Aetna Medicare Advantage Review

Licensed Insurance Agent and Medicare Expert Writer
December 10, 2019
Aetna
  • Pro Bullet
    HMO
  • Pro Bullet
    PPO
  • Pro Bullet
    MAPD
  • Pro Bullet
    DSNP
  • Pro Bullet
    HMO-POS

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 is the fourth-largest single provider (tied with Kaiser Permanente), accounting for 10% of all enrollment in 2019.2 Currently, Aetna has Medicare Advantage Prescription Drug (MAPD) plans in 44 states.3

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 5.4

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.5
  • World-travelers: All Aetna MA plans offer ER and urgent care coverage worldwide.6
  • Dual Eligibles: Aetna offers plans for beneficiaries who are eligible for both Medicare and Medicaid in select states.7
  • 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.8
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Aetna Medicare Advantage plans

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 Medicare Advantage sample plans
Aetna Medicare Value Plan (HMO)
Aetna Medicare Premier Plan (PPO)
Aetna Medicare Choice Plan (PPO)
Aetna Medicare Dual Complete (HMO SNP)
Aetna Medicare Platinum Plan (HMO)
Location

Portland, ME, 04101

The Villages, FL, 32162

San Diego, CA, 92128

Fort Worth, TX, 76110

Redmond, WA 98052

Drug coverage

Yes

Yes

Yes

Yes

Yes

Deductible

$0

$0 (in-network)/$975 (out-of-network)

$0 (in-network)/$500 (out-of-network)

$0

$0

Maximum Out-of-Pocket (MOOP)

$5,900

$6,700 (in-network)/$10,000 (Combined in- and out-of-network)

$6,000 (in-network)/$9,000 (Combined in- and out-of-network)

$6,700

$6,200

Primary Care Visit

$0

$15 (in-network)/$50 (out-of-network)

$5 (in-network)/40% (out-of-network)

$0

$5

Network

Must stay in-network

Lower costs for in-network services

Lower costs for in-network services

Must stay in-network

Must stay in-network

Plan #

H3597-001

H5521-033

H5521-053

H8597-002

H3931-127

*Data effective 12/11/2019

Aetna Medicare Value Plan (HMO)

Like other Health Maintenance Organization plans, this HMO requires beneficiaries 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, the Aetna Medicare Value Plan can 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, as the name suggests, an all-around good value for a lot of people. But for those who want alternative therapies or coverage outside of a few counties, Aetna may offer better options (such as their Platinum plan).

Aetna Medicare Premier Plan (PPO)

In a Preferred Provider Organization (PPO) plan, beneficiaries pay lower rates if they stay within the network, but it's not required. Additionally, they are not required to have a primary care physician.

Although in- and out-of-network costs can vary for any plan, seeing a specialist in the Premier Plan we sampled cost the same ($50) whether or not they were in the network. So if you had a favorite specialist, it wouldn't matter if they were out of the network—at least, not for the copay.

What sets this plan apart from others is the "explorer" feature, which means that beneficiaries enrolled in this plan can see any Aetna provider in the United States and pay in-network costs. This benefit makes the Premier Plan a solid choice for snowbirds or anybody who enjoys traveling.

Aetna Medicare Choice Plan (PPO)

In this PPO, enrollees pay lower rates in-network, but they’re not obligated to stay in the network. To be sure, rates will generally be lower within the network.

In general, the Choice Plan may include dental benefits or even dental plus hearing, but you may pay an additional premium to receive this coverage. The big selling point on a Choice Plan from Aetna is the potential of the “explorer” feature. This feature allows enrollees to see any Aetna provider within the United States and still be considered in-network. 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 Medicare Dual Complete (HMO SNP)

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

For example, costs for PCP visits, specialists, lab services, X-rays or transport by ambulance are significantly lower in an HMO SNP than is typical in other Medicare Advantage plans. 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 these plans only in select states.

Aetna Medicare Platinum Plan (HMO)

Like other Health Maintenance Organization plans, this HMO requires beneficiaries 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). Aetna sometimes offers their Platinum plan as a PPO as well.

Aetna’s Platinum Plan can have an accompanying fitness membership and potentially vision and dental coverage as well. Compared to other plans, this stands apart for offering coverage for alternative therapies in certain areas. Coverage for alternative therapy is not something you see every day from a Medicare Advantage plan, so it may be worth investigating Aetna’s Platinum plan if that interests you.

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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, with all of our sampled plans offering fitness benefits. Those we researched 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 retirees who love to travel or have second homes in other states.

If you’re ready to find a plan that fits your needs best, call us. One of our licensed Medicare agents will help find 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 2019 Medicare Advantage changes to see what’s new with these plans.


Sources
1. United States S.E.C., “Aetna Inc. Form 10-K
2. Kaiser Family Foundation, “A Dozen Facts About Medicare Advantage in 2019
3. Center for Medicare and Medicaid Services, “2020 Medicare Landscape"
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.

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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