Aetna Medicare Review

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Aetna is among the largest health insurance companies in the country, ranking 5th by market share in 2015. sitting at number 46 on the Fortune 500 list, the company is aiming to become even bigger if a proposed merger with Humana goes through.

Aetna serves more than 23 million people with a variety of health insurance plans, and that includes Medicare members. The merger between Aetna and Humana positions them to become the largest provider of Medicare plans in the nation.

Not looking for Medicare information? Click here for our general review of Aetna.

About Aetna

Aetna was founded as a fire insurance company in 1819 in Hartford, Connecticut, and incorporated as Aetna Life Insurance Company in 1853. In 1891, the company expanded into accident insurance, beginning a process of diversification that continues to this day. In 1899, the company offered their first health insurance policies, available as an add-on option for Aetna life and accident policyholders. In 1960, Aetna went international when they acquired a Canadian life insurance company; they would continue to spread across the globe in coming years. By 1996, Aetna reduced its multiline status by selling its property and casualty divisions off to Traveler’s Insurance. That year, they merged with U.S. Healthcare to form Aetna U.S. Healthcare. By 2000, the company’s financial services branch would be sold as well.

Aetna’s history with Medicare goes back to 1966, when they paid their first Medicare claim. Under the Affordable Care Act, Aetna began offering Medicare Advantage plans, and controls about 7% of that market – a number that will rise drastically with the proposed Humana merger. Opposition to the merger has the future of the two companies still in limbo as of fall 2016. The 2013 acquisition by Aetna of Coventry also gave the company a big boost in the Medicare market.

Aetna today writes mainly group insurance plans offered through employers, having moved away from the individual private insurance market in the 1990s. However, they have repositioned themselves in the individual market as part of the Affordable Care Act. They offer health, dental, vision, disability, and prescription coverage as well as Medicare and Medicaid products.

Aetna’s Medicare Products

Aetna offers three types of Medicare coverage: Medicare Advantage Plans (Part C or MA Plans), Medicare Prescription Drug Plans (Part D plans), and Medicare Supplement Insurance Plans. These plans can be purchased separately or combined as needed for comprehensive coverage.

Medicare Advantage

Medicare Advantage plans from Aetna offer consumers Part C coverage through a contract the company holds with the state in which you reside. This means that they cover everything a state-run Medicare plan covers, with the exception of hospice care.

These plans were designed to create a privately administered option for Medicare-eligible consumers. Both PPO and HMO plans are available, although what each plan covers can vary from state to state. Medicare Advantage plans frequently include prescription drug coverage (Part D), and Aetna’s plans are no exception. Part D can also be purchased separately through Aetna. In some states, only Part D coverage is offered.

The Aetna site doesn’t provide a clear rundown of their Medicare plans without entering a specific zip code, so results may vary from state to state. Using a Southern California zip code, our results were an offering of three main Part C plans.

Aetna Medicare Prime Plan

This is an MAPD – Parts C and D – plan that includes medical coverage and prescription drug coverage. As the most basic plan, it has no premium cost above and beyond what you are paying for Medicare Part B coverage already. This is a no co-pay for office visits plan with an annual maximum out-of-pocket cost of $2800 – in-network. The prescription drug coverage that is included has a range from $0 for preferred generics at a preferred pharmacy up to $300 for non-preferred drugs from a mail-order pharmacy.

This plan includes free fitness club membership, $150 per year in eye wear coverage, and also has optional add-on coverage. Although there is no premium for the base plan, adding dental or dental plus hearing aid coverage comes with an additional premium.

The Prime plan is an HMO plan, and as such will require referrals for specialist visits.

Aetna Medicare Select Plan

This plan comes with a relatively small annual premium, and slightly different coverage from Prime. The plan has no deductible and no co-pays for office visits. The out-of-pocket maximum under the Select plan is $5400 based on our sample zip code. It has no deductible for either medical or prescription drugs, and drug coverage carries the same costs as that for Prime.

This plan does not include coverage for eye wear, hearing aids, or dental care. These can be added on as options for an additional premium. Like the Prime Plan, this is an HMO, but appears to have a wider range of available providers.

Aetna Medicare Choice Plan

This is Aetna’s highest-cost plan, and is a PPO, which means the network is expanded and referrals may not be needed to see a specialist. There is no in-network deductible, but a $750 deductible out of network. The in-network maximum out-of-pocket is $6700 with a combined in and out of network total of $10,000.

The Choice plan has a co-pay for office and specialist visits in-network as well as a 40% co-insurance out-of-network. Co-insurance costs apply to most areas of coverage, although in-network preventative care is covered at no cost. This plan offers the same drug coverage as the other two options, but there are no options available for dental, hearing aids, or eye wear.

Part D – Prescription Drug Plans

Aetna offers three levels of Part D coverage. These plans can be purchased separately from the Part C plans.

