Aetna Medicare Review

Pros Explained

• Low-premium prescription drug plans: In 2021, Aetna introduced a new, low-premium stand-alone prescription drug plan. At $7.15 per month, this plan will be the lowest-premium plan in all 50 states. All three stand-alone prescription drug plans have $0 copayments for Tier 1 drugs at preferred retail pharmacies.
• More $0-premium Medicare Advantage plans in 2021: Aetna expanded their $0-premium Medicare Advantage options. This year, these plans will be available to 81% of Medicare-eligible beneficiaries.
• Extensive extra benefits: All Aetna Medicare Advantage members can get SilverSneakers fitness benefits, and many can get dental, vision, and hearing benefits. Some Aetna members can also get Resources for Living support, over-the-counter benefits, and meal delivery after hospitalization. 
• Pay your premium at some CVS locations: Members can pay their bills at some CVS retail locations. With the “Pay at the Store” barcode, members can then pay their health insurance bill with cash, credit, or debit cards, just like any other pharmacy purchase. 

Cons Explained

• Average to low customer satisfaction: According to J.D. Power’s 2020 U.S. Medicare Advantage Study, Aetna scored 789 out of 1,000, compared to the industry average of 800, putting it squarely in the middle of the top 10 plans.
• Many subsidiaries have low health plan satisfaction: According to the NCQA health plan ratings, many Aetna subsidiaries scored a 2 out of 5 on customer satisfaction with their health plan, even if overall ratings was higher because of other measures. 
• Average Medicare Star Ratings: CMS, the agency that oversees Medicare, evaluates Medicare plans on a 1 through 5 scale. Aetna’s subsidiaries are evaluated individually, with the range for Medicare Advantage plans from 3.5 to 4.5 Stars. These aren’t bad scores; they’re just average.

Available Plans

Medicare Advantage Plans

Aetna offers several types of Medicare Advantage plans, each with different benefits, costs, and rules. All of Aetna’s plans limit the maximum out-of-pocket costs a member could have to pay in a year, unlike Original Medicare. They all offer fitness benefits through SilverSneakers, and many also offer dental, vision, hearing benefits, and mail-in pharmacy benefits.

HMO Plans 

HMO plans typically require members to have a primary care provider who helps coordinate care and acts as a gatekeeper to other health care services. Members in Aetna’s Medicare Advantage HMO may need a referral to see a specialist. Most of Aetna’s HMO plans require members to use a set network of health care providers, except in an emergency. Many of these plans include pharmacy benefits and other extra benefits.

HMO-POS Plans 

Some Aetna HMO-POS (point of service) plans may offer flexibility to see health care providers outside of a specific network, but out-of-network providers may cost more. Aetna’s HMO-POS plans require members to have a primary care provider, and some require members to get a referral to see a specialist. These plans consistently offer pharmacy, dental, vision, and hearing, along with over-the-counter benefits and home-delivered meals after a hospital stay. 

PPO Plans

PPO plans tend to offer more flexibility in seeing out-of-network providers than the other Medicare Advantage plans, but those providers may cost more. Aetna’s PPO plans do not typically require members to have a primary care provider, and there are no referrals needed to see specialists. Many of Aetna’s PPO plans have the other extra benefits members get in the HMO-POS plans.

Medicare Advantage Prescription Drug Plans

Medicare Advantage Prescription Drug (MAPD) plans combine prescription coverage—Medicare Part D—with Medicare Parts A and B. Aetna’s $0-premium MAPD plans are available to 81% of Medicare-eligible beneficiaries.

Stand-Alone Prescription Drug Plans

Stand-alone prescription drug plans (PDP) cover medications that fall into the Medicare coverage gap, but do not offer any medical coverage or other benefits. These plans work alongside Original Medicare Parts A and B. In 2021, Aetna will offer three stand-alone PDPs, with premiums ranging from $7.15 to $69.52 per month. The lowest-cost option, SilverScript Smart Rx, is the lowest available premium in 50 states and Washington, D.C. All three plans start with $0 copayments for Tier 1 drugs at preferred pharmacies. The lowest premium plan has the highest Tier 2 copayments ($19). The highest premium plan has no deductible on any tier and additional gap coverage, where the other two options do not. Aetna’s stand-alone prescription drug plans are offered by CVS SilverScript.

