Aetna is an experienced and reputable insurance company within the Medicare Insurance industry. They are one of the largest and oldest insurance companies in the United States. Aetna traces its roots back to 1853. Since 2018, Aetna has been owned by CVS Health.
Aetna will offer products in all three major Medicare areas: Medicare Supplement Insurance, standalone Part D Prescription Drug Plans, and Medicare Advantage plans in 2023. In this Aetna Medicare Advantage plan review, we will specifically look at Aetna’s Medicare Advantage Plans and share the pros and cons of this coverage.
Is Aetna good insurance?
Aetna is considered to be a quality insurance company. They have a long history and are considered financially sound by rating agencies. This means that Aetna is expected to pay all claims over the foreseeable future. In other words, you can count on Aetna to be solvent whenever you need to use your Aetna health insurance benefits. Besides this, Aetna generally has good reviews and third-party ratings, which we’ll cover later in the Aetna Advantage Plan review.
Pros and cons of Aetna Medicare plans
When assessing the pros and cons of any Medicare Advantage plan, including for Aetna, you need to understand these plans are designed for local areas. For instance, most Medicare Advantage plans are sold by zip code. There is no such thing as a national Aetna Medicare Advantage plan.
Instead, there are dozens of different Aetna Medicare Advantage plans available all across the country. The plans in your area will differ from those in another zip code, county, or state. The pros and cons listed below are based on an overall review of all available Aetna plans.
Aetna Medicare Advantage plans
There are several kinds of Medicare Advantage plans. While they all work similarly in many ways, there are several significant differences. Most of the differences involve the network of providers included within the plan, like doctors, specialists, and hospitals.
A Preferred Provider Organization (PPO) offers maximum flexibility. If you use in-network doctors, you will have the lowest out-of-pocket costs. However, you can use out-of-network providers; the plan will still cover you. However, your cost share will generally be higher when you use out-of-network providers. You can also usually see specialists without a referral.
A Health Maintenance Organization (HMO) features a closed network of providers and requires a Primary Care Physician (PCP). Your PCP manages your healthcare. It would be best if you had referrals from your PCP to see specialists. Additionally, you must use in-network providers. If you go out of network, your plan won’t cover any part of the cost.
An HMO-POS is a traditional HMO with a point-of-service option. The point-of-service option can allow you to receive care out of network. However, out-of-network providers are not required to accept the plan's terms, so you must find providers who accept an HMO-POS plan. When seeing in-network providers, an HMO-POS functions just like a traditional HMO plan. This type of Medicare Advantage plan is rarely available or chosen by people.
A Dual Special Needs Plan (D-SNP) is a Medicare Advantage Plan designed for people who are dually eligible for Medicare and Medicaid. These plans feature extremely low out-of-pocket costs for medical services and prescription medications. You must be enrolled in your state’s Medicaid program, or eligible for your state's Medicaid Buy In Program, to be eligible for a D-SNP. These plans also tend to have very generous extra benefits.
Aetna Medicare Advantage benefits
The benefits provided by Medicare Advantage plans can be separated into two groups:
- Services and procedures covered by Parts A and B of Original Medicare
- Extra benefits beyond what Original Medicare coverage
Aetna Medicare Advantage Plans are required to cover everything Original Medicare covers. This includes hospital stays, doctor’s visits, treatment for illness or injury, and things of that nature.
However, they also voluntarily cover other types of benefits. Aetna Medicare Advantage plans offer many extra benefits, including:
- Hearing aids
- Over-the-counter supplies
- Prescription Drug coverage under Part D
- Part B Premium reduction
Dental, vision, and hearing benefits are among the most popular for those who rely on Medicare Advantage plans. These benefits are generally available for no additional premium. Each insurance company and Medicare Advantage plan uniquely designs these benefits, which will differ for each plan offered throughout the country.
The Part B reduction benefit is only available with select plans but is also growing in popularity. With this extra benefit, your base Part B premium is reduced by a fixed amount each month. The premium reduction usually starts at $10 monthly and increases from there.
In addition, Part D drug coverage is built-in to most Medicare Advantage plans. In most cases, this drug coverage is included in the standard premium for the plan, so the drug coverage doesn't cost any extra. Per-prescription co-payments and out-of-pocket maximums are separate from the medical portion of these plans.
How much do Aetna Medicare Advantage plans cost?
Premiums for Aetna Medicare Advantage plans are set for each unique plan offered. Remember that these are set by zip code, county, and state, so the cost of Aetna Medicare Advantage plans are local. This is critical information when considering Aetna Advantage Plan Reviews. It would be best if you compare prices for your specific area.
