What Aetna Medicare Plans Are and How They Work

Aetna Medicare is a set of health insurance plans sold by Aetna (now part of CVS Health) specifically for people aged 65 and older. Aetna offers three main types: Original Medicare supplement plans (called Medigap), Medicare Advantage plans (Part C), and prescription drug plans (Part D). You do not get these plans automatically — you choose them during your enrollment period and pay a monthly premium to Aetna, separate from any Medicare premium you owe to the federal government.

The key difference between Aetna's offerings: Medigap plans fill gaps in Original Medicare (like copays and coinsurance), Medicare Advantage plans replace Original Medicare entirely and usually bundle prescription coverage, and Part D plans cover only medications. Which one makes sense depends on your health, your doctors, and what you can afford to pay out of pocket.

Aetna operates in most states, but not all plans are available everywhere. Availability also changes year to year. Before you decide, you need to check whether Aetna offers the type of plan you want in your zip code and whether your doctors are in their network.

Key Takeaways

  • Aetna Medicare plans come in three types — Medigap supplements, Medicare Advantage, and prescription drug coverage — and you must choose which one fits your situation.
  • Not all Aetna plans are available in every state or zip code, so you must verify coverage in your area before comparing costs.
  • Medicare Advantage plans lock you into Aetna's doctor and hospital network, while Medigap plans work with any provider who accepts Medicare.
  • You can change Aetna plans or switch to a different company during the annual enrollment period (October 15 to December 7) or if you have a may have access to life event.
  • Aetna's plan costs, coverage details, and formularies (drug lists) change every January, so you should review your plan each fall even if you have been with Aetna for years.

Aetna Medicare Advantage vs. Medigap: Which Type Fits Your Needs

If you choose an Aetna Medicare Advantage plan, you are replacing Original Medicare with Aetna's managed care network. You pay a monthly premium (sometimes zero), but you must use Aetna doctors and hospitals except in emergencies. These plans usually include prescription drug coverage built in. Out-of-pocket costs are typically capped — Aetna sets a yearly maximum you will not exceed — but you may pay more per visit than you would with Medigap.

If you choose an Aetna Medigap plan, you keep Original Medicare and Aetna covers the costs Medicare does not — deductibles, copays, and coinsurance. You can see any doctor or hospital in the country that takes Medicare. You pay Aetna a monthly premium on top of your Medicare Part B premium. Prescription drugs are not covered by Medigap, so you would need to buy a separate Part D plan (which Aetna also sells).

Medicare Advantage works best if you are healthy, use doctors within a network, and want predictable costs. Medigap works best if you have chronic conditions, see many specialists, or travel and want to use any provider. Neither is objectively better — it depends on your health and habits.

How to Check if Aetna Plans Are Available in Your Area

Aetna's website has a plan finder tool where you enter your zip code and see which plans are offered where you live. You can also call Aetna directly at 1-800-MEDICARE (1-800-633-4227) — this is the federal Medicare line, and they can tell you which private insurers, including Aetna, serve your area.

Do not assume a plan you saw last year is still available. Aetna adds and removes plans every year, and some zip codes lose coverage entirely. Check availability in the fall (September or October) before the annual enrollment period starts on October 15.

When you find plans available to you, also verify that your current doctors are in Aetna's network. If you use Medicare Advantage, being out of network means higher costs or no coverage. Aetna publishes provider directories on its website, or you can call your doctor's office and ask directly whether they accept Aetna Medicare.

Aetna Plan Costs: Premiums, Deductibles, and Out-of-Pocket Limits

Aetna Medicare Advantage plans often have a zero monthly premium, but that does not mean they are free. You still owe your Part B premium to Medicare, and you will pay copays or coinsurance when you use care. Aetna sets an annual out-of-pocket maximum — once you hit that number, Aetna covers the rest of your care for the year. This maximum varies by plan and changes every January.

Aetna Medigap plans charge a monthly premium that varies by age, location, and which Medigap plan letter you choose (Plan A, B, C, and so on). Medigap premiums are usually higher than Medicare Advantage premiums, but you have no copays or deductibles — Medigap covers the gaps. You still owe your Part B premium to Medicare separately.

