In 2022, Aetna will be the fourth-largest provider of Aetna Medicare Advantage plans. As a CVS Health company since 2018, it provides a robust set of benefits including dental, Aetna vision, and hearing coverage, and many plans including additional (and valuable) perks.
About Aetna, A Part Of The CVS Health Family
Aetna Inc is one of the nation’s leading diversified health and wellness benefits companies, American medical association, providing information and resources to approximately 37.3 million people to help them make better informed decisions about their health care.
It provides medical, pharmacy, dental, behavioral health, group life and disability plans, as well as medical management capabilities, Medicaid health care management services, and health information technology services.
Employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups, and expatriates are among the customers.
This is a brand name used for products and services offered by one or more of the Aetna group of companies, which includes Aetna Life Insurance Company and its affiliates. Exclusions and limitations apply to health benefits and health insurance.
It was founded in Hartford, Connecticut, in 1853, and in 2018, the insurer became a subsidiary of CVS Health Corp. Hartford is the company’s headquarters.
Medical, dental, and pharmacy plans are available through Aetna. It offers Medicare Advantage plans (MAp), Medicare prescription drug plan, and Medicare Supplement Insurance to individuals and groups. It covers 10.6 million Medicare beneficiaries in the United States as of October 2022, including more than 3.2 million in Aetna MA plans and 6.1 million in stand-alone prescription drug coverage.
How Does The Aetna Benefits Mastercard Prepaid Card Work?
From January 1, the top up the card with $100 every quarter. Members can use it to pay for in-network copays when visiting a general practitioner (PCP), a specialty office, and offices that provide certain other types of services.
If your branch accepts Mastercard® pre-paid, the member can use it as a debit one (with or without PIN) to pay their own amount. The member can pay the full amount in this way. Or, if your branch allows the use of more than one payment method, the member may choose to pay part of the amount and use another payment method for the rest of the amount.
What If The Member Forgets To Bring Their Card Or It Does Not Have Enough Money On?
The member must pay the co-payment in another way and then request a manual refund. Or, if the member knows their balance, your branch can make a split payment where the member can pay part of the amount with the cards and use another payment method for the rest of the amount.
What If It Doesn’t Work Or Is Declined?
- Make sure that the member only uses the card benefits for a personal contribution.
- The card is not activated. The member can activate his card by calling the number on his activation sticker. That number is 1-877-261-9951 (TTY: 711).
- The costs may not be considered eligible under the plan. The member should consult his Explanation of Coverage (EOC) document.
- The member may not be part of a qualifying subscription. Eligible plans are Keystone Market Plans H3959-001, H3959-002, H3959-010, H3959-011, H3959-037, H3959-041, H3959-047, H3959-051, H3959-053, H5521-261, and H5522- 018.
Aetna Medicare Advantage Service Pros And Cons
For 2022, Aetna added 83 new counties across the country, providing an additional 1 million more Medicare beneficiaries access to an Aetna plan. Aetna’s Medicare Advantage service offer has advantages and disadvantages.
- Multiple Advantages: In addition to dentistry, vision, and hearing, many plans give Aetna beneficiaries access to benefits card such as over-the-counter reimbursement, meal delivery services, and home health visits.
- Strong $0 Premium Offering: By 2023, Aetna estimates 84 percent of eligible beneficiaries in the U.S. will have access to a $0-per-month Aetna MA subscription.
- Wide Availability: Aetna offers MA plan in 46 states and Washington, DC, as well as standalone drug plan in all 50 states plus Washington, DC
- Savings on Drugs: All Aetna MA prescription drugs have a $0 deductible for all Tier 1 drugs, and almost all offer a $0 copay for Tier 1 drugs. Aetna’s most popular formulary also moves nearly 300 drugs to cheaper levels.
- Average star ratings: The Centers for Medicare & Medicaid Services (CMS) give Aetna’s 2023 Medicare Advantage coverage an average weighted rating of 3.67 out of 5 stars.
- Moderate Member Love: When it comes to member satisfaction, JD Power found that Aetna® Medicare Advantage scored 796 out of 1,000 points, below the industry average of 809.
