network.

HMO-POS Plans

An HMO point-of-service (HMO-POS) health plan covers some health care costs outside your network, but premiums and copayments are typically higher than HMO plans. 

PPO Plans

A Preferred Provider Organization (PPO) health plan allow you to see any provider that accepts insurance. You don’t need a referral from your primary physician to get specialist help.

PFFS Plans

Private Fee-for-Service (PFFS) plans allow members to see any health care provider enrolled in Medicare that accepts your plan. 

SNPs

Special Needs Plans (SNPs) are plans for people with specific needs or diseases. For example, people who live with chronic conditions or those that live in assisted living facilities.

Overall, Aetna’s Medicare Advantage plans give Medicare beneficiaries throughout the U.S. a chance to get health insurance coverage. They even offer veteran-focused policies in 41 states and Medicare Advantage plans for dual-eligibles in 27 states.

Other benefits from Aetna include:

  • Vision: Some plans cover vision care, including eye exams and prescription glasses.

  • Dental: Aetna offers full or partial dental coverage on some of its Medicare Advantage policies. Dental services covered include screenings, denture fittings, and dental surgery.

  • Hearing benefits: Some Aetna plans offer coverage for hearing care. These can include hearing tests, hearing aid devices, and hearing aid fittings.

  • Over-the-counter (OTC) health benefits: Members on specific plans can get OTC benefits to save on general medication costs.

  • Care Management Services and Disease Management Services: Aetna provides their members with telephonic, online, and in-person services to assist them with care and disease management.

  • Fitness benefits: Aetna’s SilverSneakers program gives its members access to gyms and health centers around the country.

  • Meals program: Members can get meals delivered to their homes after being released from the hospital. 

  • 24-Hour Nurse Line and Telehealth Services: Aetna members can access telephonic nurse care and other telephone health services to assist them with their health questions

  • Prescription home delivery services: Aetna offers its members a prescription drug delivery service to receive their medication on time each month.

  • Concierge services for members to find local resources: the company also gives members access to their Resources for Living program to find local activities, support, and care.

How Much Do Aetna Medicare Advantage Plans Cost?

Prices for Medicare Advantage plans vary depending on where you live and some health plans are only available in certain areas. Take a look at the examples below to understand what it might cost to join Aetna’s Medicare Advantage plans. 

Be sure to check the Medicare.gov website to see if Aetna offers Medicare Advantage in your county and what it will cost to enroll.

Many Aetna Medicare plans are premium-free but this doesn’t mean that you won’t pay anything each month for insurance cover. You will still have to pay your Part A and Part B monthly premiums. 

Some Medicare Advantage providers can charge $0.00 monthly premiums on certain plans for a number of reasons. If you’d like to learn more, check out our article on zero-premium Medicare Advantage plans.

Here’s an example of what Aetna Medicare Advantage plans for a person living in Los Angeles in 2021:

Plan Name Is there a monthly premium? Copayment (Primary Doctor) Out of Pocket Maximum Prescription Drugs Tier 1 Copay Select benefits
Select Plan (HMO) No $0.00 (in-network) $2,000.00 $0.00 Partial or complete dental cover, vision insurance, and hearing insurance.
Prime Plan (HMO) No $0.00 (in-network) $2,200.00 $0.00 In-network dental insurance, vision insurance, and hearing insurance.
Plus Plan (HMO) No $0.00 (in-network) $999.00 $0.00 In-network dental cover, vision insurance, and hearing insurance.
Eagle Plan (HMO) No $0.00 (in-network) $4,200.00 Prescription drug coverage is not included. In-network dental insurance, vision insurance, and hearing insurance.
Choice Plan (PPO) Yes $10.00 (in-network) $11,300 $0.00 Full dental cover.

* Be sure to check each plan to understand coverage limits and options. 

**Prices and costs listed here are subject to change and should not be considered as the final amount you will pay for Medicare Advantage coverage. If you would like to find out what a plan might cost you, contact PolicyScout.

Here’s an example of Aetna’s Medicare Advantage plans in Indianapolis in 2021 (these prices exclude your Part B monthly premium).

