Aetna Medicare is a private insurance company offering Medicare Advantage and Medicare Supplement plans

Aetna is one of several private insurers contracted by Medicare to offer Medicare Advantage plans (also called Part C) and Medigap policies (also called Medicare Supplement plans). These are not government programs — they are insurance products sold by Aetna that work alongside or instead of Original Medicare. Aetna operates in most states, though which specific plans are available depends on where you live.

If you choose an Aetna plan, you are still enrolled in Medicare, but Aetna becomes your primary insurer. You pay Aetna a monthly premium (in addition to your Medicare Part B premium), and Aetna handles claims and manages your coverage. Understanding what Aetna offers and how it differs from Original Medicare helps you decide whether an Aetna plan fits your needs.

Key Takeaways

  • Aetna offers Medicare Advantage plans that bundle hospital, medical, and prescription drug coverage, usually with lower premiums than Medigap but with network restrictions and out-of-pocket limits.
  • Aetna also sells Medigap policies that work alongside Original Medicare to cover costs that Medicare does not pay, with no network restrictions but higher monthly premiums.
  • Which Aetna plans are available in your area changes yearly, and you can switch plans during the Annual Enrollment Period (October 15 to December 7) or if you may have access to for a Special Enrollment Period.
  • You must be enrolled in Medicare Part A and Part B before you can join an Aetna Medicare plan.
  • Aetna plans have different deductibles, copays, and out-of-pocket limits depending on which plan you choose.

How Aetna Medicare Advantage plans work

An Aetna Medicare Advantage plan is an all-in-one alternative to Original Medicare. It covers hospital care (Part A), doctor visits and outpatient care (Part B), and usually prescription drugs (Part D) — all through Aetna. Most Aetna Medicare Advantage plans are Health Maintenance Organization (HMO) or Preferred Provider Organization (PPO) plans, which means you must use doctors and hospitals in Aetna's network to receive full coverage.

When you use an in-network provider, you pay a copay (a fixed amount like $20 for a doctor visit) or coinsurance (a percentage of the cost). If you go out of network, you pay more or sometimes the full cost. Aetna Medicare Advantage plans have an out-of-pocket maximum — once you spend that amount in a year, Aetna covers the rest of your care at no cost. This protects you from very high medical bills, unlike Original Medicare.

Most Aetna Medicare Advantage plans charge a low or zero monthly premium beyond your Medicare Part B premium, which makes them attractive to people on a fixed income. However, you typically pay more per visit than you would with Original Medicare plus Medigap. Aetna Medicare Advantage plans also require you to choose a primary care doctor who coordinates your care and provides referrals to specialists.

How Aetna Medigap policies work

An Aetna Medigap (Medicare Supplement) policy is insurance that works alongside Original Medicare, not instead of it. You keep your Original Medicare coverage and pay Aetna a separate monthly premium for the Medigap policy. The policy then covers some or all of the costs that Original Medicare does not — such as deductibles, copays, and coinsurance.

Medigap policies are standardized by the federal government, meaning all insurers (including Aetna) offer the same coverage levels, labeled Plan A through Plan N. The only difference between Aetna's Plan G and another company's Plan G is the monthly premium. Aetna Medigap policies have no network restrictions — you can see any doctor or hospital that accepts Medicare, anywhere in the country.

Medigap premiums are higher than Medicare Advantage premiums, sometimes $100 to $300 per month depending on the plan and your age. However, you have more flexibility in choosing providers and typically lower out-of-pocket costs per visit. Medigap does not cover prescription drugs, so if you choose a Medigap policy, you must also enroll in a separate Medicare Part D prescription drug plan (which may or may not be through Aetna).

Aetna Medicare plan availability and enrollment

Aetna offers different Medicare plans in different parts of the country. You can see which Aetna plans are available in your zip code by visiting Medicare.gov, calling 1-800-MEDICARE, or contacting Aetna directly. Plan availability changes every year, and the plans offered in your area may be different from those offered in a neighboring county.

You can enroll in an Aetna Medicare plan during the Annual Enrollment Period, which runs from October 15 to December 7 each year. Coverage begins January 1 of the following year. If you miss this window, you may still be able to enroll if you may have access to for a Special Enrollment Period — for example, if you recently moved, lost employer coverage, or have Medicaid.

