Aetna Medicare Advantage plans offer a robust alternative to Original Medicare. These plans, provided by Aetna, a CVS Health company, cover a wide range of healthcare services. They are designed to meet the needs of seniors and eligible individuals.
In 2025, Aetna’s plans include hospital care, medical services, and often prescription drugs. They also provide extra benefits like dental, vision, and wellness programs. Understanding these plans helps you make informed healthcare choices.
This guide details what Aetna Medicare Advantage covers, including costs and enrollment. It highlights key features and tips to maximize your benefits. Let’s explore how these plans support your health in 2025.
Overview of Medicare Advantage
Medicare Advantage, or Part C, is a private insurance option approved by Medicare. It combines coverage for hospital (Part A) and medical services (Part B). Many plans include prescription drug coverage (Part D).
Aetna’s Medicare Advantage plans are available in 46 states and Washington, D.C. They cover over 2,269 counties, serving millions of beneficiaries. Plans vary by location, so check availability by ZIP code.
You must be enrolled in Medicare Parts A and B to join. These plans often include benefits not offered by Original Medicare. Aetna’s focus is on affordability and comprehensive care.
Types of Aetna Plans
Aetna offers Health Maintenance Organization (HMO) plans, requiring in-network providers and a primary care physician (PCP). Referrals are often needed for specialists. These plans keep costs low.
Preferred Provider Organization (PPO) plans allow in- and out-of-network care, with higher costs for out-of-network providers. No PCP or referrals are required. They provide greater flexibility.
HMO-Point of Service (HMO-POS) plans offer some out-of-network coverage. Dual Special Needs Plans (D-SNPs) cater to those with Medicare and Medicaid. Aetna’s Medicare Eagle plans target veterans in 43 states.
Core Medical Coverage
Aetna Medicare Advantage plans cover all services under Original Medicare. Part A includes hospital stays, skilled nursing, and hospice care. Part B covers doctor visits, outpatient services, and durable medical equipment.
Preventive services, like annual wellness visits and cancer screenings, have $0 copays in-network. Emergency and urgent care are covered worldwide. This ensures access to essential healthcare.
Lab tests, imaging, and physical therapy are included. Coverage details vary by plan, so review the Evidence of Coverage. Aetna’s plans emphasize preventive care to maintain health.
Prescription Drug Benefits
Most Aetna Medicare Advantage plans include Part D prescription drug coverage. This covers generics, brand-name drugs, and vaccines like flu and shingles. Each plan has a formulary listing covered medications.
Tier 1 generics have low copays, often $0-$5 at preferred pharmacies like CVS. Higher tiers, like specialty drugs, may cost $50-$100. The 2025 out-of-pocket drug cap is $2,000, per the Inflation Reduction Act.
Mail-order through CVS Caremark offers 90-day supplies with free shipping. Use Aetna’s drug cost estimator to check prices. Some drugs require prior authorization or step therapy.
What Does Aetna Medicare Advantage Cover: Extra Benefits
What does Aetna Medicare Advantage cover extends beyond Original Medicare. Many plans include dental coverage, such as cleanings, fillings, and dentures. Comprehensive dental may have allowances up to $2,000 annually.
Vision benefits cover eye exams, glasses, or contacts, with allowances up to $300. Hearing benefits include exams and hearing aids, often with $500-$1,000 per ear. These enhance overall wellness.
Wellness programs, like SilverSneakers, provide gym access and online fitness classes. The Resources For Living program connects members to community support, like meal delivery. These benefits vary by plan and region.
Costs and Affordability
Many Aetna plans have $0 monthly premiums, but you must pay the Part B premium ($185 in 2025). About 83% of beneficiaries can access $0 premium plans. Deductibles range from $0 to $500.
Copays are typically $0-$50 for doctor visits and $100-$500 for hospital stays. Out-of-pocket maximums cap costs at $8,900 for in-network care. PPO plans have higher out-of-network costs.
The Medicare Extra Benefits Card offers allowances for OTC items or health expenses. Insulin copays are capped at $35 monthly. Check your Summary of Benefits for exact costs.
Comparing Aetna Plan Types
| Plan Type | Key Coverage | Best For |
|---|---|---|
| HMO | In-network care, PCP required | Low costs, coordinated care |
| PPO | In- and out-of-network care, no referrals | Flexibility in provider choice |
| D-SNP | Medicare and Medicaid, tailored benefits | Dual eligibles, comprehensive needs |
Enrollment Periods
The Initial Enrollment Period (IEP) is a seven-month window around your 65th birthday. The Annual Enrollment Period (AEP), October 15 to December 7, 2024, allows plan changes for 2025. Coverage begins January 1.
