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Aetna Medicare Review

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Eric Stauffer is a former insurance agent and banker turned consumer advocate. His priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best...

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UPDATED: Apr 10, 2020

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Aetna is one of the biggest names in health insurance across the U.S. As of 2017 statistics, Aetna stood as the third largest health insurance company, behind only United Health Group and Anthem based on revenue and enrolled members. Aetna provides individual health insurance, group coverage, and Medicare plans to more than 23 million people across the country.

About Aetna

Aetna originally started out as a fire insurance company founded in 1819 in Hartford, Connecticut. In 1853, the company shifted course, incorporating as Aetna Life Insurance Company. Diversification began in 1891 with the addition of accident insurance, leading the way for Aetna’s entry into the health insurance market in 1899.

Aetna expanded into the global insurance market in 1960 when they purchased a Canadian life insurance company. The company’s diverse interests took a turn in 1996, when Aetna sold off all of its property and casualty insurance, focusing in on the health insurance market; that focus was enhanced by a merger with U.S. Healthcare. By 2000, Aetna was known as solely a health insurance company and was on its way to becoming a giant.

The company has been serving the Medicare market since 1966. They were quick to enter the Medicare Advantage market under the Affordable Care Act. A proposed merger with Humana that would have made the combined company a force to be reckoned with in the Medicare industry was killed in the courts in 2017. The merger did not stop Aetna from adding 250,000 Medicare members in the first quarter of 2018 alone and moving up the list of biggest Medicare providers in the country.

Aetna’s new proposed merger with CVS, which at the time of this review appears poised to go through, will still have an impact on Medicare, according to a Kaiser Foundation study. Either way, Aetna will remain one of the biggest names in Medicare.
Aetna Medicare plans are available in most states, although not all. Plans are sold directly through the company website.

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Aetna Medicare Plans

Not surprisingly, Aetna has a full range of Medicare products available: Advantage, Part D, and Supplement. Plan availability varies from state to state; we used a Southern California zip code as our sample for the purpose of this review.

Medicare Advantage Plans

Aetna offers three Advantage plans in our sample area, all of which include prescription drug coverage. There are two HMO plans, both of which are zero-premium, and one PPO plan. All of the plans have a $0 deductible.

Medicare Select is the first HMO plan. It has $0 copays for either office visits or specialists and a $260 per day copay for the first five days of a hospital stay ($0 thereafter). Hearing, vision, and dental are not included in this plan, but they can be added for a monthly premium.

Like all of the plans, Select includes prescription drug coverage. Tier 1 drugs have a $0 copay, Tier 2 a $5 c pay. Tiers 3 and 4 have a $42 and $100 copay respectively, while Tier 5 is covered with a 33% coinsurance.

Medicare Prime is also an HMO plan and is again a $0 premium plan. This plan has similar copay amounts, with no charge for office visits or specialists, but has a lower out of pocket maximum. It also has a $0 copay for hospital stays. Fees under the plan are lower in many areas, although prescription drug coverage is the same as the Select plan.

Unlike Select, Prime does include limited coverage for hearing, dental, and vision. There is no premium for these services.

Medicare Choice is the only PPO plan among the Advantage offerings. Because of the much wider selection of providers offered by a PPO, this plan does have a monthly premium. Primary care visits have a $10 copay, and specialist visits have a $40 copay. Hospital stays have a $225 copay for the first five days, $0 thereafter.

Prescription coverage on this plan is the same as that offered on the HMO plans. This plan includes a prescription eyewear benefit, but dental and hearing coverage are optional and can be added for an additional premium.

Medicare Part D (Prescription Drug) Plans

In our sample area, there are three Part D plans available. All of the plans have $0 deductibles for Tier 1 & 2 drugs.

Select, the lowest priced plan, has a $405 deductible for Tiers 3, 4, and 5. Copays start at $0 for Tier 1 and $3 for Tier 2, going up from there. There is a $5,000 out of pocket maximum with this plan.

Saver has a $375 deductible on Tiers 3, 4, and 5. The Tier 1 copay is $1, Tier 2 is $2, and increase from there, although most copays are lower than with the Select plan. Again, out of pocket maximum is $5,000.

The final plan, First Health Part D Value Plus, has no deductible at any level. Again, Tier 1 and 2 drugs have copays of $1, and $2 respectively, but the other copays are more in line with the higher rates on the Select plan. Again, the out of pocket limit is $5,000 with this plan.

All of these plans can be purchased to compliment a regular Medicare plan, but not one of Aetna’s Advantage plans. All Advantage plans already include Part D.

Medicare Supplement

In our sample area, Aetna offers several of the standardized Medicare Supplement plan options.

Like all companies, they start at the base level Plan A, which covers coinsurance amounts for medical, hospital, and hospice, along with the first three pints of blood each year.

Additional plans available are B, F, G, and N. F, which offers the most comprehensive coverage of all the standard plans, is available as a high deductible plan in some areas.

