Aetna Medicare Advantage 2021 Review

Here are the costs, performance and benefits of Aetna Medicare Advantage in 2021.

Kate AshfordApr 12, 2021
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Aetna, a CVS Health company since 2018, is the fourth-largest provider of Medicare Advantage plans. The company offers a strong array of benefits, with most plans including dental, vision and hearing coverage, and many plans offering additional (and valuable) perks. They’re also largely low cost, with an estimated 80% of Medicare beneficiaries having access to a $0-premium Aetna plan and the lowest-cost stand-alone drug plan in the country.

Although Aetna’s offerings are notable, its plans score in the “average” range for member satisfaction and quality of care. And if you’re looking beyond HMO, PPO and Special Needs Plans, Aetna doesn’t offer other plan types. Here’s what you should know about Aetna Medicare Advantage.

Aetna Medicare Advantage pros and cons

Aetna’s offerings have advantages and disadvantages.

Pros

  • Multiple benefits offerings: In addition to dental, vision and hearing, Aetna Medicare beneficiaries in many plans have access to benefits such as an over-the-counter allowance, meal delivery services and in-home health visits.

  • Strong $0 premium offerings: In 2021, Aetna estimates that four out of five Medicare-eligible beneficiaries in the U.S. will have access to a $0-monthly-premium Aetna Medicare Advantage plan.

  • Low-cost drug coverage: Aetna offers the lowest-premium stand-alone prescription drug plan nationwide, including in Washington, D.C.

  • Broad availability: Aetna offers plans in 46 states and Washington, D.C., as well as stand-alone drug plans in all 50 states plus Washington, D.C.

Cons

  • Average star ratings: The Centers for Medicare & Medicaid Services gives Aetna’s 2021 Medicare Advantage plans an average rating of 3.7 out of 5 stars, with not a single plan earning 5 stars. (The national average for all providers is 4.16.)

  • Mediocre member love: When it comes to member satisfaction, J.D. Power found that Aetna Medicare Advantage scored 789 points out of 1,000, placing it fifth overall out of 10 Medicare Advantage companies ranked and just below the industry average of 800 points.

  • Limited plan types: Aetna offers HMO, PPO and Special Needs Plans, but doesn’t offer private fee-for-service or medical savings account plans.

Available Medicare Advantage plans

Aetna offers several different kinds of Medicare Advantage plans, and they vary in terms of structure, costs and benefits available. Most plans offer dental, vision and hearing benefits, worldwide emergency care, and fitness benefits through SilverSneakers.

In general, Aetna offers Medicare Advantage Prescription Drug plans, or MAPDs, as well as stand-alone prescription drug plans and Medicare Advantage Plans without drug coverage. New this year, the company is offering Aetna Medicare Eagle MA-only plans in 27 states, designed for veterans to complement their VA health care coverage.

Plan availability may vary by county. Other plan offerings may include the following types:

A health maintenance organization, or HMO, generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.

HMO point-of-service plans give you a bit more flexibility than traditional HMO plans. While you do have a primary doctor and you may still need a referral, you have more freedom to see out-of-network providers, although you’ll pay more for out-of-network care.

Preferred provider organization, or PPO, plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.

If you have Medicare and Medicaid and live in one of the 23 states where Aetna offers this, you may be eligible for a Dual-Eligible Special Needs Plan, or DSNP. These plans combine hospital, doctor and drug coverage, along with additional benefits such as a care coordinator to help you manage medical visits, a social worker to connect you with local and state programs, and a member advocate to help you access your state benefits.

Available Part D prescription drug plans

While many of Aetna’s Medicare Advantage plans include Part D drug coverage, the company also sells stand-alone Part D prescription drug plans. These plans are meant to accompany Medicare Part A and Part B and do not provide medical coverage.

Aetna offers three stand-alone prescription drug plans in 2021, with average monthly premiums that range from $7.15 to $69.52:

  • SilverScript SmartRx: Average premium of $7.15. Offers Tier 1 generic drug coverage with a $0 deductible and $0 copays. This is the lowest-cost stand-alone drug plan nationwide.

  • SilverScript Choice: Average premium of $28.49. Offers Tier 1/Tier 2 coverage of generic and brand-name drugs, with $0 copays for Tier 1.

  • SilverScript Plus: Average premium of $69.52. Offers gap coverage and a $0 deductible for all tiers, plus a $0 copay for Tier 1 drugs and $2 copay for Tier 2 drugs on a 30-day supply.

Additional benefits

Aetna Medicare Advantage offers most MA members access to routine vision, dental and hearing coverage. Many of its plans offer other benefits as well, many of which aren’t available in other Medicare Advantage plans. Here are a few standouts:

  • Fitness benefits: Many plans include SilverSneakers, which gives you access to participating gyms, community centers, online fitness classes, healthy living discounts and a fitness app, among other things.

  • In-home health visits: Some beneficiaries can request an in-person home health visit or telehealth call as an added convenience.

  • Concierge services for local resources: Aetna’s Resources for Living program can help beneficiaries find the help they need, whether that’s help at home, caregiver resources or help finding local activities.

  • Over-the-counter benefit: Some plans include an OTC benefit that allows you to pick up certain items, like vitamins and cold medications, from participating drugstores (or online) at no extra cost.

  • Meals at home: After a hospital stay, some plans offer to bring healthy meals to your door to help you recuperate.

  • Telehealth: All 2021 plans will offer virtual primary and urgent care visits, and some plans will also cover virtual mental and behavioral health visits.

