at a glance
- Aetna is one of the largest private insurance companies that offers Medicare Advantage plans.
- Aetna offers HMO, HMO-POS, PPO, and D-SNP plans.
- Not all of Aetna’s Medicare Advantage plans may be available in your area.
- As of 2018, Aetna provided medical benefits to more than 22.1 million members, offering access to 1.2 million healthcare professionals and a network of over 5,700 hospitals.
Aetna is a health insurance company based in Connecticut. It’s one of many private insurers that Medicare has approved to sell Medicare Advantage (Part C) plans.
Aetna offers a wide range of Medicare Advantage plans designed to fit multiple budgets and healthcare needs. Not every plan is available in every state, county, or even ZIP code.
Now we’ll take a closer look at how the four types of Aetna Medicare Advantage plans typically work.
Aetna HMO plans
With most of Aetna’s Health Maintenance Organization (HMO) plans, you’re required to choose an in-network primary care physician (PCP). You’ll have access to a specified network of doctors and hospitals that includes specialists.
You may need a referral from your PCP to see a specialist. In the case of an emergency, you’ll be able to use an out-of-network doctor, ER, or hospital. All plans include worldwide ER and urgent care coverage.
Aetna HMO-POS plans
HMO Point-of-Service (HMO-POS) plans are HMOs that include an out-of-network option. Plan members may access medical treatment outside their HMO network for specific treatments or under special circumstances. With an Aetna HMO-POS plan, you’ll typically pay more to see an out-of-network doctor.
Aetna HMO-POS plans also require you to choose a PCP. Some will require specialist referrals from your PCP as well.
Aetna PPO plans
Aetna’s Preferred Provider Organization (PPO) plans let you use any doctor, in and out of network, provided that they accept Medicare and Aetna’s plan terms. Seeing an out-of-network provider will typically cost more.
You’re not required to choose a PCP and don’t need referrals to see specialists.
Aetna D-SNPs
Dual Eligible Special Needs Plans (D-SNPs) are designed for people who are eligible for both Medicare and Medicaid. This is known as being “dual eligible.”
These plans offer the most comprehensive benefits for people with the highest need. Most of these plans include access to a personalized care team.
Aetna offers three standalone Part D prescription drug plans:
- SilverScript Smart Rx
- SilverScript Choice
- SilverScript Plus
All of Aetna’s Medicare Advantage plans also include prescription drug coverage and offer a mail-order prescription drug benefit. You’ll also get an over-the-counter medication benefit that will provide free access to many products.
If you are currently shopping for Medicare Advantage or separate Part D plans, you can use the find a Medicare plan tool to view each available plan in your area. You can enter your medications to see which plans cover them and how much they will cost.
Aetna offers Medicare Advantage plans in 49 states. Medicare Advantage plans are not currently sold in Alaska.
Although there is wide availability throughout the country, specific types of plans and coverage options may only be offered in certain areas. This means that if your relative in another state has an Aetna plan, the same plan might not be available to you.
Coverage under Aetna Medicare Advantage plans vary based on the plan you choose. However many of Aetna’s plans include:
- dental
- hearing
- vision
- gym membership through the SilverSneakers program
Some plans also offer:
- access to nonemergency medical transportation services
- meal delivery at home after a hospital stay
Each plan may offer different benefits. Read them carefully to make sure you are getting the coverage you would use the most.
The Medicare Advantage marketplace is getting more competitive each year. There may be dozens of different plans to choose from in the area where you live.
The following are some examples of the costs you may see with Aetna’s Medicare Advantage plans in different areas of the country in 2021.
| City/plan | Star rating | Monthly premium | Health deductible; drug deductible | Out-of-pocket max | PCP visit | Specialist visit |
|---|---|---|---|---|---|---|
| Reno, NV: Aetna Medicare Platinum Plan (HMO) | 3.5 | $0 | $0; $100 | $7,550 in network | $0 | $45 |
| Bothell, WA: Aetna Medicare Select Plan (PPO) | 4 | $99 | $0; $0 | $7,000 in network; $10,800 out of network | $0 copay in network; 40% coinsurance out of network | $40 copay in network; 40% coinsurance out of network |
| Wichita, KS: Aetna Medicare Assure (HMO D-SNP) | not yet available | $0 | $0; $220 | $7,550 in network | $0 | $0 |
| Miami, FL: Aetna Medicare Credit (HMO) | 4 | $0 | $0; $0 | $3,450 in network | $0 | $35 |
| Staten Island, NY: Aetna Medicare Elite Plan (PPO) | 4 | $0 | $1,000; $250 | $7,550 in network; $11,300 out of network | $10 | $45 |
It’s important to know that these costs don’t include your monthly Part B premium, which you’ll have to pay in addition to your Part C plan costs.
By entering your ZIP code into Medicare’s plan finder tool, you can compare the various plans available in your area.
Medicare Advantage (Part C) plans cover at least as much as original Medicare (Part A and Part B) plans do. They’re popular because they usually provide extras, such as dental, vision, and hearing coverage.
Some Part C plans include prescription coverage as well, so that you don’t have to opt into a separate Medicare Part D plan.
Not every plan is available everywhere. Your state, county, and ZIP code will determine which plans you can join. The costs for each plan vary by location as well. There’s a wide range of Part C plans that accommodate a wide range of budgets.
- Aetna offers many Medicare Advantage (Part C) plan options, including HMO, HMO-POS, PPO, and D-SNP.
- Plans vary by cost and offerings in different states, counties, or even ZIP codes.
- You must be eligible for original Medicare to join a Medicare Part C plan.