Available Medicare Advantage Plans
Aetna offers several types, and they vary in structure, cost, and advantage. Most plans offer dental, vision, and hearing, as well as fitness benefits through SilverSneakers.
Generally, Aetna gives Medicare Advantage – Prescription Drugs, or MAPDs, as well as standalone ones and MA plan with no drug coverage. The company has expanded this plan for veterans – Aetna Medicare Eagle plan will feature 42 states by 2023.
The plan is designed to supplement the health care coverage veterans receive from the VA. The plans are designed with Veterans to complement their VA health care coverage and ensure access to important benefits for this population
Aetna will also introduce the Longevity Plan in Pennsylvania in 2023. This is an Institutional Special Needs Plan, designed for members who live in nursing homes. Subscription availability may vary by province. Other subscriptions may include the following types:
A health maintenance organization, or HMO, generally requires you to use a specific network of doctors and hospitals. You may need a referral from your primary doctor to see a specialist, and the out-of-network advantages are usually limited.
HMO point-of-service plans give you a little more flexibility than traditional HMO. While you have a primary care physician and may still need a referral, you have more freedom to see out-of-network caregivers, although you’ll pay more for out-of-network care.
Preferred Provider Organization, or PPO offers the most freedom, so you can see every 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 30 states, you may qualify 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 an advocate to help you access your state benefits.
Medicare Prescription Drugs Plans
Aetna’s standalone prescription drugs (PDP) serve 5.7 million Medicare members. In 2022, Aetna Medicare will offer the same three separate standalone PDPs as in 2021. SilverScript SmartRx (PDP), with an average monthly premium of $7.08, will once again be the lowest premium Aetna plan available from Aetna.
SilverScript Choice (PDP) falls under the benchmark pricing of CMS in 49 states and DC, while SilverScript Healthy Benefits Plus has the most robust coverage for drugs. All three plans are available in all 50 states and DC and have lower Tier 1 and Tier 2 copays at preferred pharmacies. 3
Medicare Supplement Plans
With more than 1.2 million members, the discounted individual Medicare Supplement plan utilizes a simplified underwriting process. They also offer popular dental, vision, and hearing products in 37 states. The supplemental plan options cover 45 states and can provide users with coverage for life, advantages paid directly to them after a cancer diagnosis, or for hospital stays, and recovery care at home or in a trained nursing facility.
Aetna Medicare Advantage offers most users access to routine vision, dental, and hearing coverage. Many of which are not available in other MAp. Here are a few notable things:
Fitness: Many plans include SilverSneakers, which include access to participating gyms, community centers, online fitness classes, healthy living discounts, and a fitness app.
Home health visits: Some beneficiaries may request an in-person home health visit or telecare for added convenience.
Concierge Services for Local Resources: Aetna’s Resources for Living program can help beneficiaries find the support they need, whether that’s home help, caregiving resource or help finding local activities.
Over-the-counter: Some plans include an OTC benefit that allows you to pick up certain items, such as vitamins and cold medicines, at participating drug stores (or online) at no additional cost.
Meals at home: After you are hospitalized, some plans offer you healthy meals to help you recover.
Telehealth: All plans for 2023 offer virtual visits for primary care, emergency care and specialty care, as well as mental health. Telehealth is also available for physical, occupational, and speech therapy, substance abuse treatment, kidney disease education, and diabetes self-management training.
Extras With Limited Space
Aetna MA also offers some benefit programs available on only a few plans in select locations, including the following:
Companionship Benefit: In some D-SNP plans, Aetna pairs users with a companion who can help them run errands or keep them company for up to 10 hours per month.
- Extra Card: Some people have access to a preloaded debit card that can be used for over-the-counter items, healthy food, utilities, or transportation.
- Memory Fitness: Some have access to a library of brain games and exercises, as well as information about brain health.
- Fresh Food Boxes: Certain users are eligible to receive a box of fresh fruits and vegetables at regular intervals, such as biweekly or monthly.
- Fall Prevention: Some users are eligible for an annual stipend that they can use for safety items that can reduce the risk of injury from falls.
