Aetna Medicare Review

Pros Explained

• Offers very low Part D premiums: Aetna’s SilverScript SmartSaver plan is an ultra low-cost prescription drug plan, with an average monthly premium of only $5.92. 
• Medicare Advantage plans offer additional coverage during the gap: Some Aetna plans offer $0 copays on generic drugs in the Medicare donut hole. 
• Medicare star rating of 4.1 out of 5 stars for Medicare Advantage plans: The Centers for Medicare and Medicaid Services (CMS) provides star ratings that assess each plan’s overall quality. Aetna’s Medicare Advantage plans earned an average star rating of 4.1; its PPO plan is especially well-rated.
• A (Excellent) financial strength rating from AM Best: Aetna is considered financially strong by the independent credit rating agency AM Best, with an excellent ability to pay claims. 
• Most Medicare Advantage plans come with extra benefits: These may include fitness benefits, over-the-counter benefits, meals-from-home after a hospital or nursing facility stay, and ER and urgent care coverage worldwide.

Cons Explained

• Below-average J.D. Power rating for Medicare Advantage plans: Aetna ranked sixth out of nine companies in the J.D. Power 2022 U.S. Medicare Advantage Study, which measures customer satisfaction.

Third-Party Ratings

Aetna fares better for financial strength than it does for customer satisfaction. The company has an A (Excellent) financial strength rating from AM Best. This rating is significant because a high grade indicates a high likelihood that a company will meet its financial obligations to policyholders. However, Aetna didn’t do so well in the 2022 J.D. Power U.S. Medicare Advantage Study. It received a score of 796 out of 1,000 points, below the industry average score of 809. 

Aetna’s other customer satisfaction rankings were more favorable, but still not as high as some competitors. The company’s NCQA rating, which reflects quality of care and member satisfaction, is 3.6 out of 5 stars. And ratings from the CMS are:

• Medicare Advantage plans: 4.1
• Medicare prescription drug plans: 3.5 

Policies Available

Medicare Advantage (Part C) Plans

Medicare Advantage plans include Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Most plans from Aetna also include prescription drug coverage with mail delivery, dental, vision, and hearing coverage, and other benefits. 

Aetna offers the following plan types:

• HMO plans, which require you to use only doctors and facilities that are in-network for non-emergencies
• HMO-POS plans, which offer more flexibility
• PPO plans, which don’t require you to have a primary care doctor or get referrals to see a specialist, and which allow you to see out-of-network doctors for an added cost. 

Some plans offer $0 copays for Tier 1 and Tier 2 generics during the coverage gap. And some plans also offer $0 physician copays. The average Medicare Advantage premium for plans with drug coverage is $13.72 in 2023, the average drug deductible is $78.21, and the average out-of-pocket maximum is $5,685.48. Overall, the cost for Aetna’s Medicare Advantage plans is on par with other major providers. 

Additionally, Aetna offers a Dual Eligible Special Needs Plan (D-SNP), which is a type of Medicare Advantage plan available to people who qualify for both Medicare and Medicaid.

Part D Prescription Drug Plans

Aetna was our pick for lowest premiums among the Best Medicare Part D providers. Aetna offers three prescription drug plans, which are designed to provide drug coverage for people who have Medicare Part A and/or Part B or who have certain Medicare Advantage plans that don’t include drug coverage. The best plan for you will depend on the medications you take. 

Aetna’s SilverScript SmartSaver plan offers ultra-low premiums (but not the lowest copays), making it ideal for people who don’t take prescriptions currently or who only take a few generics. The SilverScript Choice plan has a higher premium with lower copays for people who take more medications. And the SilverScript Plus plan comes with a higher premium, but has a $0 deductible, low copays in the initial coverage phase, and $0 copays for some medications during the coverage gap. 

Medicare Supplement Plans (Medigap)

Medigap policies are intended to provide additional help with paying for copays and coinsurance and covering deductibles. These plans are sold by private insurers but coverage is standardized, regardless of the insurer offering it. In most states, plans are identified by letters. Aetna offers plans A, B, D, G, high-deductible G, and N, in addition to plans C, F, and high-deductible F for people who became eligible for Medicare before 2020. We found some of Aetna’s Medicare Supplement plans to be among the priciest available. Therefore, you won’t find the company on our list of the Best Medicare Supplement Insurance Companies. 

Customer Service

Aetna maintains extended customer service hours from 8 a.m. to 8 p.m. ET on weekdays. For Medicare Advantage and prescription drug plans, call 1-855-335-1407. For Medicare Supplement plans, call 1-800-358-9749. You can also request a call or email Aetna through an online form. Once you're a member, you can chat with the company online through your online account. But Aetna doesn’t offer weekend hours like some other Medicare providers.

Our Methodology: How We Review Medicare Insurance Carriers

Literature Review

We identified top companies by market share within the industry offering Medicare plans from various business and market insight databases including Statista, Plunkett, and Gale. We also considered user-generated data from Google to determine public interest and trends in Medicare plans. 

Data Collection and Verification

Our data was collected through third-party rating agencies, official government websites and databases, and directly from companies via websites, media contacts, and existing partnerships. Our sources include: AM Best, the National Committee for Quality Assurance (NCQA), J.D. Power, and the Centers for Medicaid and Medicare Services (CMS).

Data was verified to ensure data integrity and accuracy by cross-referencing the records and citation corresponding to each data point with our primary sources.

Ratings Methodology

We calculated star ratings for the quality of each company’s plan types. Factors considered for companies offering Medicare plans were: 

• Plan quality and customer satisfaction: CMS and NCQA ratings were considered to measure these criteria. Each organization independently rates the quality of Medicare plans on a one-to-five scale to help people compare plans during open enrollment. 
• Cost to value: This is a measure of plan value based on plan premiums, deductibles, maximum out-of-pocket amounts, whether additional drug coverage is offered in the Medicare gap, and star ratings.
• Additional coverage offered in the Medicare gap: The coverage gap or "donut hole" refers to a period when there is a limit on drug coverage. During this time, members are responsible for up to 25% of brand name and generic drugs. You may spend less on prescription drugs if your plan provides additional coverage during the gap.
• State availability: This measure indicates how widely available plans are across the U.S.
• Additional plan benefits: This measure concerns additional benefits available, including vision, dental, hearing, non-emergency transportation, worldwide emergencies, gym memberships, and telehealth. 
• Types of plans available: Insurance companies offer Medicare Advantage plans through managed care organizations, including HMOs and PPOs. This measure concerns the number of managed care options available.
• Special needs plans: This is a measure of whether the company offers plans designed for those with specific diseases.
• Financial strength: This measure accounts for each company’s AM Best financial strength rating to understand how well it’s positioned to pay insurance claims. 

We do not offer every plan available in your area. Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE (TTY users should call 1-877-486-2048) 24 hours a day/7 days a week to get information on all of your options.

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