Aetna Insurance Review & Complaints: Medicare (2024)

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Aetna is one of the biggest names in health insurance across the U.S. As of 2020, Aetna stood as the third-largest health insurance company, behind only United Health Group and Anthem based on revenue and enrolled members across their network. Aetna provides individual health insurance, group coverage, as well as Aetna Medicare Advantage and Medicare Supplement plans to more than 23 million people across the country.

This Aetna Medicare review will focus on the company’s Medicare plans, but we have a full Aetna review as well if you need more company information, or are interested in seeing if they can offer you a better rate or a policy that’s better for your family. Read on to learn about Aetna Medicare plans, pricing, and coverage, and to look at Aetna Medicare quotes to see if this provider can help you reduce your out of pocket expenses.

Before you decide to buy Aetna Medicare insurance or any of their services, make sure you have compared your pricing and policy options.

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What is Aetna?

Aetna originally started out as a fire insurance company and was founded in Hartford, Connecticut. The company wrote its first insurance policy in 1819. In 1853, the company shifted course, incorporating as Aetna Life Insurance Company. Diversification began in 1891 with the addition of accident insurance, leading the way for Aetna’s entry into the health insurance market in 1899.

Aetna expanded into the global insurance market in 1960 when they purchased a Canadian life insurance company. The company’s diverse interests took a turn in 1996, when Aetna sold off all of its property and casualty insurance, focusing on the health insurance market and centering their services there; that focus was enhanced by a merger with U.S. Healthcare. By 2000, Aetna was known as solely a health insurance company and was on its way to becoming a giant organization.

The company has been serving the Medicare market since 1966. They were quick to enter the Medicare Advantage market under the Affordable Care Act. A proposed merger with Humana that would have made the combined company a force to be reckoned with in the Medicare industry was killed in the courts in 2017. The merger did not stop Aetna from adding 250,000 Medicare members in the first quarter of 2018 alone and moving up the list of biggest Medicare providers in the country.

Aetna’s merger with CVS Health, which was concluded in 2018, does still have an impact on Medicare, according to a Kaiser Foundation study. The merger makes Aetna and CVS Health a force to be reckoned with in health care.

Aetna Medicare Advantage and Aetna Medicare Supplement plans are available in most states, although not all. Health plans are sold directly through the company website. Aetna Medicare provider phone numbers can be found through a search.

Read more:

• Aetna Final Expense Insurance: Complete Guide & Review
• Aetna Insurance Review & Complaints: Health Insurance

What types of insurance plans are offered?

Not surprisingly, Aetna has a full range of Medicare products available: Advantage, Part D, and Supplement. The availability of insurance plans varies from state to state; we used a Southern California zip code as our sample for the purpose of this health insurance coverage review.

Aetna Medicare Advantage Plans

There are five Aetna Medicare Advantage plans for 2021 in our sample area, and all but one include prescription drug coverage. There are three HMO plans, all of which are zero-premium, and one PPO plan. All of the plans have a $0 deductible, which means that cost is not going to be a barrier if you need oa policy.

Medicare Plus is the first HMO plan. Copays for primary care and specialists are both $0. There is likewise no copay for hospital stays. Prescriptions have no deductible and generic drugs are $0. Vision, hearing, and dental insurance are included.

Medicare Select is the next HMO plan. It has $0 copays for either office visits or specialists and a no hospital copay either. Hearing, vision, and dental insurance are also included in this plan.

Like all of the plans, Select includes prescription drug coverage. Tier 1 drugs have a $0 copay, Tier 2 a $5 copay. Tiers 3 and 4 have a $42 and $100 copay respectively, while Tier 5 is covered with a 33% coinsurance.

Medicare Prime is also an HMO plan and is again a $0 premium plan. This plan has similar copay amounts, with no charge for office visits or specialists, but has a lower out of pocket costs maximum. It also has a $0 copay for hospital stays. Fees under the plan are lower in many areas, although prescription drug coverage is the same as the Select plan.

