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Is Aetna A Medicare Advantage Plan

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Aetna Medicare Advantage Plans: Great For Active Adults

Aetna Medicare Advantage PPO With $0 Premiums?

More seniors than ever are adopting more active lifestyles, and with Aetna, your health insurance can keep up. If you like to travel, check out one of their Explorer plans. These plans are available in 28 states and allow you to receive in-network benefits from any Aetna facility or provider in the United States. Plus, all Aetna Medicare Advantage plans offer coverage for emergency room and urgent-care visits worldwide.

Aetna is also on the forefront digitally. Aetna offers an integration with Apple Watch via the Attain by Aetna app. This means that enrollees can track their overall health, set fitness goals, and receive rewards for reaching goals and participating in healthy activities. And if you dont have or use an Apple Watch, you can still take advantage of SilverSneakers. With this popular program, youll receive free access to more than 15,000 fitness locations across the United States.

Aetna Medicare Advantage Plans 2020

Committed to creating a healthier, stronger global community and helping you age with elegance and strength, Aetna International is one of the Industrys largest and most prominent health benefits providers which delivers all-inclusive and affordable health benefits and population health management solutions. Founded in 1853, Aetna provides healthcare, dental, pharmacy, group life, and disability insurance as well as employee benefits.

With the PPO plan getting a 4 out of 5-star rating in 2017 award by Center for Medicare and Medicaid Services , Aetna Medicare Advantage ensures that you stay healthy by helping you manage your long term medical condition or illness and ensuring that you are satisfied with the plan you choose.

Aetnas Fehb Medicare Advantage Plan

Yes, Virginia, there is a Santa Clause. Prescription drug copays under Aetnas Medicare Plans remain the same regardless of whether or not you enter the Part D prescription drug gap. This includes all three of their plans: Self Only , Self + 1 , Self and Family .

I talked to a number of Aetna customer service reps while researching my previous article about Aetnas Medicare Advantage plans. I received conflicting information on how drugs were reimbursed in this plan. Their pharmacy specialist assured me that the Gap coverage I outlined in the original article was correct! I was referred to the Medicare site for clarification and the information I relayed reflected that guidance.

Susan Allgood, Aetnas relationship manager for federal plans stated, the member continues to pay the same co-payment through the entire year. She referenced Aetnas Medicare Plan Summary of Benefits and I excerpted the following coverage gap clarification from this document.

Most insurers have numerous Medicare Part C Plans and many of those plans, not associated with the FEHB, are subject to the Medicare prescription drug Gap. If you are considering a Medicare Part C plan that isnt associated with the FEHB program, be aware that the prescription drug gap rules outlined in my original article may apply.

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When Does Aetna Medicare Pay For Cataract Surgery

Cataract surgery is often considered a medically necessary procedure, and your doctor will refer you for surgery upon a diagnosis of cataracts and vision impairment.

Some Aetna Medicare Advantage plans may require prior authorization before a coverage determination may be made. Some of the factors that may be used in making a determination include:

  • Diminished ability to carry out activities of daily living
  • A level of visual acuity of 20/50 or worse
  • Significant improvement can be expected as an outcome of the surgery

Cataracts can affect your perception of colors and light, cause double vision, blurred or cloudy vision, seeing halos around lights, and increasing difficulty seeing at night.

Aetna Medicare Advantage plans like all Medicare Advantage plans are required by law to cover at least as much as Original Medicare covers. Because Original Medicare covers cataract surgery if its performed using traditional techniques or using lasers, Medicare Advantage plans will offer at least that same level of coverage, if not more.

Most Medicare Advantage plans offer additional benefits that Original Medicare doesnt cover, such as prescription drug coverage, dental, hearing, transportation and more.

Aetna Medicare Advantage plans that include vision benefits typically cover routine vision care, eyeglasses or contact lenses, eye exams and more.

Do Aetna Medicare Plans Pay For Other Caregiving And Home Health Services

Aetna Medicare Advantage Card

While Medicare Advantage plans are required to meet the above coverage of home health care, Aetna Medicare Advantage plans often go above and beyond to include additional home health care benefits.

In fact, Aetna has partnered with a caregiving agency called CareLinx to provide in-home caregiving services for its members. Aetna members may use their plan benefits for covered caregiver services such as meal preparation, cleaning, transportation and more.

Covered caregiving services may also be provided by a friend or family member, and Aetna offers a caregiving resource guide to help new caregivers find their way.

Below are some of the home health care services and other benefits that may be utilized within the home that you might find covered in an Aetna Medicare Advantage plan.

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Supplemental Retiree Medical Coverage

The Aetna Supplemental Retiree Medical Plan is a fully insured, non-network-based commercial retiree group health product. In all states but Florida and Minnesota, it is offered as a supplementary medical plan, not a Medicare plan. In Florida and Minnesota, it is approved as a group Medicare Supplement product.

This coverage is offered only to retirees and their eligible dependents who are enrolled in Medicare.