Rates

As noted, the two HMO Medicare plans from Aetna are $0 premium – this means you do not pay an additional amount beyond your regular Medicare premium. The PPO plan has a monthly premium of $79.

While Select includes dental, vision, and hearing at no cost, adding them to the other plans has an additional premium.

For Prime there are several options:

  • Dental alone, $11/month
  • Dental plus eyewear, $18/month
  • Dental plus eyewear and hearing, $22/month

For Choice (which includes eyewear already), there are two options:

  • Dental only, $23/month
  • Dental plus hearing aids, $26/month

Part D plan rates for our sample area are:

  • Select, $19.70/month
  • Saver, $31.60/month
  • Value Plus, $56.30/month

The Aetna site does not offer rates for Supplement plans at this time.

Overall, Aetna’s Medicare plans are well priced for the coverage they provide. The company seems to have made adjustments to rates since the last time we reviewed them; all rates appear to be a flat monthly amount, which makes shopping for Medicare insurance a lot easier.

Ratings and Consumer Reviews

Both of Aetna’s HMO plans have a 3.5-star rating from Medicare, and the PPO plan has a 3-star rating. This indicates that Aetna definitely has some room for improvement.

The National Committee for Quality Assurance rates Aetna solidly across all states for Medicare, with a 4.5 rating across the board. Although the underlying ratings in each state vary, there is not one state where they offer coverage that ranked any lower. That is a very positive sign for Aetna.

The Better Business Bureau (BBB) gives Aetna, Inc. an A+ rating. There is a total of 568 complaints on file in the past three years. Given that those complaints cover all of Aetna’s approximately 23 million customers in all areas of health insurance, that is a really low complaint volume. Only 177 of those complaints were closed in the past 12 months.

Consumer Affairs has 789 reviews of Aetna, with an overall 1.5-star rating. That rating is based only on the 106 ratings submitted in the past year. Bearing in mind again the size of this company, and the fact that these ratings apply to all of the company’s business and not only Medicare, those numbers are again quite low.

We would like to see Aetna’s Medicare star rating come up a bit, and it will be important to watch how things change if and when the current merger with CVS is completed.

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The Bottom Line

Much like the last time we reviewed this company, Aetna is on the verge of a major change. When the acquisition by pharmacy giant CVS is complete, there may be some changes to the way Medicare plans are handled. As of the time of this review, however, Aetna has some good plans at good prices and appears to have a pretty good reputation as well. Those in the market for Medicare coverage will find their approach straightforward and their options affordable and easy to choose from.

For a list of companies that we recommend, visit our Best Insurance Companies page.

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Review Information

Summary
Review Date
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Aetna Medicare
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About Eric Stauffer

Author: Eric StaufferI am a former insurance agent and banker turned consumer advocate. My priority is to help educate individuals and families about the different types of insurance they need, and assist them in finding the best place to get it.

16 Comments

  1. My Husband’s Union switched our original Medicare & secondary of Blue Cross to Aetna Medicare Advantage on 1/1/20.

    We were never told that we needed prior authorization for MRI, CT Scans & physical therapy.

    My husband had knee replacement 11/5/19 & had no problems with in-home nursing & therapy & outside rehab.

    1/1/20 his rehab was stopped & after fighting with Aetna they gave him only 5 more sessions, although his Dr wanted 12.

    They have an independent company that reviews the cases.

    If you need any radiology testing the dr must apply & it could take between 72 hrs to 2 weeks.

    This is ridiculous. We never had to do this.

    Please do not get this plan. Stay with original Medicare & get a secondary.

    Reply
  2. I have had no complaints until this year.

    It seems Aetna has changed my Drug Ins. to WellCare.

    The premium has been taken out of my Social Security but because the Pharmacy didn’t have a card number they couldn’t get drugs paid.

    I have not received a plan card which I need very badly.

    Reply
  3. I was going to sign up for Medicare Advantage for my husband and myself.

    After reading all the reviews there is no way I will sign up with this horrible company.

    I just cannot believe how they can still be in business.

    Reply
  4. I am 81 years old. I have high pressure, high cholesterol, & restless legs syndrome.

    I have been with Dr. Sweinschaupt for at least 15 years.

    When I see him, he comes in with my ex written. He has laid hands on me a maximum of 10 times, with the exception of if I asked them to check for skin cancer.

    He never listens to my heart, lungs, etc. If I get an EKG or blood work. It’s by my request.

    There have been times he sends a PA in with written prescriptions.

    I had blood work in 2015, which high cholesterol his response was ” is she taking her cholesterol medication”,

    2017 high cholesterol again “is she taking her cholesterol medication”.

    Also decreased kidney function. Now, after my request, blood work is done. Cholesterol high “is she taking her cholesterol medication”.

    I called my pharmacist & found in 10/29/15 he prescribed Lipitor 40 mg 1 at bedtime, no refills.