Medicare Supplement (Medigap) Insurance 

Medicare Supplement plans, also known as Medigap, cover some of the costs that Original Medicare doesn’t cover like copayments, coinsurance, and deductibles. You must have Medicare Parts A and B, and you can’t have Medicare Advantage, to get a Medigap plan. There are 10 standardized plans that cover different costs; not all are available in every state. Medicare.gov offers information about Medigap plans, but you buy them directly from private insurers. These plans do not require members to use any specific provider network, so the coverage is portable and flexible. Medigap plans do not cover prescriptions, and cannot be combined with certain other coverage, like a Medicare Advantage plan. 

Aetna offers the following Medigap plans:

Available to all applicants:

• A: Supplements coinsurance or copayments for Medicare Parts A and B
• B: Supplements Parts A and B coinsurance or copayments and Part A deductible
• D: Supplements prescription drug coverage
• G: Supplements Parts A and B coinsurance, Part A deductibles, Part B excess charges, plus skilled nursing facility coinsurance and foreign travel emergency (80%)
• N: Supplements Parts A and B coinsurance and Part A deductibles, plus skilled nursing facility coinsurance and foreign travel emergency (80%)

Available only to people who were eligible for Medicare before 2020:

• C: Supplements Parts A and B coinsurance and deductibles, plus skilled nursing facility coinsurance and foreign travel emergency (80%)
• F: Supplements everything in Medigap C, plus Part B excess charges

Aetna’s website has more information about its Medigap offerings.

Medicare Advantage Dual-Eligible Special Needs Plans (D-SNP)

Dual-eligible Special Needs plans (D-SNP) are a type of Medicare Advantage plan for people who have both Medicare and Medicaid. D-SNPs offer all the benefits of Medicare Advantage, plus additional benefits the private insurer may choose to include. People who qualify for these plans typically have their costs covered by Medicare and Medicaid. Aetna’s D-SNPs include a dedicated care team to support people with chronic diseases or special health care needs. They also offer other programs to help with non-medical costs such as housing, utilities, transportation, and food.

Extra Benefits

Most Medicare Advantage plans offer extra benefits, such as fitness, dental, and vision benefits, as well as hearing aids, over-the-counter medications, and meal benefits. These benefits have become increasingly common. In 2020, 98% of Medicare Advantage plans also offered telehealth benefits. 

Aetna’s Medicare Advantage plans offer most if not all of these add-on benefits, including dental, vision, and hearing, fitness benefits from SilverSneakers, over-the-counter medication benefits, care management to help members manage health conditions, and a meals-at-home program. 

Aetna’s Medicare Advantage members can also get concierge services through Resources for Living, which helps members access household help, caregiver support, community transportation, or connection to activities or classes. The member pays for the services, but the concierge call is free. 

Most of these extra benefits are not offered with Supplement (Medigap) or stand-alone prescription drug plans.

Customer Service

Aetna’s customer service is available by phone or email. Medicare Advantage and Prescription Drug Plan phone support is available seven days a week, from 8 a.m. to 8 p.m. EST, at 855-335-1407 (TTY: 711). 

Medicare Supplement Insurance Plan service is available Monday through Friday, 8 a.m. to 8 p.m. EST, at 800-358-8749 (TTY: 711).

Members and prospective members can request a call or contact the plan via the website. It is common for health care organizations not to offer email or chat because of privacy rules and caution to protect member confidentiality.

Customer Satisfaction 

The National Association of Insurance Commissioners (NAIC) tracks complaints against insurers of all types, including health insurers. In its complaint index, NAIC divides the company’s share of complaints by its share of premiums in the U.S. market. A score of less than one means the insurer received fewer than expected complaints; a score of greater than one means they received more than expected.

For Medicare Supplement plans, Aetna’s complaint index was 4.87 in 2019 and 3.89 in 2018, with more than twice the likely complaints. There were no complaints in 2017. Though complaints against Aetna rose over this period, the numbers are small and may not yet indicate a worsening trend. 

Third-Party Ratings

AM Best

AM Best, the credit rating agency that assesses insurance companies’ financial strength, affirmed its A (Excellent) Financial Strength Rating of the Aetna Life Insurance Company, effective November 21, 2019. The rating applies to the majority of Aetna Health & Life group subsidiaries. An A rating indicates that the company, in AM Best’s opinion, has an excellent ability to meet their ongoing insurance obligations. This rating reflects Aetna’s strong financial performance.