Medicare Prescription Drug Plans

The Aetna standalone prescription drug plans serve 5.7 million members. In 2022, Aetna Medicare will offer the same three individual standalone PDPs as in 2021. SilverScript SmartRx , featuring an average monthly premium of $7.08, will again be the lowest premium plan available from Aetna. SilverScript Choice will be under the Centers for Medicare & Medicaid Services benchmark pricing in 49 states and D.C., while SilverScript Plus has the most robust prescription drug coverage. All three plans are available in all 50 states and D.C and feature lower Tier 1 and Tier 2 copays at preferred retail pharmacies. Source: CMS 2022 PDP Landscape Source Files available at

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Available Part D Prescription Drug Plans

While many of Aetnas Medicare Advantage plans include Part D drug coverage, the company also sells stand-alone Part D prescription drug plans. These plans, which are meant to accompany Medicare Part A and Medicare Part B, don’t provide medical coverage.

Aetna offers three stand-alone Medicare prescription drug plans in 2022, with average monthly premiums that range from $7.08 to $68.97:

  • SilverScript SmartRx: Average premium of $7.08. Offers Tier 1 generic drug coverage with a $0 deductible and $1 copays.

  • SilverScript Choice: Average premium of $30.78. Offers Tier 1/Tier 2 coverage of generic and brand-name drugs with a $0 deductible, and with $0 copays for Tier 1.

  • SilverScript Plus: Average premium of $68.97. Offers gap coverage and a $0 deductible for all tiers, plus a $0 copay for Tier 1 drugs and $2 copay for Tier 2 drugs.

Aetna offers three stand-alone Medicare prescription drug plans in 2021, with average monthly premiums that range from $7.15 to $69.52:

  • SilverScript SmartRx: Average premium of $7.15. Offers Tier 1 generic drug coverage with a $0 deductible and $0 copays. This is the lowest-cost stand-alone drug plan nationwide.

  • SilverScript Choice: Average premium of $28.49. Offers Tier 1/Tier 2 coverage of generic and brand-name drugs with a $0 deductible, and with $0 copays for Tier 1.

  • SilverScript Plus: Average premium of $69.52. Offers gap coverage and a $0 deductible for all tiers, plus a $0 copay for Tier 1 drugs and $2 copay for Tier 2 drugs.

$ Medicare Advantage Plans At A Glance

Lifes a Journey, Not a Destination | Aetna Medicare Solutions

Our PPO plans

Requires you to use a provider network

No. But seeing out-of-network providers generally costs more.

Yes, unless it’s an emergency

Varies by plan. Seeing out-of-network providers generally costs more. But most allow non-network dental providers.

Requires you to have a primary care physician

Usually no PCP required

Requires referral to see a specialist

No referral required

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Medical deductible

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Varies by plan, check your ZIP code for details

Limits what you pay out-of-pocket for medical care each year

Includes prescription drug coverage

Yes, in most plans

Yes, if plan has Rx coverage

Yes, if plan has Rx coverage

Yes, if plan has Rx coverage

Dental, vision and hearing coverage

Yes, in most plans

ER and urgent care coverage worldwide

Meals-at-home program

Yes, in most plans

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Transition Of Coverage For Part D

Members who are taking Part D drugs that are not on the plan’s formulary, or that are subject to utilization management requirements, can get a transition supply of their drug under certain circumstances. They can work with you to complete a successful transition and avoid disruption in treatment.

Aetna Medicare Prime Plan

  • Provides coverage with a multistate network of medical providers and facilities.
  • More flexibility to visit out-of-network providers and medical facilities.

You may have other plan options available.

A licensed agent can help you compare your Aetna plan options and find one that works for your Medicare coverage needs and budget. You can speak with a licensed agent directly at , TTY: 711, 24/7.

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Aetna Medicare Advantage Pros And Cons

As one of the top four largest Medicare Advantage plan providers in the United States, Aetna ranks pretty highly across the board. Aetna has relatively few customer complaints for a company its size, according to the National Association of Insurance Commissioners, and it also ranks fourth among insurance companies in the J.D. Power Medicare Customer Satisfaction Survey.

Perhaps Aetna’s biggest draw is that it offers enrollees some of the cheapest Medicare Advantage Plans among all insurers, without sacrificing quality. Here are some more Aetna pros and cons.

Find The Right Medicare Advantage Plan

Aetna Medicare Advantage Replacement Card

Its important to do your research before selecting a health plan for yourself. Here are some questions to consider:

  • What are the plans costs? Do you understand what the plans premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plans network.

  • Are your prescriptions covered? If youre on medication, its crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit or call 800-MEDICARE .


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Switch Your Plan Not Your Doctor

Though you have a new plan option, chances are you may be able to continue seeing your doctors. This is because this plan is the Aetna Medicare Plan with an extended service area . This is a type of Medicare Advantage plan. With this type of plan you pay the same cost for any doctor or hospital, according to the costs listed on the plan benefits summary. The provider must be eligible to receive Medicare payment and accept the Aetna plan.

