Aetna Medicare Advantage Review

Alex Enabnit
Licensed Insurance Agent and Medicare Expert Writer
August 05, 2020
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As one of the largest healthcare providers in the country, Aetna serves an estimated 37.9 million people nationwide.1 In the Medicare Advantage (MA) scene, Aetna (and parent company CVS Health) is the fourth-largest health provider, accounting for 11% of all enrollment in 2020.2

States without Aetna Medicare Advantage plans:

  • Alaska
  • Hawaii
  • Minnesota
  • Montana
  • North Dakota
  • Vermont

Aetna's Medicare Advantage plans have an average Medicare Star Rating of 4.1 out of 5.3

In general, the quality and quantity of Aetna’s MA offerings could provide a good bang for the buck for Medicare enrollees looking for some bonus perks.

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Is an Aetna Medicare Advantage plan right for you?

Aetna offers a variety of plans throughout the United States, mostly through HMO and PPO plans. They also provide a few unique offerings for these people:

  • Snowbirds: With an “explorer” benefit (available in 28 states), beneficiaries can receive in-network benefits from any Aetna facility in the US.4
  • World-travelers: All Aetna MA plans offer ER and urgent care coverage worldwide.5
  • Dual Eligibles: Aetna offers plans for beneficiaries who are eligible for both Medicare and Medicaid in select states.6
  • Fitness-minded individuals: One of the benefits you can expect from an Aetna MA plan is a SilverSneakers program membership with access to 15,000+ locations.7
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Aetna Medicare Advantage plans: an overview

As a large healthcare provider, Aetna may provide a lot of extra benefits in most of its HMO, PPO, or HMO-POS plans—dental, vision, and hearing coverage, for instance. But their benefits don’t necessarily stop there. Aetna also includes prescription drug coverage in most of its plans, with a mail-order option to boot. And for those that want fitness benefits, Aetna also offers a membership to the SilverSneakers program as a benefit of Medicare Advantage.

At this time, Aetna doesn’t offer a Medical Savings Account (MSA) or a Private Fee-for-Service (PFFS) plan.

Aetna HMO Medicare Advantage Plans

Like other Health Maintenance Organization plans, Aetna requires beneficiaries enrolled in an HMO plan to see doctors or go to hospitals that are part of the plan’s network (except for emergencies). Most HMO plans also require beneficiaries to have a primary care physician (PCP).

In general, Aetna's HMO plans include Part D coverage for your prescription drugs. Aetna's HMO plans may also provide benefits Original Medicare doesn’t, such as vision, hearing, and both preventive and comprehensive dental. Benefits like this can be quite appealing to a lot of enrollees and can provide an all-around good value for a lot of people.

Depending on where you live, you might have access to even more plan benefits, such as a free fitness membership to SilverSneakers. Some of the Aetna plans we saw even covered alternative treatments—something not frequently covered in Medicare Advantage plans.

Aetna PPO Medicare Advantage plans

In a Preferred Provider Organization (PPO) plan, beneficiaries pay lower rates if they stay within the network, but you're not required to stay in a network for your medical treatments to be covered by Aetna. With Aetna's PPOs, you're not generally required to designate a primary care physician.

While PPOs may generally have higher out-of-pocket maximums or copays than HMO plans, the freedom to go outside the network is a selling point to many beneficiaries.

What sets Aetna's PPO plans apart from competitors is the "explorer" feature. With an "explorer" feature, beneficiaries enrolled in an Aetna PPO plan can see any Aetna provider in the United States and still pay in-network costs.

The "explorer" feature could be an alluring benefit for snowbirds or anybody who enjoys traveling. So you can take that kayak tour in Puget Sound without anxiety—at least about your insurance—Aetna’s got plenty of providers nearby.

Aetna HMO SNP Medicare Advantage plans

By partnering with the state-run Medicaid program, Special Needs Plans (SNPs) can offer benefits for significantly reduced costs. Although enrollees of Aetna's HMO SNPs must stay within a network like a typical HMO (except for emergencies), all costs within that network are generally lower than a non-SNP HMO.

To join this type of plan, however, you must be receiving Medicaid assistance and be eligible for Medicare as well. This is known as dual eligibility. Aetna offers HMO SNP plans in select states.

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Bottom line: Aetna’s network provides crowd-pleasing benefits

While each plan varies by location, it’s clear that Aetna’s plans can pack a lot of benefits beyond Original Medicare, but it may appeal the most to those who prefer HMOs and PPOs.

Aetna’s MA plans pack a lot of benefits into one package, many of them offering fitness benefits. Aetna's plans may also provide either vision, dental, and/or hearing coverage (or the option to add them for an additional cost). A distinguishing factor in some of Aetna’s plans is the “explorer” feature, allowing enrolled beneficiaries to see any Aetna provider in the US as “in-network.” This feature makes many of Aetna's plans an excellent choice for wayfaring retirees or snowbirds.

If you’re ready to find an Aetna plan, call a licensed Medicare agent for help finding the best plan for you.

Want to learn more?

Most of Aetna's plans offer additional drug coverage; you can read more about that below. Aetna also sells Medicare Supplement (Medigap) plans, if you'd rather stick with Original Medicare but need additional coverage.

Or, learn about Medicare Advantage.


Sources
1. United States S.E.C., “Aetna Inc. Form 10-K
2. Kaiser Family Foundation, “A Dozen Facts About Medicare Advantage in 2020
4. Center for Medicare and Medicaid Services, “2020 Medicare Landscape"
5. Aetna News, “Aetna Announces Biggest Medicare Advantage Expansion in Its History
6. Aetna Medicare Solutions, “Aetna Medicare Advantage Plans at a Glance
7. Aetna Medicare Solutions, “Aetna Medicare Advantage Plans at a Glance
8. Aetna Medicare Solutions, “Gym Memberships & Fitness Classes

Content on this site has not been reviewed or endorsed by the Centers for Medicare & Medicaid Services, the United States Government, any state Medicare agency, or any private insurance agency (collectively "Medicare System Providers"). Eligibility.com is a DBA of Clear Link Technologies, LLC and is not affiliated with any Medicare System Providers.

Alex Enabnit
Written by
Alex Enabnit
Medicare and geriatric care expert, Alex has one motivation behind every word he writes, and that’s finding you the best medical coverage for your situation. Alex has been featured on Bloomer Boomer, Best Company, HealthPopuli.com, the Daily Ledger on the One America News Network, WBAP News radio, and more. Outside of work, you can find him hiking with his wife and pup or (occasionally) going to the gym.
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