Aetna Part D plans help cover prescription drug costs for Medicare beneficiaries. These plans, offered by Aetna, a CVS Health company, are designed to make medications affordable. Understanding their coverage ensures you get the most from your plan.
Part D plans cover a wide range of medications, from generics to brand-name drugs. They work alongside Original Medicare or Medicare Advantage plans. In 2025, Aetna’s Part D options include enhanced benefits and cost-saving features.
This guide explains what Aetna Part D covers, including drugs, costs, and limitations. It provides tips to maximize benefits and navigate the plan effectively. Let’s explore how Aetna Part D supports your healthcare needs.
Understanding Medicare Part D
Medicare Part D is a voluntary prescription drug benefit for Medicare beneficiaries. It’s offered through private insurers like Aetna, approved by the Centers for Medicare & Medicaid Services (CMS). You need Part A or B to enroll in Part D.
Aetna offers standalone Part D plans and integrates them into some Medicare Advantage plans. These plans cover medications dispensed at pharmacies, not hospital-administered drugs. Coverage varies by plan formulary.
Part D plans have premiums, deductibles, and copays. Aetna’s plans aim to balance affordability and access. Always review the plan’s formulary to ensure your medications are covered.
Aetna Part D Plan Options
Aetna offers three main Part D plans in 2025: SilverScript SmartSaver, SilverScript Choice, and SilverScript Plus. SmartSaver has low premiums, ideal for those with fewer prescriptions. Choice balances cost and coverage for broader needs.
SilverScript Plus provides enhanced benefits, like $0 copays for Tier 1 and 2 drugs at preferred pharmacies. It covers more medications and includes international coverage. Each plan serves different healthcare needs.
Plans are available in all 50 states and Washington, D.C. Use AetnaMedicare.com to compare options by ZIP code. Call 1-833-570-6670 (TTY: 711) for personalized guidance.
Covered Medications
Aetna Part D plans cover a wide range of prescription drugs. These include generics, brand-name medications, and some vaccines. The plan’s formulary lists covered drugs, organized into tiers.
Common medications include those for diabetes (metformin), heart disease (atorvastatin), and pain (gabapentin). Vaccines like shingles (Shingrix) and flu shots are often covered. Coverage requires in-network pharmacy use.
Formularies are updated annually. Check the 2025 formulary on AetnaMedicare.com for specifics. Some drugs may require prior authorization or step therapy.
Tiers and Costs
Aetna Part D plans use a tiered formulary system. Tier 1 (generics) has the lowest copays, often $0-$5 at preferred pharmacies. Tier 2 includes preferred brand-name drugs with moderate copays.
Higher tiers (3-5) cover non-preferred brands and specialty drugs, with copays up to $100 or coinsurance. The 2025 out-of-pocket maximum is $2,000 for covered drugs, per the Inflation Reduction Act. Deductibles vary, with SmartSaver at $545 and Plus at $0.
Preferred pharmacies, like CVS, offer lower copays. Mail-order services through CVS Caremark provide 90-day supplies with free shipping. Use Aetna’s drug cost estimator for accurate pricing.
What Does Aetna Part D Cover: Key Benefits in 2025
What does Aetna Part D cover includes thousands of medications across all plans. SilverScript Choice covers generics and many brand-name drugs, with a $0 deductible in some states. SilverScript Plus includes Tier 1 and 2 drugs at $0 copay at CVS.
Vaccines like pneumococcal and RSV are covered under pharmacy benefits. Insulin costs are capped at $35 monthly for covered brands. Over-the-counter (OTC) drugs are not covered, except in specific plans.
Specialty drugs, like those for cancer, are covered under higher tiers. Prior authorization may apply for high-cost medications. Check the formulary or call Aetna for coverage details.
Pharmacy Network
Aetna’s Part D network includes over 63,000 pharmacies nationwide. Preferred pharmacies, like CVS and ShopRite, offer lower copays, often $0 for Tier 1 drugs. Walgreens and Rite Aid are also in-network but may have higher costs.
Mail-order services through CVS Caremark provide convenience for long-term medications. You can get 90-day supplies with free standard shipping. Specialty drugs are handled by CVS Specialty.
Use AetnaMedicare.com/FindProvider to locate in-network pharmacies. Always present your Aetna member ID card at pharmacies. Out-of-network pharmacies may not be covered, except in emergencies.
Coverage Phases
Part D plans have four coverage phases in 2025. The deductible phase requires you to pay full drug costs until meeting the deductible (up to $545). SilverScript Plus often has a $0 deductible.
In the initial coverage phase, you pay copays or coinsurance per the formulary. The coverage gap, or “donut hole,” is eliminated in 2025, with a $2,000 out-of-pocket cap. The catastrophic phase kicks in after this, with minimal or no copays.