    I do have RLS & I do have to take Subutex sublingual at bedtime.

    I have had this condition since I was 30. I saw a neurologist & was told it would get worse with age & it has.

    My problem is with the very poor care & concern my primary has. Please let this be anonymous.

    Reply
    • In my opinion: Aetna-liars, crooks and thieves.

      I purchased a policy from my employer with Aetna.

      I became disabled because of a health condition, verified by 3 doctors, state and other insurance companies.

      Aetna harassed my spouse and I, threatened me with being fired, discontinued my employer pay and benefits, conveniently lost documents my doctors and I sent to them several times, misquoted and distorted facts in medical documents I submitted, forced me to retire because of no pay or benefits, committed fraud, made numerous mistakes always in Aetna’s favor, told me verbal lies in phone conversations, made outrageous demands under the threat of being fired “if you don’t go to the doctor today and submit these forms you will be terminated from your job”, Etc.

      Aetna CEO Mark Bertolini’s compensation was valued at $17.3 million last year.

      He got it by screwing people like you and me.

      Don’t get Aetna insurance for any coverage of any kind.

      Often Aetna will not pay claims and will do anything dishonest to avoid paying.

      If you do have Aetna coverage, get rid of them ASAP. Aetna consistently acted in bad faith.

      If you do have problems with Aetna, keep a log, FAX or send all documents 3 times and file complaints with your employer and department of insurance, etc. Anonymous Aetna victim, because of Aetna reprisals.

      Reply
  5. What does PPO stand for?
    Please advise…..

    Reply
  6. These reviews really concern me. I have been considering changing to Aetna and have been told, by an agent, that Aetna has really good reviews and ratings. Really, if they do, I cannot find them. I have decided to not enroll in Aetna.

    Reply
  7. Good morning and thank you for openly dedicate yourself to “declassifying” insurance for us, the ones in the receiving end of that field.
    After more than 30 years covered by BCBS our retirement plan has changed our coverage from Horizon Medicare Advantage PPO (NJ) to Aetna Medicare Advantage PPO (NJ) starting Jan 1, 2019, Needless to say we are extremely concerned about this unwanted change imposed on us, after seeing complaint after complaint about Aetna’s way of handling claims etc.
    We are retired and not looking forward to these changes at our age!

    Reply
    • Likewise!!!!

      Reply
    • You do not have to accept being “automatically” enrolled in this Aetna Medicare Advantage plan that is being forced on NJ workers/teachers etc
      Page 1 of the booklet they gave you “Inspired By You” at the bottom right tells you how to opt out of the coverage.
      You can still have your federal Medicare but NJ10 and NJ15 will be gone. Instead, you can choose NJ15 and NJ25 which appear to be the same with a slightly higher co-pay.
      No one wants anyone playing games with their health insurance.

      Reply
  8. Worst company ever. I moved house and missed 1 payment after 7 years and they canceled me.

    Reply
  9. We just started with the Aetna Medicare Part D Rx plan – and it is a nightmare! They have placed one of my generics on Tier 3 (“Preferred Brand”) although their formulary calls it a generic (in order to collect the deductible). I started to get notices that I will get a penalty for not having prior credible coverage and called in and was told it had been verified – only to get a final notice three weeks later. I called again and they said they would now verify it since they hadn’t corrected it before. To make matters worse, I had signed up for the EFT (auto debit from my bank account) and then found that it hadn’t been entered into the system. When I called and asked where my banking information had gone, I was told “not to worry about it” but give the info again. NOT LIKELY! These people are grossly incompetent and dangerous – and arrogant as well – threatening to hang up if you ask too many questions.

    Reply
  10. Please DO NOT USE AETNA. They change Pricing Tiers (always upwards) so you pay more every year. Somehow my medication was classified as a generic in 2017 but now is a brand? I am not sure how that is possible since absolutely nothing has changed. They also appear to only pay for one medication per medical diagnosis even if the doctor calls for two medications for that one illness. Their appeals process is so cumbersome they obviously have no interest in what is medically necessary or what the doctor recommends. I am changing plans to ANYONE BUT AETNA!

    Reply
  11. I have Aetna Medicare PPO.
    Your 2017 advertising shows a company
    truly concerned about your Members.
    In reality, I can’t even get Aetna to pay
    for my medically necessary Vitamin
    B12 medication. The latest untruth was told by an Aetna agent to my PCP’s office
    that this medication would only be covered by Aetna if I was receiving Dialysis.

    Reply
  12. I had aetna extra help for a couple years then got employed and new coverage so i tried to cancel December 2016. Aetna made it impossible for me to cancel giving me the run around saying oh u need to call the state, u need to call Medicare blah blah. Then I call back January to make sure its canceled as i kept on giving me notices and they say nope u need to do this dis-enrollment form, oh and you owe us 60$ for the past 2 months and if u don’t pay well write it off and send to collections! Terrible company

    Reply

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