Paul Sanchez
Aetna is a health insurance company that offers a range of Medicare plans, known as Aetna Medicare Advantage (Part C) plans. These plans provide comprehensive health and wellness coverage, including hospital and medical care, prescription drugs, and additional benefits such as dental, vision, and hearing. Aetna's Medicare Advantage plans are available in most states, but specific types of plans and coverage options may vary by location. The company also offers Preferred Provider Organization (PPO) plans, which allow members to use any doctor that accepts Medicare and Aetna's plan terms, as well as Dual Eligible Special Needs Plans (D-SNPs) for individuals eligible for both Medicare and Medicaid. Members can manage their prescriptions and find drug pricing information on the Caremark.com website. Premium payments can be made through trusted payment services such as InstaMed and Payer Express.
| Characteristics | Values |
|---|---|
| Medicare Plan | Medicare Advantage (Part C) |
| Plan Options | Medicare Advantage plans with prescription drug coverage, Medicare Advantage-only plans, Dual Eligible Special Needs Plans (D-SNPs), Chronic Condition Special Needs Plans (C-SNP), Institutional Special Needs Plans (I-SNPs), Medicare Supplement plans |
| Plan Availability | 44 states for Medicare Advantage plans with prescription drug coverage, 43 states for Medicare Advantage-only plans, plus Washington, DC |
| Plan Costs | Plan premiums starting as low as $0, monthly Part B premium of $185, Part B deductible of $257 in 2025 |
| Plan Benefits | Prescription drug coverage, mail-order prescription drug benefit, over-the-counter medication benefit, dental, vision, and hearing coverage, annual eye and hearing exams, access to fitness locations and classes, coverage for fillings and extractions |
| Payment Methods | Payer Express, InstaMed |
| Plan Selection | Compare plans in your area using ZIP code, review benefits, costs, and drug coverage, check if your doctor is in the network |
| Appeals Process | Members have the right to appeal coverage determination and request an independent external review for denials based on medical necessity |
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What You'll Learn
Medicare Advantage (Part C) plans
Medicare Part C, also known as Medicare Advantage, is offered by private insurance companies like Aetna. These plans give you additional coverage not provided by Original Medicare. To get a Medicare Advantage plan, you need to first sign up for both Part A and Part B. You can then choose a Medicare Advantage plan that suits your needs.
Aetna Medicare Advantage (Part C) plans take a holistic approach to health. They include prescription drug coverage and additional benefits with plan premiums starting as low as $0. With their Medicare Advantage health maintenance organization (HMO) plans, you choose a primary care provider who helps coordinate your care within a network of Aetna Medicare HMO providers and hospitals. For medical care, their HMO-POS plans require you to choose a primary care provider from a group of participating providers. For routine dental care, most HMO-POS plans provide you with the flexibility to go to licensed dental providers either in or out of their network.
Aetna also offers Medicare Advantage Preferred Provider Organization (PPO) plans, where you can visit Medicare-approved providers in or out of their provider network who accept Aetna plan terms. You may pay more when you go out of network. They also offer targeted SNP plans for those with specific chronic health conditions, are dual eligible with Medicaid, or are in an institution.
Aetna Medicare Advantage plans also include access to over 15,000 fitness locations, online tools, classes, and workshops. You can also get an annual eye exam and coverage for eyeglasses or contacts, as well as an annual hearing exam and hearing aid coverage.
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Prescription drug coverage
Aetna offers prescription drug coverage through its Medicare Part D plans. These plans cover thousands of drugs, including brand-name and generic options. To find out if a specific drug is covered, members can log in to their secure member website or use the Aetna drug search tool.
Aetna's prescription drug coverage is divided into five tiers, with Tier 1 being the least expensive and Tier 5 the most expensive. The tier of a drug can be found on the member's formulary or drug list, which is available on their member portal. Members can also consult their Evidence of Coverage to help them understand which drugs are covered by their plan.
Aetna's Medicare Part D plans include SilverScript Choice, which offers a wide range of brand-name and generic drugs, with more than 1,400 drugs on the formulary. This plan may lower premiums for those who qualify for the Medicare Part D Extra Help program.
It's important to note that some prescription drugs have special coverage rules, such as step therapy, prior authorization, and quantity limits. Additionally, there may be a late enrollment penalty for Part D, resulting in a permanent increase in costs if an individual does not have Medicare drug coverage for 63 days or more after their Initial Enrollment Period ends.
Aetna also offers Medicare Advantage with Prescription Drug plans (MAPD), which provide medical and prescription drug coverage. These plans allow individuals to manage their prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options.
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Medicare eligibility
Medicare is generally for people aged 65 or older. However, you may be eligible for Medicare earlier if you have a disability, End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant), or ALS (also known as Lou Gehrig's disease).
