Medicare Aetna is a Medicare Advantage Plan
Yes, Medicare Aetna is a Medicare Advantage Plan, which is an alternative to traditional Medicare offered by private insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS). 1
What is a Medicare Advantage Plan?
Medicare Advantage plans (also known as Medicare Part C) are offered by private insurance companies like Aetna that contract with Medicare to provide all Medicare Part A and Part B benefits. These plans:
- Are administered by private insurance companies rather than the federal government
- Must cover all services that Original Medicare covers
- Often include additional benefits not covered by traditional Medicare, such as:
- Prescription drug coverage (Medicare Part D)
- Dental benefits
- Vision services
- Hearing services 2
How Medicare Advantage Plans Differ from Traditional Medicare
Coverage Structure
- Traditional Medicare consists of Part A (hospital insurance) and Part B (medical insurance), with optional Part D (prescription drug coverage) purchased separately
- Medicare Advantage plans combine Parts A and B, and typically include Part D, in a single plan 1
Supplemental Benefits
Medicare Advantage plans like Aetna's often include supplemental benefits not covered by traditional Medicare:
- Vision coverage is offered in approximately 71% of Medicare Advantage plans
- Hearing services are covered in about 56% of plans
- Dental benefits are available in roughly 41% of plans 2
However, the comprehensiveness of these benefits varies significantly. A recent study found that while beneficiaries could choose from an average of 34.9 plans offering some dental benefit, only 1.7 plans per county offered comprehensive dental coverage, with just 39.9% of counties having at least one comprehensive dental plan available 3.
Cost Structure
- Traditional Medicare has standardized deductibles and coinsurance
- Medicare Advantage plans like Aetna's may have different:
- Monthly premiums (sometimes as low as $0)
- Deductibles
- Copayments
- Out-of-pocket maximums 1
Provider Networks
- Traditional Medicare allows you to see any provider who accepts Medicare
- Medicare Advantage plans typically use provider networks (HMO or PPO models)
Financial Considerations for Medicare Advantage Plans
Medicare Advantage plans receive payments from CMS based on a benchmark system:
- Plans bid against benchmarks set by CMS
- The difference between the bid and benchmark determines funds available for extra benefits or reduced premiums
- Changes to benchmarks directly affect plan generosity - a $1,000 decrease in benchmarks would lead to approximately $60 increases in annual premiums and $27 increases in annual deductibles 4
Access and Equity Considerations
Despite offering supplemental benefits, there are concerns about access to care in Medicare Advantage plans:
- Low-income beneficiaries are more likely to report unmet dental, vision, and hearing needs due to cost, regardless of plan benefit generosity 5
- Enrollment in higher-rated plans is associated with lower dental unmet needs
- Income-related disparities in dental unmet needs are lower in the highest-rated plans 5
Important Considerations When Choosing Between Traditional Medicare and Medicare Advantage
When deciding between traditional Medicare and a Medicare Advantage plan like Aetna's, consider:
- Provider networks and whether your preferred doctors participate
- Specific supplemental benefits offered and their comprehensiveness
- Out-of-pocket costs including premiums, deductibles, and copayments
- Prescription drug coverage and formulary
- Plan ratings and quality scores, which may correlate with better access to care 5
Medicare Advantage plans like Aetna's represent a significant portion of Medicare coverage, with enrollment particularly high among low-income beneficiaries who may not have the means to purchase stand-alone supplemental insurance in traditional Medicare 2.