Offering Innovative New Programs And Benefits
Aetna gives individual member benefit plan access to convenient and affordable care through several benefits and programs new this year:
Additional support for low-income people
Most D-SNP offer prescription drugs at no out-of-pocket costs and additional benefits for members who qualify for LIS. Coverage varies by plan and may include healthy food or utility, as well as companionship or fall prevention benefits.
Aetna understands that users who require hospice services may require special care and support. As part of the comprehensive coverage of select MAp in Ohio and Pennsylvania, Aetna will be responsible for the members’ complete medical coverage and hospice.
People who are enrolled in the Aetna Compassionate Care program and who use select health care providers have access to extra benefits to support their end of life.
They will receive ongoing temporary concurrent care such as treatment for diagnosis of terminal illness and related conditions, additional transportation, additional meals, home support, and access to a Personal Emergency Response System (PERS).
Aetna Medicare Debit
Aetna has partnered with PayFlex ® to offer a new debit card that includes out-of-pocket payments for in-network primary and specialty care and other medical and diagnostic services. Eligible users receive $100 per quarter with a maximum of $400 per year. This benefit is included with certain individual MAp in Pennsylvania and Minnesota.
As an extension of the alternative medicine benefits, select MAp in the Northwest region will cover up to 24 therapeutic massage visits per year.
Medical Clinical Policy
With MAp that includes a dental network benefit, you are covered in advance for specific dental services, but you may need to see a dentist within your network of providers.
Some Preferred Providers (PPO) and Preferred Provider Organizations (HMO-POS) and HMO-POS (Health Maintenance Organization) plans allow you to see any licensed dental provider, but you can save money by visiting a provider in the network. You can find a network provider by logging in as a member and going to the provider list.
Preventive services such as cleaning, oral exams, and X-rays are 100 percent covered on most plans. This means you don’t pay anything out of pocket if you stay in the network.
For comprehensive services, such as fillings, extractions, and crowns, coverage varies by plan and may require you to pay a portion of the cost. Please refer to your subscription for more information.
When planning your dental care, keep in mind that you may have limits on how many preventive care visits you can make each year, as well as limits on coverage for extended services.
Most plans also have a maximum benefit, a limit on the amount the plan will pay out to cover dental services. This maximum benefit can range from about $150 to $6,000.
For details visit to Medical Aetna Clinical Policy Bulletins
Dental Clinical Policy
This Dental Clinical Policy covers many different aspects of dental care, including preventive care, basic procedures, and major procedures. Preventive care includes routine teeth cleanings and exams. Basic procedures include fillings, extractions, and root canals. Major procedures encompass more extensive work, such as bridges, implants, and dentures.
This policy is important for both patients and dentists because it provides guidance on what treatments are covered by Aetna’s dental insurance.
For further information go to Dental Clinical Bulletins
Medicare Advantage Providers
More information about some of the major providers can be found below. These insurers provide coverage in the majority of states. The plans available to you will be determined by your ZIP code and county.
These are the other medicare providers for your references: AARP, Anthem, Blue Cross Blue Shield, Cigna, Humana, Kaiser Permanente, UnitedHealthcare, Wellcare.
Addressing Social Health Determinants With New And Expanded MA Benefit
The MAp takes a total approach to health that goes beyond clinical care. With this approach in mind, Aetna has expanded the benefits to include:
Telehealth: All Aetna 2022 MAp cover telehealth visits for primary care, emergency care and specialist care provided by a physician, including mental health services. Depending on location, people can schedule 24/7 telehealth visits through MinuteClinic Video Visit ™ , Teladoc ® or another network provider that offers this service.
Healthy Foods Card: To address food insecurity, the availability of the Healthy Foods Card is expanding to 77 MA plans in 28 states. Qualified users receive compensation that they can use to purchase nutritious foods from more than 30,000 accredited retailers nationwide.
Utility card: Select DNSP subscriptions in 2022 offer a new utility card. This debit card provides a monthly allowance for use towards the health care costs of utilities such as water, electricity, sewage and gas.