If you are already receiving Social Security benefits before turning 65, you may be automatically enrolled in Medicare. Otherwise, you will need to actively sign up.
To be eligible for premium-free Part A coverage, you must meet one of the following criteria:
- Qualify for or receive retirement or disability benefits from Social Security or the Railroad Retirement Board.
- Obtain Medicare before turning 65.
- Are 65 or older, and you or another qualifying person (such as your current or former spouse) paid Medicare taxes while working for a certain period, typically at least 10 years.
If you do not qualify for premium-free Part A, you may have the option to purchase it. On the other hand, you will be required to pay a monthly premium for Part B coverage, regardless of whether you utilise any Part B-covered services.
Aetna offers a range of Medicare plans, including Medicare Advantage (Part C) plans, which provide comprehensive health coverage. These plans can include prescription drug coverage and additional benefits, with plan premiums starting at $0. With the Medicare Advantage HMO-POS plans, you have the flexibility to choose a licensed dental provider from both in-network and out-of-network options for routine dental care.
Aetna also provides Medicare Supplement Insurance plans, Dual Eligible Special Needs Plans (D-SNP), and prescription drug plans. You can review the available plans in your area, compare benefits and costs, and check if your doctor and drugs are covered.
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Payment options
Aetna offers a range of payment options for its Medicare plans. You can choose to set up monthly payments or make one-time payments, using a secure payment system. To make payments, you will need your Aetna member ID card, date of birth, and credit/debit card or bank account details. You will receive an invoice, or premium invoice, stating the amount you need to pay.
Aetna also offers payment services through trusted partners, such as InstaMed and Payer Express. Your login details for these services may differ from your Aetna secure member site login. With these services, you can set up automatic payments, update your payment method, and manage your account.
For Aetna Medicare SilverScript members, the website caremark.com provides a secure platform to manage prescriptions, sign up for mail delivery, view order status, find drug pricing, and identify savings options.
Aetna also offers a Medicare Prescription Payment Plan to help manage drug costs. This plan allows you to spread the cost of prescription drugs over the plan year, billing you for a portion of the cost each month. This option may help with monthly expense management, especially if you have high-cost drugs early in the plan year.
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Dental, vision and hearing coverage
Dental, vision, and hearing coverage are essential for overall well-being, especially as you age. Original Medicare does not cover any routine hearing, vision, or dental care, which can become expensive. However, many Aetna Medicare Advantage (MA) plans offer dental, hearing, and vision coverage, helping to improve your quality of life and social interactions.
Aetna Medicare Advantage plans cover a wide range of dental services. Preventive dental care includes annual oral exams, cleanings, X-rays, and fillings. Some plans offer more comprehensive coverage for dental services such as dentures and root canals. Members of some plans can also see dentists that are not part of their plan's network, although this may result in higher costs.
Vision coverage is also included in many Aetna Medicare Advantage plans, offering one routine vision exam per year. Some plans provide a benefit amount or allowance each year to purchase prescription eyewear. With a network benefit, you can see any vision provider in your plan's network. Alternatively, with a DMR benefit, you can choose a licensed provider of your choice, although you may need to pay out of pocket first and then file a claim for reimbursement.
Hearing benefits are available through NationsHearing, with some plans covering one routine hearing exam per year, as well as hearing aids and one hearing aid fitting per year. Many MA plans include coverage for hearing exams and an annual allowance to help cover the cost of hearing aids, which can prevent health risks associated with hearing loss, such as social isolation, dementia, and depression.
Aetna also offers dental insurance plans for individuals and families, known as Aetna Dental Direct. These plans provide quality insurance coverage for various dental services, including checkups, cleanings, X-rays, fillings, crowns, and root canals. Vision coverage can be added to these dental plans, providing more choice, savings, and convenience for overall health.
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Frequently asked questions
Aetna Medicare plans provide comprehensive health and wellness coverage. This includes hospital and medical care, prescriptions, and extras like dental, vision, and hearing. Plans may also include access to fitness locations, online tools, classes, and workshops.
Aetna handles premium payments through trusted payment services like Payer Express and InstaMed. You can create an account or log in to manage your existing account, set up automatic payments, and update your payment method.
Aetna Medicare Advantage plans take a total approach to health, offering a single, convenient plan that includes prescription drug coverage and additional benefits. These plans may include health maintenance organization (HMO) options, where you choose a primary care provider within a network of providers.
You can enter your ZIP code to review plans in your area and compare benefits, costs, and drug coverage. You can also find out if your doctor is in the network and if your drugs are covered.
Aetna provides its members with the right to appeal a coverage decision. Members may also have the opportunity for an independent external review of coverage denials based on medical necessity or experimental/investigational status for services costing $500 or more.
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