Aetna Medicare Advantage 2021-2022 Review

Aetna Medicare Advantage is a low-cost option with average reviews for member satisfaction.
Kate AshfordOct 26, 2021

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Aetna is the fourth-largest provider of Medicare Advantage plans [1]. A CVS Health company since 2018, Aetna offers a strong array of benefits, with most Aetna Medicare Advantage plans including dental, vision and hearing coverage, and many plans offering additional (and valuable) perks. They’re also largely low cost, with an estimated 84% of Medicare beneficiaries having access to a $0-premium Aetna plan and one of the cheapest stand-alone drug plans in the country.

Although the company's offerings are notable, Aetna Medicare Advantage plans score in the “average” range for member satisfaction and quality of care. 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 2022, Aetna estimates that 84% of 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 one of the the lowest-premium stand-alone Medicare prescription drug plans nationwide, including in Washington, D.C.

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

  • Walk-in clinic access: As a CVS Health company, Aetna offers members the ability to visit one of a network of walk-in clinics or MinuteClinics for the same copay as a regular visit to a primary care physician, as long as they're in PPO and HMO plans that don't require a PCP visit. This network includes walk-in locations across 33 states and Washington, D.C.

Cons

  • Average star ratings: The Centers for Medicare & Medicaid Services gives Aetna’s 2022 Medicare Advantage plans an average rating of 3.8 out of 5 stars. (The national average for all providers is 4.37.)

  • Mediocre member love: When it comes to member satisfaction, J.D. Power found that Aetna Medicare Advantage scored 795 points out of 1,000, which is below the industry average of 806. That places it sixth overall out of nine Medicare Advantage companies ranked.

  • 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 kinds of Medicare Advantage plans, and they vary in structure, costs and benefits. 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. The company has expanded its Medicare Advantage plan for veterans — Aetna Medicare Eagle — to 41 states in 2022. The plan is designed to complement the health care coverage vets receive from Veterans Affairs.

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 27 states where Aetna offers this, you may be eligible for a Dual-Eligible Special Needs Plan, or D-SNP. These plans combine hospital, doctor and drug coverage 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, which are meant to accompany Medicare Part A and Medicare Part B, don't provide medical coverage.

Aetna offers three stand-alone Medicare prescription drug plans in 2022, with average monthly premiums that range from $7.08 to $68.97:

  • SilverScript SmartRx: Average premium of $7.08. Offers Tier 1 generic drug coverage with a $0 deductible and $1 copays.

  • SilverScript Choice: Average premium of $30.78. Offers Tier 1/Tier 2 coverage of generic and brand-name drugs with a $0 deductible, and with $0 copays for Tier 1.

  • SilverScript Plus: Average premium of $68.97. 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.

Aetna offers three stand-alone Medicare 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 a $0 deductible, and 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.

Additional benefits

Aetna Medicare Advantage offers most members access to routine vision, dental and hearing coverage. Some of its plans offer added benefits, 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 support they need, whether that’s assistance 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 2022 plans will offer virtual visits for primary care, urgent care and specialty care, as well as mental health services.

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 eight states, Aetna partners with Papa Inc. to connect local college-age individuals with older adults who need help with light chores, technology or companionship.

  • Healthy Foods debit card: In 77 Medicare Advantage plans in 28 states, a Healthy Foods debit card with monthly allowance will be included for qualified members to help address food insecurity.

  • Utility card: In 2022, some D-SNP plans will offer a debit card with a monthly allowance that members can use for utility expenses, including electricity, gas, water and sewage.

  • Fall prevention: In some Medicare Advantage plans, some members will be eligible for a yearly allowance they can use for safety items that may decrease the risk of injuries from falls.

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 1,875 counties. In terms of stand-alone prescription drug plans, Aetna has plans in all 50 states and D.C. [2]

Aetna expanded its Dual-Eligible Special Needs Plan to 27 states, and the Aetna Medicare Eagle plans — new Veteran-specific Medicare Advantage offerings in 2021 — are available in 41 states.

Overall, Aetna is the third-largest health insurer in the country [3], and it is the third-largest in terms of for-profit health plans [4]. More than 2.9 million Medicare beneficiaries are enrolled in Aetna Medicare Advantage plans.

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 84% of Medicare-eligible beneficiaries will have access to a $0-monthly-premium Aetna Medicare Advantage plan in 2022.

For 2022 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $10 to $217 [5]. For Dual-Eligible Special Needs Plans, or D-SNPs, monthly premiums range from $15 to $35.60 [6]. Aetna also offers low-premium stand-alone prescription drug plans nationwide, with an average monthly premium as low as $7.08 [7].

Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $148.50 in 2021 ($170.10 in 2022), 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.

For 2021 Medicare Advantage plans with a premium, the monthly consolidated premium (including Part C and Part D) ranges from $15 to $225. For Dual-Eligible Special Needs Plans, or D-SNPs, monthly premiums range from $20.60 to $34.30. Aetna also offers the lowest premium stand-alone prescription drug plan product nationwide in 2021, with monthly premiums starting as low as $5.70.