Companionship: Aetna expands its companionship benefit to address social isolation to select MAp in eight states. In association with Papa Inc. adult companions connect with qualified users to help with household chores and technology for up to 10 hours per month at no extra cost. Remote guidance can be provided via telephone or secure video.
Fall Prevention: Aetna is expanding its fall prevention benefit through CVS Pharmacy to other states and plans. In selected MAp, eligible users receive annual compensation for certain clinically appropriate safety items that help reduce the risk of injury from falls in the home.
Making Healthcare More Affordable, Accessible And Easier
Cost-sharing of $0 for select benefits: To ensure that key services are affordable, three of the four Aetna Individual MAp now offer no cost-sharing for people for primary care or lab visits. In addition, all Aetna MAp offer $0 copay for A1c, urine protein and COVID-19 tests and $0 copay for diabetes eye exams including retinal photo.
OTC: Aetna is expanding the availability of its over-the-counter (OTC) benefit through OTC Health Solutions, a CVS Health Company, and increasing the OTC stipend amount available to people of many MAp. The OTC benefit allows users to choose certain healthcare products for home delivery by phone, catalog or online.
They can also present their ID card to receive items directly from 3,000 select CVS Pharmacy ® or Navarro Discount Pharmacy ® locations in 37 states. In line with CVS Health’s commitment to helping people lead smoke-free lives, Aetna is pleased to offer all members the OTC benefit to provide access to nicotine replacement therapy (NRT).
Eligible users can choose from a variety of FDA-approved smoking cessation products, such as gums, lozenges, or patches.
Reducing Insulin Costs: Aetna is extending its participation in the Part D Senior Savings model to offer people in some individual MAPD plans and all SilverScript Plus Part D plans affordable, predictable co-payments of no more than $35 for a 30-month daily supply of selected insulins.
SilverScript is a Medicare-approved Prescription Drug Plan with a Medicare contract marketed by Aetna Medicare.
Prescription Drugs: All of Aetna’s individual MAPD plans will increase the daily supply for prescription drugs to a maximum of 100 days for drugs at levels 1-4. People can take advantage of the new increased daily supply without increasing copay/coinsurance.
Innovative Dental Design: Aetna Medicare introduces a new Total Choice dental benefit available on many individual MA HMO-POS and PPO plans. This dental reimbursement provides coverage of preventive and comprehensive dental services up to a maximum of the reimbursement and allows the member to choose a licensed dentist, within or outside the network.
Reduced Cash Costs: Aetna has reduced the maximum cash costs of members in the network in approximately one-third of its individual MAps for 2022.
Member Rewards Program: In 2022, they will extend the rewards program to all individual Medicare Advantage members of Aetna. The program helps them improve their health and well-being with personalized rewards activities.
They can earn $150 or more by completing activities such as preventive screenings and annual physical exams already covered by their benefits.In addition, Aetna will continue to offer the following benefits or other services as part of its Medicare Advantage plans:
All MAp offer an annual in-house assessment at no additional cost, including a comprehensive health risk assessment and non-invasive physical exam from the comfort of the member’s home. The clinician will also assess the home environment for potential fall risks so that the member can stay home safely.
The Aetna Resources For Living ® program helps address loneliness and other social needs by connecting users to key community resources, such as transportation, housing, food programs, caregiver support and utilities, based on the needs of individuals. The program serves as an early intervention point for the many issues that affect physical and mental health.
SilverSneakers ® fitness memberships are available at no additional cost to all individual MA members of Aetna. Through SilverSneakers, people have access to more than 16,000 fitness locations.
SilverSneakers FLEX ® also gives them access to training programs outside of traditional gyms, such as recreation centers, shopping centers and parks. Individuals can also connect to a support network and virtual resources through SilverSneakers LIVE™, SilverSneakers On-Demand™ and the mobile app, SilverSneakers GO.
Aetna will continue to provide access to routine facial, dental and hearing coverage for most Medicare Advantage members.
Visit AetnaMedicare.com to learn more about Aetna Medicare plans for 2022. Or call 1-844-588-0041 (TTY: 711) 7 days a week, 8 a.m. to 8 p.m. The annual Medicare enrollment period is October 15 through December 7, 2021. An authorized agent can answer your call.
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