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New to Medicare Plans from Aetna? Here’s What You Need to Know

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According to Aetna’s website, approximately 46 million Medicare beneficiaries have access to plans from Aetna®, including Medicare Advantage. The company was founded in Connecticut in 1853. Aetna is now part of the CVS Health family of companies.

When does my coverage begin?

This depends on when you enrolled in your plan. Many people choose Medicare plans from Aetna during the Initial Enrollment Period, which begins three months before your 65th birthday month, includes the month you turn 65, and extends for three months after. If you sign up in the three months before your birthday, your coverage begins on the first day of the month in which you turn 65.

Do I need to choose a primary care doctor with Medicare plans from Aetna?

Aetna may offer both Medicare Advantage HMO (health maintenance organization) and PPO (preferred provider organization) plans. If you enrolled in one of the HMO Medicare plans from Aetna, you will generally need to choose a primary care physician to oversee your health care. You will need to get all your routine care within your plan’s network, and you may need to get a referral or prior authorization for specialist care.

You can select your primary care physician when you enroll in a plan, or by calling the number on your ID card once you receive it. You can change your primary care physician. Just check the website to see which doctors in your area participate in Medicare plans from Aetna.

If you enrolled in an Aetna Medicare Advantage PPO plan, you generally do not need to choose a primary care physician or get your care from providers within the plan’s network. However, you may save money, out of pocket, if you use the plan’s preferred providers.

Do Medicare plans from Aetna cover my prescription drugs?

After you enroll in one of the Medicare plans from Aetna, you’ll generally receive an introductory letter, your ID cards, evidence of coverage documents, and your plan formulary. The formulary is a list of medications covered by your plan, and how much of a copayment/coinsurance you pay for each. If you have mail order pharmacy benefits, you’ll also get information on how to fill your prescriptions using this service. These documents typically arrive within the first two weeks after you enroll in a plan.

Are dental, hearing, and vision benefits included in Medicare plans from Aetna?

Most Aetna Medicare Advantage plans offer supplemental benefits for routine vision, dental and hearing care. In some cases, you may pay extra for this coverage, and in others, it’s included in your plan. Check your coverage documents to see whether your plan includes these benefits, and what coverage limits apply. You may need to use network providers to access your vision, dental and hearing benefits.

Can I use Medicare plans from Aetna anywhere in the U.S.?

If you enrolled in an Aetna Medicare Advantage HMO, you can generally only use your plan for emergency care outside your plan’s coverage area. If you enrolled in a PPO, you can generally use your plan anywhere where Medicare plans from Aetna are accepted, although you may pay more for your care outside your plan’s provider network.

What other benefits are included in Medicare plans from Aetna?

All Aetna Medicare Advantage plan members have access to the Resources For Living® program, which connects you with services in your community such as meal delivery, caregiver support and help at home.

Most Medicare plans from Aetna also include fitness benefits with SilverSneakers®, which has over 15,000 participating gyms and fitness centers nationwide. You get a basic membership if your plan includes this benefit.

If you have a serious or chronic health condition, you may also qualify for Aetna’s case management and disease management programs to help you stay well and avoid hospitalization. These come at no extra cost.

Some Medicare plans from Aetna also include expanded coverage for certain over-the-counter products such as vitamins and cold medicines, and home meal delivery for a period of time after discharge from the hospital.

To begin searching for Medicare Advantage plans from Aetna, enter your ZIP code on this page.

Aetna Medicare is a PDP, HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.

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