Limited-area extras

Aetna Medicare Advantage also offers some unique benefit programs that are available for only a few plans in select locations, including the following:

  • Companionship benefit: In six states, Aetna partners with Papa Inc. to connect local college-age individuals with older adults who need help with light chores, technology or companionship.

  • Foodsmart: In Illinois, some plans will include a benefit for members to have their condition and eating habits assessed online or over the phone, in order to receive customized meal plans and guidance to help them make healthy food choices.

  • CHF remote monitoring program: In six plans in Kentucky, Ohio and Pennsylvania, Aetna is implementing a Home Heart Care program, in which eligible high-risk members with CHF receive a 5G-enabled scale, blood pressure cuff and electronic table to monitor their blood pressure and weight at home.

  • Healthy Foods debit card: In 24 of Aetna’s Dual Eligible Special Needs Plans and two Pennsylvania plans for members in the Healthy Heart partnership program, a new Healthy Foods debit card with monthly allowance will be included to help address food insecurity.

Customer service

Aetna Medicare Advantage members can contact their plan’s customer service in a variety of ways:

Aetna Medicare Advantage service area

Aetna offers Medicare Advantage Prescription Drug plans in 46 states and Washington, D.C., including 1,793 counties. In terms of stand-alone prescription drug plans, Aetna has plans in all 50 states and D.C.

Aetna expanded its Dual Eligible Special Needs Plan to 23 states, and the company offers Aetna Medicare Eagle MA plans — a new offering — in 27 states.

Overall, Aetna is the fifth-largest health insurer in the country, and it is the third-largest in terms of for-profit health plans. Nearly 2.7 million Medicare beneficiaries are enrolled in an Aetna Medicare Advantage plan, and the company added 210,000 new members for the 2021 plan year.

Cost

Costs for Medicare Advantage plans will depend on your plan, your geographic location and your health needs. One of the costs to consider is the plan’s premium, and Aetna has expanded its offering of $0-premium plans. The company estimates that four out of five Medicare-eligible beneficiaries will have access to a $0-monthly-premium Aetna Medicare Advantage plan in 2021. Aetna also offers the lowest premium stand-alone prescription drug plan product nationwide.

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $148.50 in 2021, although some plans cover part or all of this cost.

Other out-of-pocket costs to consider include:

  • Whether the plan covers any part of your monthly Medicare Part B premium.

  • The plan’s yearly deductibles and any other deductibles, such as a drug deductible.

  • Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.

  • The plan’s in-network and out-of-network out-of-pocket maximums.

  • Whether your medical providers are in-network or out-of-network, or how often you may go out of network for care.

  • Whether you require extra benefits, and if the plan charges for them.

To get a sense of costs, use Medicare’s Plan Finder to compare information among available plans in your area. You can select by insurance carrier to see only Aetna plans, or compare across carriers. You can also shop directly from Aetna’s website by entering your ZIP code.

Medicare star ratings

Average star rating: 3.7

If you want Medicare’s take on Aetna’s plans, look no further than the Centers for Medicare & Medicaid Services' own star ratings, which rank each plan from best (5 stars) to worst (1 star). The agency bases these ratings on plans’ quality of care and measurements of customer satisfaction, and ratings may change from year to year.

Based on the most recent year of data, Aetna’s Medicare Advantage plans get an average rating of 3.7, and the company’s prescription drug plans (Part D) get an average score of 3.8. The average star rating for plans from all providers was 4.06. Although two of Aetna’s prescription drug plans score a 5 — in Georgia and Pennsylvania — none of its Medicare Advantage plans rank above a 4.5. You can check the Medicare Plan Finder for star ratings of plans available in your area.

Third-party ratings

There are a few companies that weigh in on health plans or on the strength of the company in question, and we’ve included two here:

In its 2020 Medicare Advantage Study — the sixth it's done so far — J.D. Power measured member satisfaction with Medicare Advantage plans based on six factors: coverage and benefits, provider choice, cost, customer service, information and communication, and billing and payment. On these measures, Aetna scored 789 points out of 1,000 and came in fifth out of the top 10 Medicare Advantage providers.

The National Committee for Quality Assurance rates health insurance plans on a 5-point scale (with 5 being best) based on clinical quality, member satisfaction and results from the NCQA's accreditation survey. The ratings highlight the results of care and what patients say about their care.

In its 2019-2020 ratings of Aetna plans (there were no ratings in 2020), the NCQA awarded ratings between 4.5 and 2.5, with the vast majority receiving 4 or 3.5 ratings. The top-rated plans with scores of 4.5 were Aetna Health Inc. of Connecticut and Aetna Health Inc. of Maine. Two plans — Aetna Better Health of Illinois and Aetna Better Health of Michigan — received ratings of 2.5, with low scores on customer satisfaction and prevention, a category that indicates how well plans provide preventive services.

Alternatives

Compare Medicare Advantage providers

Company

Percent in a 4-star plan or higher

Service area

Average Medicare star rating

87%

46 states and Washington, D.C.

3.7

93%

50 states, Washington, D.C., and Puerto Rico.

3.7

76%

50 states and Washington, D.C.

3.9

26%

27 states.

3.4

59%

44 states

3.8

Find the right Medicare Advantage plan

It’s important to do your research before selecting a health plan for yourself. Here are some questions to consider asking:

  • What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?

  • Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.

  • Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?

  • Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?

  • Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?

If you have additional questions about Medicare, visit Medicare.gov or call 1-800-MEDICARE (1-800-633-4227, TTY 877-486-2048).

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