Aetna Part D plans (prescription drug coverage) have a monthly premium, an annual deductible, and copays for each drug. The cost depends on which drugs you take — Aetna publishes a formulary (the list of covered drugs) for each plan, and drugs are sorted into tiers with different copay amounts.

All Aetna plan costs change on January 1 each year. Even if you have been with Aetna for years, review the new rates and coverage in October so you can switch if costs have risen too much.

When You Can Switch to or From Aetna Medicare

The main enrollment window is the annual enrollment period, which runs from October 15 to December 7 each year. During this time, you can switch from Original Medicare to an Aetna Medicare Advantage plan, from Aetna to another company, or between different Aetna plans. Changes take effect on January 1.

You can also switch outside the annual period if you have a may have access to life event: you move out of your plan's service area, you lose other health coverage, you become may be able to access for Medicaid, or certain other circumstances. You have 60 days from the event to make a change. Contact Aetna or Medicare to report the event and confirm you are may be able to access to switch.

If you are new to Medicare (you just turned 65 or became may be able to access due to disability), you have a special enrollment period of up to three months to choose a plan. Do not miss this window — if you do not choose a plan, you may be automatically enrolled in Original Medicare, and you could face a late-enrollment penalty if you join a private plan later.

How to Compare Aetna Plans With Other Medicare Insurance Companies

The Medicare Plan Finder tool (available at Medicare.gov) lets you enter your zip code, your doctors, and your medications, and it shows you all available plans from all companies, including Aetna. The tool estimates your out-of-pocket costs for each plan based on your actual health needs, not just the premium.

When you compare, look at three things: whether your doctors are in-network, what your total yearly cost would be (premium plus copays plus deductibles), and whether the plan covers your medications at a cost you can afford. A plan with a low premium but high copays might cost more overall than a plan with a higher premium.

You can also request a printed comparison from Medicare or call 1-800-MEDICARE to speak with someone who can walk you through the options. This service is free and not affiliated with any insurance company.

Common Mistakes When Choosing an Aetna Medicare Plan

The biggest mistake is choosing based on premium alone. A zero-premium Medicare Advantage plan sounds free, but if your doctors are out of network or your medications are not covered, you will pay far more in copays and deductibles. Always check network and formulary first, then look at total cost.

Another common error is not reviewing your plan every year. Aetna changes networks, formularies, and costs every January. A plan that worked well last year might no longer cover your doctor or might have raised copays significantly. Set a reminder in September or October to review your coverage and compare other options.

People also sometimes enroll in a Medicare Advantage plan without realizing they are locked into Aetna's network. If you travel frequently or see specialists outside the network, Medigap may be a better fit, even though the premium is higher. Understand what you are choosing before you enroll.

Frequently Asked Questions

Can I switch from Aetna Medicare Advantage to Medigap mid-year?

No, not unless you have a may have access to life event (you move, lose coverage, or become may be able to access for Medicaid). Otherwise, you must wait for the annual enrollment period in October to switch. If you are unhappy with your plan, document the reason — it may may have access to as a life event.

Does Aetna Medicare cover dental and vision?

Some Aetna Medicare Advantage plans include dental and vision coverage, but not all. Medigap plans do not cover dental or vision. Check the specific plan details on Aetna's website or in the plan's summary of benefits. If dental and vision matter to you, make sure the plan you choose includes them.

What happens to my Aetna Medicare plan if I move to a different state?

If you move out of your plan's service area, you have a 60-day special enrollment period to switch to a different plan. Aetna may not offer plans in your new state, so you will likely need to choose a different company. Contact Aetna or Medicare as soon as you know you are moving so you can find a new plan before your current one ends.

Do I need a referral to see a specialist with Aetna Medicare Advantage?

It depends on the specific plan. Some Aetna Medicare Advantage plans require a referral from your primary care doctor; others do not. Check your plan documents or call Aetna to confirm. Medigap plans do not require referrals.

Can I have both Aetna Medicare Advantage and Medigap at the same time?

No. You can have either Medicare Advantage or Original Medicare with Medigap, but not both. If you enroll in Medicare Advantage, your Medigap coverage ends. If you switch back to Original Medicare, you can enroll in Medigap again, though you may not get the same rates you had before.