NCQA

The National Committee for Quality Assurance (NCQA) is a leading health plan accreditation organization that assesses and rates health plans each year based on health care quality and customer satisfaction measures. In the 2019–2020 ratings, Aetna subsidiaries scored between 2.5 out of 5 for the Medicare-Medicaid plans such as Aetna Better Health of Michigan and Aetna Better Health of Illinois, and 4.5 out of 5 for Aetna Health in Connecticut and Maine. These composite scores include measures of customer satisfaction, including satisfaction with the consumer’s ability to get needed care, satisfaction with the doctors, and satisfaction with the health plan. 

Several Aetna subsidiaries score worse on satisfaction with the health plan, compared with physician satisfaction or overall ratings. For example, Aetna Health of Connecticut scores a 4.5 overall, but just a 3.5 for customer satisfaction and 2.0 for satisfaction specifically with the health plan.

J.D. Power

In its 2020 U.S. Medicare Advantage Study, J.D. Power measured member satisfaction with Medicare Advantage plans based on the plans’ coverage and benefits, choice of health care providers, cost, customer service, information and communications, and billing and payment. On the overall customer satisfaction index, Aetna scored 789 points out of 1,000, placing it just below the industry average of 800 and fifth overall.

Medicare Star Ratings

The Centers for Medicare and Medicaid Services (CMS) rates Medicare Advantage and prescription drug plans on a five-star quality rating system. These ratings are based on how well the plans help members stay healthy and manage chronic conditions, as well as how members rate their experience with the plan and its customer service. These ratings incorporate member complaints into the overall rating.

Star Ratings vary by state, county, and plan. Aetna’s Medicare Advantage plans range from 3 to 4.5 Stars; their Part D prescription plans range from 3 to 5 Stars. Aetna’s highest-ranking Part D plans are those in Georgia and Pennsylvania, both 5-Star plans. Check Aetna’s Star Ratings in your county and for the plan you have or are considering. 

Cost

Medicare health plan costs depend on many factors, including where you live, which type of coverage you want, and what insurance company you choose. The best way to compare specific cost information across insurers in your area is through the plan finder on Medicare.gov. Aetna’s site, on the other hand, lets you compare Aetna Medicare Advantage, Medicare Advantage Prescription Drug Plans, and stand-alone Prescription Drug Plans in one search.

Monthly premiums are the most obvious costs to consider, and many Medicare Advantage plans have low or $0-dollar premiums. Sixty percent of Medicare Advantage Prescription Drug Plan enrollees paid no premium in 2020, and the average premium for all Medicare Advantage enrollees, including those with and without premiums, is projected to be $21 in 2021.  Aetna expanded its $0-premium Medicare Advantage offering in 2021.

Premiums do not tell the whole cost story. Medicare Advantage plans, with and without prescription coverage, can include copayments, coinsurance, and deductibles. Those other costs can actually outweigh the savings you might have on a $0-premium plan. But these plans also set a cap—an out-of-pocket maximum—that limits your total financial exposure for the year. Many Medicare Advantage plans also offer discounts and other ways to save money, which may contribute to the overall value of the plan.

Details on premiums, copayments, coinsurance, deductibles, and out-of-pocket maximums for each plan in each county are available on Aetna’s Summaries of Benefits and Coverage. 

Competition: Aetna vs. Highmark

Highmark is the top-rated Medicare Advantage plan in the J.D. Power 2020 U.S. Medicare Advantage Survey, with a score of 830 out of 1,000 compared with Aetna’s 789. Despite the appeal of signing up for the top-ranked Medicare Advantage for customer satisfaction, Highmark’s limited geographic footprint puts it at a disadvantage relative to a plan the size and scale of Aetna's. If you live in one of the states where Highmark operates (Pennsylvania, West Virginia, and Delaware), you might opt for the better-ranked plan. Anywhere else, though, Highmark won’t be an option. 

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How We Reviewed Medicare Providers

Even Medicare health plans with 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 Best’s financial stability ratings. We also considered information from the companies on their programs and strategies.