Track your spending on Aetna’s member portal to understand your phase. The $2,000 cap includes deductibles, copays, and coinsurance. Contact Aetna for phase-specific questions.
Additional Benefits
Aetna Part D plans include extras like $0 copay flu shots at CVS MinuteClinics. Some plans offer wellness programs, like medication therapy management, to optimize drug use. SilverScript Plus covers drugs during international travel.
The Extra Help program lowers costs for low-income beneficiaries. Qualifying members pay $0-$10 per prescription. Aetna’s SmartSaver plan has a $0 premium for Extra Help recipients in 33 states.
Medication reviews with pharmacists are available. These help manage side effects and drug interactions. Use Aetna’s app for real-time benefit tracking.
Limitations and Exclusions
Aetna Part D doesn’t cover OTC drugs, like ibuprofen, unless specified. Drugs for cosmetic purposes, like hair growth, are excluded. Some medications require prior authorization or step therapy.
Experimental drugs or those not on the formulary aren’t covered. Hospital-administered drugs fall under Part A or B, not Part D. Check the formulary for exclusions.
Appeals are possible if coverage is denied. Work with your doctor to submit medical necessity documentation. Contact Aetna at 1-833-570-6670 (TTY: 711) for appeal guidance.
How to Maximize Part D Benefits
- Use Preferred Pharmacies: Choose CVS or ShopRite for lower copays.
- Opt for Generics: Select Tier 1 drugs to save on costs.
- Use Mail-Order: Get 90-day supplies through CVS Caremark for convenience.
- Apply for Extra Help: Check eligibility for low-income subsidies at SSA.gov.
Enrollment and Plan Selection
Enroll in Aetna Part D during the Initial Enrollment Period (IEP) around age 65 or the Annual Enrollment Period (AEP), October 15 to December 7. Coverage starts January 1, 2025. Special Enrollment Periods (SEPs) apply for events like moving.
Compare plans on AetnaMedicare.com by entering your medications and ZIP code. SilverScript Choice suits moderate needs, while Plus is best for extensive prescriptions. Call 1-833-570-6670 (TTY: 711) for help.
Late enrollment incurs a penalty of 1% of the national premium ($34.43) per month delayed. Avoid gaps by enrolling on time. Use Medicare.gov’s Plan Finder for additional comparisons.
Special Considerations
Low-income beneficiaries qualify for Extra Help, reducing premiums and copays. Apply through SSA.gov or call 1-800-772-1213 (TTY: 711). Dual eligibles (Medicare and Medicaid) get automatic subsidies.
Seniors with chronic conditions, like diabetes, benefit from insulin cost caps. Ensure your medications are on the formulary to avoid surprises. Specialty drugs may require CVS Specialty.
Travelers benefit from SilverScript Plus’s international coverage. Contact Aetna before traveling to confirm pharmacy options. Keep your member ID card handy for emergencies.
Comparing Aetna Part D Plans
| Plan Name | Key Features | Best For |
|---|---|---|
| SilverScript SmartSaver | Low premiums, $545 deductible | Fewer prescriptions, cost-conscious |
| SilverScript Choice | $0 deductible in some states, broad coverage | Moderate prescription needs |
| SilverScript Plus | $0 deductible, $0 copay for Tier 1/2 | Extensive prescriptions, travel |
Summary
Aetna Part D plans in 2025 cover a wide range of prescription drugs, including generics, brand-name medications, and vaccines like Shingrix. With plans like SilverScript SmartSaver, Choice, and Plus, you can choose based on your medication needs and budget. Features include $0 copay generics at CVS, insulin cost caps, and a $2,000 out-of-pocket maximum. By using preferred pharmacies, mail-order services, and tools like Aetna’s Plan Finder, you can maximize benefits. Always check the formulary and enroll on time to avoid penalties.
FAQ
What does Aetna Part D cover?
Aetna Part D covers generics, brand-name drugs, and vaccines like flu and shingles. Coverage varies by formulary, with tiers determining copays. Check AetnaMedicare.com for your plan’s drug list.
How much do Aetna Part D plans cost?
Premiums range from $0 (SmartSaver with Extra Help) to $100+ monthly (Plus). Copays vary by tier, with generics at $0-$5. The 2025 out-of-pocket cap is $2,000.
Can I use any pharmacy with Aetna Part D?
Use in-network pharmacies like CVS or Walgreens for coverage. Preferred pharmacies, like CVS, offer lower copays. Check AetnaMedicare.com/FindProvider for in-network options.
What is the Extra Help program for Part D?
Extra Help lowers premiums and copays for low-income beneficiaries. Qualifying members pay $0-$10 per prescription. Apply at SSA.gov or call 1-800-772-1213 (TTY: 711).
When can I enroll in Aetna Part D?
Enroll during the IEP (around age 65) or AEP (October 15–December 7, 2024). SEPs apply for events like moving. Late enrollment incurs a permanent penalty.