Instructions on how to use Aetna Medicare Advantage provider search »
  • Step 1: After clicking on Find your provider, choose 2022 Medicare plans you through your employer
  • Step 2: Enter your home zip code OR city, state then select from the drop-down
  • Step 3: Choose select plan to find providers
  • Step 4: Choose Medicare Advantage with Prescription Drug plan
  • Step 5: Under PPO section Select Aetna Medicare Plan with Extended Service Area *
  • Step 6: Then choose medical and click continue to find care at the bottom right of your screen to find providers

*As a member of the Aetna Medicare Plan with an Extended Service Area , you can receive services from any provider that is eligible to receive Medicare payment and is willing to treat you. Your cost share will be the same as in-network care. Out-of-network providers are under no obligation to treat Aetna members, except in emergency situations.

Hmo Point Of Service Plans

Aetnas Medicare Advantage HMO Point of Service plans also offer the benefits of coordinated care through a primary care physician.

Members have the flexibility to choose out-of-network providers for some services, though this is likely to be at a higher cost.

Aetna HMO-POS plans do not require a person to use in-network health services. In some plans, members will need to select a primary care physician.

Aetna HMO-POS plan benefits include:

  • prescription drug coverage and mail-order benefits
  • dental, vision, and hearing cover
  • worldwide emergency care cover

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Important: Annual Medicare Compliance Program Requirements

Participating providers in our Medicare Advantage , Medicare-Medicaid , Dual Eligible or Fully Integrated Special Needs Plans are required to meet the Centers for Medicare & Medicaid Services compliance program requirements for first-tier, downstream and related entities as identified in the Medicare compliance FDR program guideand/or DSNP Model of Care training.

New for 2021

  • MA/MMP: Providers who participate only in our MA/MMP plans no longer need to complete an annual FDR Attestation.
  • MA/ DSNP/FIDE: Providers who are located in states/regions that offer MA/DSNP/FIDE plans continue to be required to complete the Annual DSNP Model of Care training and attestation.
  • Delegated Entities: Provider attestation collection for the FDR compliance requirements continue to be required for Delegated Entities. Delegated entities will receive their attestation directly through Adobe Sign. Completion of the DSNP MOC training and the related attestation is still required.

Notification regarding requirements will be sent directly to providers via Adobe Sign email, postcard or you can access the training and attestation at the link below. Our Compliance Department completes random audits to ensure compliance on an annual basis.

Does Aetna Cover Cataract Surgery

Aetna’s Advantage Plan Benefits
  • Aetna Medicare Advantage plans cover cataract surgery when its medically necessary. While Original Medicare also covers cataract surgery, many Aetna Medicare plans cover additional vision services that Original Medicare doesnt cover.

There are typically two questions that come to mind when told you need cataract surgery: How much does it cost and is it covered by insurance?

The average cost of cataract surgery is between $3,500 and $7,000 per eye. And yes, most health insurance plans cover cataract surgery when your doctor considers it to be medically necessary. All Medicare Advantage plans including Aetna Medicare Advantage plans cover cataract surgery when its medically necessary, though there may be some other conditions that must be met.

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How We Reviewed Medicare Providers

Even Medicare health plans with a national presence can vary locally in their cost, quality, and customer satisfaction. To evaluate Medicare plans, we looked at health insurance industry ratings from the primary accrediting agency for health plans, NCQA, and the Medicare Star Ratings from CMS, the regulatory agency that oversees Medicare. We included the National Association of Insurance Commissioners complaint index and AM Bests financial stability ratings. We also considered information from the companies on their programs and strategies.

Aetna Special Needs Plans

Special Needs plans are also known as the acronym . Most people who qualify for special needs are folks who might be living in a nursing home or a similar facility.

Another example of a special needs recipient might be when someone suffers from two chronic conditions such as high blood pressure and high cholesterol. If anyone of these events were to take place, a Medicare recipient would be able to join a SNP at any time during the year.

Additional benefits that could be found in Aetna Advantage plans may include preventive dental and vision, Travel Advantage benefits, and Wellness programs that may include Silver Sneakers to help pay for a gym membership. All Advantage plans also have 24-hour hotlines for emergencies and information.

Examples of cost sharing such as copays and deductibles are:

  • Diabetic supplies
  • Wellness program, which may include a fitness program such as Silver Sneakers
  • Travel advantage program

Also Check: How Much Does Medicare Cover For Home Health Care

Health Maintenance Organization Plans

When someone joins a Health Maintenance Organization plan, they choose an in-network primary care physician who coordinates their healthcare.

The primary care physician is a doctor who is the primary contact for all medical matters. If someone needs to see a specialist or requires a hospital visit, for example, the primary care physician needs to provide a referral.

Typically, members must use services from a specific network of doctors and healthcare facilities, unless in an emergency.

HMO plans have limited out-of-network benefits.

Aetna HMO plans require members to use a network of health services. Members must also select a primary care physician who provides referrals to see specialists.

Aetna HMO plan benefits include:

  • prescription drug coverage and mail-order benefits
  • dental, vision, and hearing cover
  • worldwide emergency care cover

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