Plan Name Is there a monthly premium? Copayment (Primary Doctor) Out of Pocket Maximum Prescription Drugs Tier 1 Copay Select benefits
Eagle (PPO) No $0.00 (In-network) $25.00 (Out-of-network) $9,000 Prescription drug coverage is not included. Part B premium reduction
Value (PPO) No $0.00 (In-network) $30.00 (Out-of-network) $9,500 $0.00 Partial or complete in-network dental, hearing, and vision insurance.
Prime (HMO) No $0.00 (In-network) $4,300 $0.00. Partial or complete in-network dental, hearing, and vision insurance.
Premier (PPO) Yes $0.00 (In-network) $20.00 (Out-of-network) $9,500 $0.00. Partial or complete in-network dental, hearing, and vision insurance.

* Be sure to check each plan to understand coverage limits and options.

**Prices and costs listed here are subject to change and should not be considered as the final amount you will pay for Medicare Advantage coverage. If you would like to find out what a plan might cost you, contact PolicyScout.

With most Medicare Advantage plans, you will pay different rates for in-network and out-of-network care.

In-network doctors are contracted to your Medicare Advantage provider, while out-of-network doctors are not contracted to your Medicare Advantage provider’s network.

Aetna offers different health insurance plans with unique prices, limits, and benefits in each area. That’s why it’s best to do your research or speak with a Medicare consultant before making a decision.

If you’re interested in learning about Aetna health plans in your county or have a question about Medicare, contact PolicyScout today at 1-888-912-2132 or email us at Help@PolicyScout.com. Our experienced consultants can help you find the right plan.

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Medicare Part D Plans Offered by Aetna

Medicare Part D plans are stand-alone drug coverage policies that people can purchase to help with prescription medication costs.

Since 2018 Aetna has been a part of CVS Health, which runs the largest chain of pharmacies in the country. This means that they can offer discounted rates for prescription drugs and over-the-counter (OTC) medication.

Aetna offered three Medicare Prescription Drug Plans (Part D) in 2021, all of which had an average monthly premium of less than $70.00 per month.

These were:

  • SilverScript SmartRx (PDP)

  • SilverScript Choice (PDP)

  • SilverScript Plus (PDP)

How Much Does Aetna Medicare Part D Plans Cost?

It’s important to remember that Part D plan prices depend on:

  • Your location

  • The pharmacy you use 

  • Your coinsurance (the portion of medical costs you have to pay)

  • Your copayments (set fees you have to pay for services, tests, and medication)

  • Your annual deductible (your payment before coverage starts)

Here’s an example of the different Aetna Part D plans if you live in Indianapolis and use Aetna’s preferred retail pharmacies (2021).

Plan Name Is there a monthly premium? Annual Insurance Deductible Tier 1 Drug Copay Tier 5 Drug Coinsurance Cover
SilverScript SmartRx (PDP) Yes $445.00 $0.00 25%
SilverScript Choice (PDP) Yes $325.00 $0.00 27%
SilverScript Plus (PDP) Yes $0.00 $0.00 33%

*Prices and costs listed here are subject to change and should not be considered as the final amount you will pay for Medicare Part D coverage. If you would like to find out what a plan might cost you, contact PolicyScout.

Part D plans use a tier system to classify medication costs and coverage. Your costs will also be different based on the brands of drugs you use. Take a look at this table to understand how the different tiers work.

Drug Coverage Tiers
Tier 1 Preferred generic drugs
Tier 2 Generic drugs
Tier 3 Preferred brand drugs and select insulin drugs
Tier 4 Non-preferred drugs
Tier 5 Specialty drugs

*Preferred - The brand is on your insurance provider’s formulary list. **Non-preferred - The brand is not on your insurance provider’s formulary list.

If you’re interested in learning more about Aetna’s Part D plans in your area, contact PolicyScout at 1-888-912-2132 or send an email to Help@PolicyScout.com. One of our Medicare consultants will be able to assist you.

Medicare Supplement Plans Offered by Aetna

Medicare Supplement Plans, or Medigap plans, offer standardized benefits that cover the costs of Medicare, such as coinsurance and deductibles.