As you look into Medicare Advantage plans, you will likely see many are available with no monthly premiums. Remember that you must always pay your Part B premium to have Medicare Advantage plan coverage. A $0 monthly premium simply means you pay nothing beyond the Part B premium for coverage.
The table shows the premiums for three different Aetna Medicare Advantage plans available in Beaufort County, SC.
|Plan name||Monthly premium||Annual out-of-pocket maximum||Common copayments|
|Aetna Medicare Essential Plan (PPO)|
|Aetna Medicare Value Plus Plan (HMO)|
|Aetna Medicare Premier Plan (PPO)|
*Aetna Medicare Advantage Plans in Zip Code 29926 (Beaufort County, SC)
HMO Plans with a higher monthly premium often have lower out-of-pocket costs, more expansive physician networks, or more favorable pricing on prescription medications. This illustrates why it’s important to compare all the plans available in your area, considering the doctors you see and the services and procedures you’ll likely use.
Aetna reviews and ratings
Always remember these plans are local when considering Aetna Advantage plan reviews and ratings. A highly-rated plan in Florida isn’t available to you in California. Also, a highly rated Medicare Advantage plan in Los Angeles County, CA, isn’t available in San Diego County, CA. You must always look for the specific plans available in your area.
Aetna Medicare Advantage plans, like all others, are rated and compared by various organizations. According to J.D. Power, Aetna’s Medicare Advantage Plans, taken as a whole, rate highly. They do particularly well in certain U.S. states. Aetna ranks in the top three for 2023 in Florida and Pennsylvania. The J.D. Power ratings were based on plan members' responses in eight real-world experience categories.
In addition to ratings and reviews from private organizations, Medicare also reviews Medicare Advantage plans and gives a Star Rating to every plan. These ratings are based on member satisfaction and cover the following areas:
- Overall rating
- Health services rating
- Drug services rating
As with every aspect of Medicare Advantage plans, these ratings are generated for each specific plan. In other words, the ratings are local. There is no overall rating for Aetna as an insurance company. Annually, Medicare assessed plans using a 5-star rating system. Ratings are important to show how well a plan performs. For instance, here is the comparison of the following Star Ratings for 2023:
|Plan||Availability||Overall rating||Health services||Drug services|
|Aetna Medicare Essentials plan (PPO) - H5521-373||Beaufort County, SC||3.5/5||4.0/5||3.5/5|
|Aetna Medicare Plus plan (HMO) - H4982-004||San Diego County, CA||3.0/5||3.0/5||2.5/5|
*CMS's Medicare Star Ratings. Data available from aetnamedicare.com considering state, county and plans for 2023.
Always be sure to check the Star Ratings for the plans available in your area.
What to consider when choosing an Aetna Medicare Advantage plan
As mentioned, you must approach your plan search from a local angle. You can only enroll in the plans available in your area, generally your zip code or county, although some state-wide PPO plans are available. Therefore, as you begin your search and look at individual plans, keep the following in mind:
- Make sure all of your doctors are in the plan’s network.
- Make sure that your medications are covered by the plan.
- Check to see if your preferred pharmacy is in the plan’s network.
- Examine the copayment and coinsurance amounts you’re likely to pay for the kinds of services you need.
- Compare the Maximum Out Of Pocket Amount (MOOP).
- Investigate the extra benefits, like dental and vision, that you’re most interested in, and determine which dentists and vision care professionals you can use.
Choosing a plan based on the premium is not a good idea. Look at the details to ensure your doctors and medications fit the plan well. Otherwise, you may pay more out of pocket than you need to.
What is the best Aetna Medicare Advantage plan?
There is no one best plan. It all depends on your needs and location. The best Aetna Medicare Advantage plan is likely one your doctors are in-network for and covers all your medications.
Does Aetna offer good insurance?
If your doctors accept Aetna Medicare Advantage plans, which cover your medications, then Aetna is likely to be good insurance for you. Remember, there is no one-size-fits-all plan. You must do your homework to find the best plan for your circumstances.
What are the main disadvantages of Aetna Medicare Advantage?
The most significant disadvantage of Aetna Medicare Advantage plans would be if your doctors or preferred hospitals aren’t in-network. Another disadvantage would be if your medicines aren’t covered. Besides this, a potential disadvantage would be if the Aetna plans in your area didn’t offer the extra benefits you were looking for or if their premiums were higher than other options.