The Medicare Advantage Open Enrollment Period runs January 1 to March 31. Special Enrollment Periods (SEPs) apply for events like moving or losing coverage. Discontinued plans offer an SEP until February 28, 2025.
Enroll via AetnaMedicare.com or call 1-833-570-6670 (TTY: 711). Late Part D enrollment incurs a permanent penalty. Use Medicare.gov’s Plan Finder for comparisons.
Provider and Pharmacy Networks
Aetna’s network includes 1.8 million providers and 6,200 hospitals. Over 63,000 pharmacies, like CVS and Walgreens, are in-network, with CVS as a preferred option. MinuteClinics offer $0 copay services for many plans.
HMO plans require in-network providers, except in emergencies. PPO plans cover out-of-network care at higher costs. Use AetnaMedicare.com/FindProvider to locate in-network options.
D-SNPs have specialized networks for dual eligibles. Always verify your doctor’s network status. Carry your Aetna ID card to ensure coverage at appointments.
Additional Services
Aetna’s 24-Hour Nurse Line provides round-the-clock medical advice. Telehealth offers virtual visits, often at $0 copay, for minor issues or mental health. In-home health assessments are available in some plans.
The Medicare Extra Benefits Card covers OTC items like vitamins or bandages. Allowances range from $25-$100 quarterly, shoppable at cvs.com/otchs/myorder. These extras enhance plan value.
Chronic Condition Special Needs Plans (C-SNPs) target conditions like diabetes. They offer $0 copays for related specialist visits. Check your plan for unique features like meal delivery.
Limitations and Exclusions
Aetna Medicare Advantage plans exclude cosmetic procedures and non-medically necessary services. Some dental benefits, like implants, may have limits or exclusions. Hearing aid allowances are capped, typically at $1,000 per ear.
HMO plans don’t cover out-of-network care, except in emergencies. Prior authorization may be needed for high-cost procedures or drugs. Appeals are available for denied services.
OTC benefits aren’t available in all plans, like some D-SNPs. Coverage varies by state and county. Review your Evidence of Coverage for specific exclusions.
Tips for Maximizing Benefits
- Stay In-Network: Use CVS or in-network providers for lower costs.
- Use Preventive Care: Schedule $0 copay screenings like mammograms.
- Leverage OTC Allowances: Shop for health products with your Extra Benefits Card.
- Explore Telehealth: Access virtual care for convenience and savings.
Special Considerations
Dual eligibles benefit from D-SNPs, offering $0 deductibles and copays. These plans coordinate Medicare and Medicaid benefits. Check state-specific eligibility on AetnaBetterHealth.com.
Veterans can choose Medicare Eagle plans, available in 43 states. These offer $0 copays for labs and colonoscopies. Confirm eligibility on AetnaMedicare.com.
Travelers get worldwide emergency coverage, but routine care requires in-network providers. PPO plans offer out-of-network flexibility. Contact Aetna before traveling for guidance.
Summary
Aetna Medicare Advantage plans in 2025 cover hospital stays, medical services, prescriptions, and preventive care, surpassing Original Medicare. Extras like dental, vision, hearing, and SilverSneakers enhance wellness, with many plans offering $0 premiums. The $2,000 drug cost cap and $0 copay preventive services ensure affordability. By using in-network providers, telehealth, and tools like Aetna’s Plan Finder, you can maximize benefits. Understanding your plan’s coverage and enrolling on time ensures comprehensive, cost-effective care.
FAQ
What does Aetna Medicare Advantage cover?
Aetna Medicare Advantage covers hospital stays, doctor visits, prescriptions, and preventive care. Many plans include dental, vision, hearing, and fitness programs. Check your Evidence of Coverage for details.
How much do Aetna Medicare Advantage plans cost?
Many plans have $0 premiums, but you pay the Part B premium ($185 in 2025). Copays range from $0-$50, with out-of-pocket maximums up to $8,900. Use Aetna’s cost estimator for specifics.
Which pharmacies can I use with Aetna Medicare Advantage?
Use in-network pharmacies like CVS (preferred) or Walgreens for lower copays. Mail-order through CVS Caremark offers 90-day supplies. Check AetnaMedicare.com/FindProvider for locations.
What extra benefits are included in Aetna plans?
Extras include dental cleanings, vision exams, hearing aids, and SilverSneakers. Some plans offer OTC allowances and telehealth at $0 copay. Benefits vary by plan and region.
When can I enroll in Aetna Medicare Advantage?
Enroll during the IEP (around age 65), AEP (October 15–December 7, 2024), or SEPs for events like moving. Discontinued plans offer an SEP until February 28, 2025.