Some of the benefits offered by Aetna’s Medicare Supplement Insurance include:

  • There are no restrictive provider networks (members can visit any physician, specialist, or hospital that accepts Medicare patients).

  • Direct cash payments to pay for medical expenses.

  • Coverage stays with you when you travel.

  • Up to 365 days of hospital cover after Medicare benefits are used up.

  • Limited copayments for specific procedures and consultations.

Here’s an overview of the Supplement Insurance Plans that Aetna offered in 2021.

Benefits A B C D F G N
Medicare Part A Coinsurance and hospital cost up to an additional 365 days after Medicare Benefits are used 100% 100% 100% 100% 100% 100% 100%
Medicare Part B Coinsurance or copayment 100% 100% 100% 100% 100% 100% 100%
Blood (the first 3 pints) 100% 100% 100% 100% 100% 100% 100%
Part A Hospice Care Coinsurance or copayment 100% 100% 100% 100% 100% 100% 100%
Skilled Nursing Facility Care 100% 100% 100% 100% 100%
Part A Deductible 100% 100% 100% 100% 100% 100%
Part B Deductible 100% 100%
Part B Excess Charges 100% 100%
Foreign Travel Emergency (up to plan limits) 80% 80% 80% 80% 80%

How Much Do Aetna Medicare Supplement Plans Cost?

Aetna offered seven Medicare Supplement Plans in 2021 and two high-deductible versions of Plans F and G.

With Aetna’s Medicare Supplement plans, members can get additional coverage for extended hospital stays and save on costs when seeing physicians or specialists.

Here are some examples of Medicare Supplement plan rates for a 66-year-old female who lives in Indiana and doesn’t use tobacco. These ranges do not include the monthly Part B premium (in 2022, the average monthly premium was $170.10).

Example - Medicare Supplement Insurance Rates in Indiana

Medicare Supplement Insurance Monthly Premium
Plan A $72.00 - $390.00
Plan B $102.00 - $308.00
Plan C $116.00 - $390.00
Plan D $110.00 - $250.00
Plan F $113.00 - $391.00
Plan G $97.00 - $341.00
Plan N $73.00 - $329.00
Plan F (High Deductible) $32.00 - $61.00
Plan G (High Deductible) $32.00 - $77.00

*Prices and costs listed here are subject to change and should not be considered as the final amount you will pay for Medicare Supplemental coverage. If you would like to find out what a plan might cost you, contact PolicyScout.

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How Do I Choose the Right Medicare Advantage Plan?

If you’re thinking about joining a private Medicare insurance plan, keep these points in mind while you choose:

  • Price: Look at how much the plan will cost every month, if the policy is affordable, and if you can pay in case your monthly premiums go up.

  • Benefits: Ask your Medicare insurance agent or Medicare provider about the benefits you’ll get and look at the plan’s details to see if it will give you what you need.

  • Out-of-pocket expenses: Make sure you are aware of the potential costs that you will have to pay. Check your plan’s coinsurance, deductibles, and monthly premiums.

  • Track record: Read up on the insurance company offering the plan. Look at how many members they have, how long they’ve operated, and how many areas they do business in.

  • Compare: Always compare plan benefits and costs before you make a final decision. Speak with a Medicare consultant to help you weigh up your options if you don’t know which plans are right for you.

About Aetna
Headquarters Hartford, Connecticut
Founding Date 1853
Current CEO Mark Bertolini
Coverage Areas All 50 States
Website https://www.aetna.com/
Medicare Members in 2021 9.8 million

Where Can I Learn More about Medicare Advantage Plans?

At PolicyScout, our goal is to simplify Medicare and help people make the best choices for their health coverage. We know that Medicare and Medicare Advantage can be confusing. That’s why we’ve created a series of articles to help you navigate through the different terms, costs, benefits, and processes.

If you’re interested in learning about Medicare, visit our Medicare Hub to get the latest health cover information for over-65s in the U.S.

You’re also welcome to give us a call on 1-888-912-2132 or send us an email at Help@PolicyScout.com if you’d like to speak with one of our trained consultants about your health care options.

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