Paul Sanchez
Medicare can be confusing, with its many parts and plans, and it's not always clear what is and isn't allowed. Aetna is a brand name used for products and services provided by one or more of the Aetna group of companies, including Aetna Life Insurance Company and its affiliates. Aetna offers Medicare Advantage plans that cover dental, vision, and hearing care, as well as prescription drug coverage. These plans can help save money and manage day-to-day health needs. Additionally, Aetna handles premium payments through trusted payment services, making it convenient for members to manage their finances.
| Characteristics | Values |
|---|---|
| Medicare plans | Medicare Advantage plans, Part D prescription plans, billing, appeals |
| Aetna Medicare plans | Medicare Advantage plans, Medicare Supplement Insurance plans |
| Medicare Advantage plans | Cover dental, vision, hearing care, prescription drug coverage, etc. |
| Aetna Medicare Advantage plans | SilverSneakers basic membership, Resources For Living program, virtual care, etc. |
| Aetna Medicare Supplement Insurance plans | Insured by Aetna Health and Life Insurance Company, Aetna Life Insurance Company, etc. |
| Aetna Medicare payments | Through InstaMed, Payer Express |
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What You'll Learn
Medicare Advantage plans
Aetna Medicare is an example of a Medicare Advantage Plan, providing HMO and PPO plans with a Medicare contract. They also offer Dual Eligible Special Needs Plans (D-SNPs), which have contracts with State Medicaid programs. Aetna Medicare SilverScript is a Prescription Drug Plan (PDP) with a Medicare contract, providing prescription drug coverage (Part D) to members.
Before enrolling in a Medicare Advantage Plan, it is important to consider the potential impact on any existing employer or union coverage. Joining a Medicare Advantage Plan may result in losing this coverage, which could also affect the coverage of a member's spouse and dependents.
Additionally, it is worth noting that Medicare Advantage Plans can disenroll members under certain circumstances, such as moving outside the plan's service area, losing Medicare or Medicaid eligibility, or if the plan's contract with Medicare ends. In such cases, a grace period with a Special Enrollment Period is provided, allowing individuals to review their options and ensure they continue to have the desired Medicare health and drug coverage.
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Prescription drug coverage
If you are looking for prescription drug coverage, you will need Medicare Part D. Aetna offers Medicare prescription drug plans (PDP) that provide medication coverage but no medical coverage. The SilverScript Choice drug plan is one such plan, offering a wide range of brand-name and generic drugs. There are more than 1,400 drugs on the Aetna SilverScript formulary (drug list). Tier 1 drugs cost no more than $5* copay at all network pharmacies.
Medicare mandates that there be at least two drugs from every therapeutic class in a formulary. However, if you need a drug that is not on the list, your doctor can contact the insurance company to request a "formulary exception". If the request is approved, the drug will be provided to you at the cost-share that applies to drugs on Tier 4, meaning you will likely pay a higher percentage of the cost than if the medicine was included on a lower tier.
Some prescription drugs have special rules that must be followed before they are covered by your plan. These rules may include step therapy, prior authorization, and quantity limits. Step therapy requires that you first take a more cost-efficient version of the drug before moving on to a more expensive medication. Prior authorization means that your doctor must get approval from your plan before the drug will be covered. Quantity limits refer to restrictions on the number of doses and/or refills that your insurer will cover, such as with opioids.
Your cost-share will depend on the benefit phase you are in. Drugs filled in a non-retail setting, such as long-term care or specialty mail, may cost more than the price listed on the Medicare Plan Finder. You can call the number on your ID card to obtain non-retail pricing. Once you have spent $2,000 on out-of-pocket costs, your plan will pay the full cost for covered drugs. This resets at the end of each plan year.
Keep in mind that there is a Part D late enrollment penalty, which is a permanent increase to your Part D costs. If you do not have Medicare drug coverage for 63 days or more after your Initial Enrollment Period ends, your premium will be raised.
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Dental, vision, and hearing care
Original Medicare (Parts A and B) does not cover dental, vision, and hearing care. However, you can get Medicare Advantage (Part C) plans that offer coverage for these services.
Aetna offers Medicare Advantage plans with dental, vision, and hearing benefits. Dental benefits include oral exams, cleanings, X-rays, fillings, and extractions. Vision benefits include an annual eye exam and coverage for eyeglasses or contacts. Hearing benefits include one routine hearing exam per year, coverage for hearing aids, and one hearing aid fitting per year.
Aetna also offers dental insurance plans for individuals and families, which can be purchased separately from Medicare. These plans start at $17 and include 100% coverage for dental checkups, cleanings, and X-rays. You can also add vision coverage to your dental plan.
If you are interested in enrolling in an Aetna Medicare Advantage plan, you can schedule a call or visit their website to compare plans and select the one that is right for you.
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SilverScript® Choice PDP
The plan has various costs, including the monthly premium, deductible, copayments, and/or coinsurance. The monthly premium is bundled into the total plan cost, and you may face additional expenses or qualify for Low-Income Subsidy (LIS) support. The annual deductible for this plan is $590, which you must pay before Aetna starts sharing the cost of your prescriptions.
You can enroll in SilverScript Choice PDP online via MedicareEnrollment.com, by calling HealthCompare or 1-800-MEDICARE, or by contacting the plan directly.
As for your other question, it is not clear if you can have both Medicare and Aetna insurance at the same time. However, Aetna does offer Medicare plans, and you can use their website to find out if your doctor is in their network and if your drugs are covered.
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Medicare Supplement Insurance plans
Medicare Supplement Insurance, also known as Medigap, is extra insurance you can buy from a private health insurance company to help pay for out-of-pocket costs in Original Medicare. Generally, you must have Original Medicare (Part A and Part B) to buy a Medigap policy.
Medigap covers costs such as copayments, deductibles, and coinsurance. Plans A through G generally provide benefits at higher premiums with limited out-of-pocket costs compared to Plans K through N. Plans K through N are cost-sharing plans offering similar benefits at lower premiums with greater out-of-pocket costs.
Aetna Medicare is a health maintenance organization (HMO) and preferred provider organization (PPO) plan with a Medicare contract. Aetna Medicare offers a range of benefits, including access to fitness locations, online tools, classes, and workshops. They also cover oral exams, cleanings, X-rays, and in some cases, fillings and extractions. Annual eye and hearing exams and coverage for eyeglasses, contacts, and hearing aids are also included.
Aetna Medicare SilverScript is a prescription drug plan with a Medicare contract marketed through Aetna Medicare. Members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options through the Caremark.com website.
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Frequently asked questions
Aetna Medicare is a HMO, PPO plan with a Medicare contract. Aetna Medicare Advantage plans cover dental, vision, and hearing care, as well as prescription drug coverage.
Aetna Medicare plans cover a range of benefits, including dental checkups, annual eye and hearing exams, and coverage for eyeglasses, contact lenses, and hearing aids. Some plans also cover fillings and extractions.
You can enter your ZIP code on the Aetna website to start your search for a suitable plan. You can also schedule a call to get answers to your questions and learn more about the plans available in your area.
Caremark.com is the secure website where Aetna Medicare SilverScript members can manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options.
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