When you first become may be able to access for Medicare (usually at age 65), you have a seven-month window called your Initial Enrollment Period to join an Aetna plan without penalty. If you delay enrollment past this window, you may owe a late enrollment penalty for as long as you have Medicare.

Costs: premiums, deductibles, and out-of-pocket limits

Aetna Medicare Advantage plan costs vary by plan and location. Most plans have a monthly premium (sometimes $0), an annual deductible (the amount you pay before coverage begins), copays for specific services, and an out-of-pocket maximum (the most you pay in a year). For example, one Aetna HMO plan might have a $0 premium, a $200 deductible, a $20 copay for doctor visits, and a $6,700 out-of-pocket maximum.

Aetna Medigap plans have only a monthly premium — there are no deductibles, copays, or out-of-pocket limits. However, the premium is usually higher. Plan G, for example, might cost $150 to $250 per month depending on your age and where you live. You still pay your Original Medicare deductible for Part B ($240 in 2024, though this amount changes yearly).

All costs change yearly. Aetna sends you a notice in the fall showing your plan's costs for the next year. Review this notice carefully, because a plan that was affordable one year may become more expensive the next, or your doctors may leave the network.

Network restrictions and provider choice

Most Aetna Medicare Advantage plans restrict you to in-network providers. If you see an out-of-network doctor without a referral, you pay a higher copay or coinsurance, or Aetna may not cover the visit at all. Some Aetna PPO plans allow out-of-network care at a higher cost, but HMO plans typically do not.

Before you enroll in an Aetna Medicare Advantage plan, check whether your current doctors are in the network. Aetna publishes a provider directory on its website or in a printed book you can request. Call your doctor's office to confirm they accept the specific Aetna plan you are considering — doctors may accept some Aetna plans but not others.

If you have a strong preference for specific doctors or hospitals, or if you travel frequently and want to see different providers in different places, a Medigap policy may be a better fit than a Medicare Advantage plan. Medigap has no network, so you can see any Medicare-accepting provider.

Prescription drug coverage through Aetna

Most Aetna Medicare Advantage plans include prescription drug coverage (Part D). The plan covers a list of approved medications called a formulary. Some drugs are covered at a lower cost, others at a higher cost, and some may not be covered at all. You may need prior authorization from Aetna before filling certain prescriptions, or your doctor may need to request an exception if a drug is not on the formulary.

If you choose an Aetna Medigap policy, you must enroll in a separate Medicare Part D prescription drug plan. This can be through Aetna or another insurer. Part D plans also have formularies and coverage rules. During the Annual Enrollment Period, review your current medications against the formulary of any plan you are considering, because formularies change yearly and your drugs may move to a higher cost tier or be removed entirely.

Frequently Asked Questions

Can I switch from Aetna Medicare Advantage to Medigap?

Yes, but timing matters. If you switch during the Annual Enrollment Period (October 15 to December 7), you can enroll in a Medigap policy with no waiting period. If you switch at other times, some Aetna Medigap policies may require you to answer health questions or may deny coverage for pre-existing conditions. Your best protection is to switch during the Annual Enrollment Period.

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

Your current Aetna plan may not be available in your new state. You have a Special Enrollment Period of 60 days after you move to enroll in a new plan. Contact Aetna or visit Medicare.gov to see which plans are available in your new location. If you do not enroll during this window, you must wait until the next Annual Enrollment Period.

Do I still pay my Medicare Part B premium if I have an Aetna plan?

Yes. Whether you choose Aetna Medicare Advantage or Medigap, you must continue paying your Medicare Part B premium (deducted from your Social Security check or paid directly to Medicare). The Aetna plan premium is separate and in addition to this.

What if my Aetna doctor leaves the network?

Aetna must give you notice and allow you to switch to a different plan or to Original Medicare without penalty. You have at least 30 days to make this change. Contact Aetna when ready if your doctor leaves the network, because waiting may limit your options.

How do I compare Aetna plans to other insurers' plans?

Visit Medicare.gov and use the Plan Finder tool. Enter your zip code, current doctors, and medications, and the tool shows you all available plans side by side, including costs, coverage, and provider networks. This is the fastest way to see how Aetna plans compare to plans from other insurers in your area.