Medicare star ratings

Average star rating: 3.8

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 2022 Medicare Advantage plans (Part C) get an average rating of 3.9, and the company’s prescription drug plans (Part D) get an average score of 3.8, with an overall score for both of 3.8. For comparison, the average star rating for plans from all providers for 2022 was 4.37 [8]. Two of Aetna's plans score an overall rating of 5 stars.

Of Aetna members who are in contracts with a Medicare Star Rating, 87% are in contracts rated 4.0 or above in 2021 [9].

To get an overall star rating, the CMS ranks contracts on 40 plan factors. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.) Here’s where Aetna plans really delivered, with average scores of 4.5 (out of 5) and above:

  • Care for older adults — medication review.

  • Diabetes care — blood sugar controlled.

  • Medication reconciliation post-discharge.

  • Plan makes timely decisions about appeals.

  • Reviewing appeals decisions.

  • Call center — foreign language interpreter and TTY availability.

  • Medicare Plan Finder price accuracy.

In some categories, Aetna contracts averaged a sub-3.0 score. (You can find definitions for each of these factors in the CMS Star Ratings Technical Notes.)

  • Annual flu vaccine.

  • Monitoring physical activity.

  • Special needs plan care management.

  • Reducing the risk of falling.

  • Improving bladder control.

  • Rating of health plan.

  • Rating of drug plan.

  • Medication Therapy Management program completion rate for Comprehensive Medication Review.

In 2021, 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 in 2021 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 find a plan’s rating with the Medicare Plan Finder.

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 three here:

AM Best is a credit rating agency that specializes in the insurance industry. In December 2020, AM Best affirmed its Financial Strength Rating of A (Excellent) for Aetna Life Insurance Company and the other operating entities of Aetna that are wholly owned subsidiaries of CVS Health. AM Best also affirmed its A (Excellent) FSR rating of Texas Health Aetna, as well as Allina Health and Aetna Insurance Company, which are joint ventures with subsidiaries of Aetna Inc.

An A rating in this category indicates that AM Best believes Aetna has an excellent ability to meet its ongoing insurance obligations.

In its 2021 Medicare Advantage Study — the seventh 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 795 points out of 1,000 and came in sixth out of the top nine Medicare Advantage providers. [10]

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 September 2021 ratings of Aetna plans, the NCQA awarded ratings between 2.5 and 4.5, with the vast majority receiving ratings of 3.5 or 4. The top-rated plans with scores of 4.5 were Aetna Health Inc. of Connecticut and Aetna Health Inc. of Maine. One plan — Aetna Better Health Premier Plan MMAI — received a rating of 2.5, with low scores on patient experience and prevention, a category that indicates how well plans provide preventive services. [11]

Compare alternatives

See how Medicare Advantage competitors stack up to Aetna.

Compare Medicare Advantage providers

Company

Percent in a 4-star plan or higher

Service area

Average Medicare star rating (2022)

87%.

46 states and Washington, D.C.

3.8.

59%.

44 states.

4.1.

87%.

26 states and Washington, D.C.

4.2.

93%.

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

4.1.

100%.

8 states and Washington, D.C.

5.

76%.

50 states, Washington, D.C., American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands.

4.2.

26%.

36 states.

3.6.

About Aetna

Aetna was founded in 1853 in Hartford, Connecticut, and the insurer became a subsidiary of CVS Health Corporation in 2018. The company’s headquarters are still in Hartford.

Aetna’s health insurance offerings include medical, dental, pharmacy and behavioral health. Aetna offers both individual and group health insurance, including Medicare Advantage Plans, Medicare Prescription Drug Plans and Medicare Supplement Insurance. As of June 2021, Aetna covers almost 9.8 million Medicare members in the U.S., including more than 2.9 million in Aetna Medicare Advantage plans and 5.7 million in stand-alone Medicare prescription drug plans.

CVS Health posted annual revenues of $268.7 billion in 2020.

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:

  • 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 800-MEDICARE (800-633-4227, TTY 877-486-2048).

ARTICLE SOURCES:

  1. Kaiser Family Foundation, “Medicare Advantage in 2021: Enrollment Update and Key Trends,” accessed Oct. 20, 2021.

  2. American Medical Association, “Competition in Health Insurance,” accessed Oct. 20, 2021.

  3. Centers for Medicare & Medicaid Services, “2022 MA Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 20, 2021.

  4. Centers for Medicare & Medicaid Services, “2022 SNP Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 20, 2021.

  5. Centers for Medicare & Medicaid Services, “2022 PDP Landscape Source Files (v 09 08 21) (ZIP),” accessed Oct. 20, 2021.

  6. Centers for Medicare & Medicaid Services, “2022 Star Ratings Fact Sheet_10_8_2021 (PDF),” accessed Oct. 20, 2021.

  7. Centers for Medicare & Medicaid Services, “2022 Star Ratings Data Table (Oct 06 2021) (ZIP),” accessed Oct. 20, 2021.

  8. NCQA, “Health Plans,” accessed Oct. 20, 2021.

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