Aetna Medicare Rx Saver

This is the most affordable plan. It has a $0 deductible for Tier 1 and 2 drugs, but does have a deductible for other Tiers. This plan doesn’t offer gap coverage. Cost for prescriptions on this plan varies based on the drug type, but has costs as low as $1 for preferred generics and as high as a 38% co-insurance on non-preferred drugs.

First Health Part D Value Plus

The mid-range option cost-wise, this plan offers no deductible on any drug Tier, as well as gap coverage on Tier 1 and 2 drugs. Drug costs range from $2 up to 50%.

First Health Part D Premier Plus

This is the most expensive of the options, but does offer a $0 deductible, full gap coverage on Tier 1 and 2 drugs, and partial gap coverage on Tier 4. Drug cost ranges from $1 up to 50% co-insurance, with preferred brand drugs costing less than on the value plan.

Medicare Supplement Insurance

Aetna offers Medicare Supplement Insurance Plans to those who choose to continue their coverage with Original Medicare. These plans are designed to compliment Medicare by providing coverage for those areas that Medicare leaves out. These plans can vary from state to state, and can’t be combined with Medicare Advantage plans.

They can cover things like Part A and B deductibles, Skilled Nursing Facility Coinsurance, and Foreign Travel Emergency coverage.

Aetna’s Medicare Coverage Rates

Medicare Advantage allows those who are Medicare eligible to shop around among a variety of insurance companies in order to select the plan and company that are best for each individual’s needs. As with all insurance purchases, price is one of the most important factors people will take into consideration.

Aetna’s Medicare Prime Plan shows a $0 base premium for coverage, but the enrolled person must continue to make Medicare Part B payments, so there is still a monthly cost associated with the plan. From this basic plan, the rates based on our use of a Los Angeles county, California zip code were $324 for the Select plan and $876 for the Choice plan, both annually. This doesn’t include any optional coverage such as dental.

Using the same location, we returned Part D rates of $385.20, $507.60, and $1448.40 for each of the three tiers of coverage (Rx Saver, Value Plus, and Premier Plus, respectively). These rates are for those seeking drug coverage only, as all Advantage plans from Aetna include Part D drug coverage.

In comparison to many other Medicare plans, Aetna’s are prices higher across the board, in some cases as much as double the rates of other companies. However, it’s interesting to note that in our rate comparisons, Humana had much lower rates. If the merger goes through, rates for both companies may change.

Ratings and Reviews for Aetna

According to Consumer Reports state-by state rankings of Medicare Advantage plans in 2013 (PDF), Aetna ranked at number one in 16 states, while also holding second and third place spots in several other states. In most states Aetna received a level 4 – better than average – customer satisfaction rating. It’s interesting to note, however, that Aetna received a “Best Value” ranking in only one state (Maine).

Most review websites don’t have a separate section for reviews relating specifically to Aetna’s Medicare plans, but some of the reviews found in our research do pertain specifically to Medicare. The main complaints regarding Medicare seem to mirror those of Aetna in general – stating that the company refused coverage.

Consumer Affairs has 632 reviews for Aetna. Of those, 120 left a star-based rating, and 114 were one-star ratings. A look through the reviews reveals similar complaints about poor customer service and coverage being denied on services or treatments that the insured believed were covered by the policy. Denied coverage is one of the most common complaints about insurance companies, particularly health insurance; without more detailed knowledge regarding plan coverage and claims, it’s difficult to say how valid these complaints are.

Pissed Consumer shows a similar one-star average based on 297 reviews. The complaints on this site are very similar to the ones seen on Consumer Affairs.

Aetna’s low star rating on review sites is based on all customers and not only on Medicare services or plans. It’s not out-of-line with reviews for other major health insurance companies. Humana, one of the largest Medicare providers in the private insurance market, also has a one-star average. So does insurance giant United Healthcare.

It’s always important to note that people are far more likely to write a negative review than a positive one; the overall number of negative reviews for Aetna isn’t all that high considering the size of the company.

Bottom Line

Aetna is a huge company, and will become even bigger if the Humana merger is approved, making them a real powerhouse in the Medicare and general health insurance markets. Currently, they don’t offer Medicare Advantage in all states – some states are Part D only, so you may need to consider another company if you’re looking for Part C coverage.

Their options and comparison system are easy to use, and the signup process appears to be straightforward. There are some complaints regarding Aetna’s unwillingness to pay claims, but there’s nothing out of line with a health insurance company of this size; more than 23 million members makes a few hundred complaints fairly minimal.

If you’re looking for a new Medicare plan with Aetna for 2017, you may want to wait to see what happens with the Humana merger. If it does go through it’s likely to have an impact on what plans are available and where coverage is offered; however, if you’re ok with the possibility of change on the horizon, Aetna does offer a selection of straightforward plans with extra options like dental and hearing aid coverage.

You might want to shop around if rates are important to you however, as Aetna’s rates are on the higher side – another thing that might change with the merger.

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

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