Prime does include limited coverage for hearing, dental, and vision. There is no premium for these services. The main difference between these plans is the out-of-pocket maximum.

Medicare Choice is the only Aetna Medicare Advantage PPO plan among the offerings. Because of the much wider selection of providers offered by a PPO, this plan does have a monthly premium. Since patients can benefit from a larger provider network, the cost is to be expected. Primary care visits have a $10 copay, and specialist visits have a $40 copay. Hospital stays have a $225 copay for the first five days, $0 thereafter.

Prescription coverage on this plan is the same as that offered on the HMO plans. This plan includes a prescription eyewear benefit, but dental and hearing coverage are optional and can be added for an additional premium.

The Medicare Eagle plan is the only plan that doesn’t include Part D. It is also a $0 deductible plan, and is an HMO plan.

Aetna Medicare special needs plans (SNP) are available in some states.

Aetna Medicare Part D (Prescription Drug) Plans

In our sample area, there are three Silverscript Part D plans available. All of the plans have $0 deductibles for Tier 1 & 2 drugs.

SmartRx, the lowest-priced plan, has a $445 deductible for Tiers 3, 4, and 5. Copays start at $0 for Tier 1 and $3 for Tier 2, going up from there. There is a $5,000 out-of-pocket maximum with this plan.

Choice has a $250 deductible on Tiers 3, 4, and 5. The Tier 1 copay is $1, Tier 2 is $2, and increase from there, although most copays are lower than with the Select plan. Again, out of pocket maximum is $5,000.

The final plan, Plus, has no insurance deductible at any level. Again, Tier 1 and 2 drugs have copays of $1, and $2 respectively, but the other copays are more in line with the higher rates on the Select plan. Again, the out of pocket limit is $5,000 with this plan.

All of these plans can be purchased to complement a regular Medicare plan, but not one of Aetna’s Advantage plans. All Advantage plans already include Part D except the Eagle plan.

What Aetna Medicare Supplement Plans Are Available?

In our sample area, Aetna offers several of the standardized Medicare Supplement plan options. These can be purchased instead of an Advantage plan to fill in some of the gaps in coverage.

Like all companies, they start at the base level Plan A, which covers the coinsurance cost for medical, hospital, and hospice, along with the first three pints of blood each year.

Additional plans available are Plan B, Plan F, Plan G, and Plan N. F, which offers the most comprehensive coverage of all the standard plans, is available as a high deductible plan in some areas.

Does the health insurance provider offer competitive rates?

As noted, the two HMO Medicare plans from Aetna are $0 premium – this means you do not pay an additional amount beyond your regular Medicare premium. The PPO plan has a monthly premium of $89.

The Aetna site does not offer rates for Aetna Medicare Supplement plans at this time.

Overall, Aetna’s Medicare Advantage plans are well priced for the coverage they provide. The company seems to have made adjustments to rates since the last time we reviewed them; all rates appear to be a flat monthly amount, which makes shopping for Medicare insurance a lot easier.

Understanding the Claims Procedure at Aetna Insurance

Ease of Filing a Claim

Aetna offers multiple convenient options for filing insurance claims, making it easy for policyholders to submit their claims. You can file a claim online through their website, over the phone by contacting their customer service, or even through their mobile app. This flexibility ensures that policyholders can choose the method that best suits their preferences and needs.

Average Claim Processing Time

Aetna is known for its efficient claims processing system. On average, the company processes claims in a timely manner, ensuring that policyholders receive their payouts promptly. The exact processing time may vary depending on the complexity of the claim, but Aetna strives to provide quick and efficient service to its customers.

Customer Feedback on Claim Resolutions and Payouts

Customer feedback is a valuable indicator of an insurance company’s performance in handling claims. Aetna has received positive feedback from many policyholders regarding their claim resolutions and payouts.

Customers appreciate the company’s commitment to addressing their needs and providing fair and timely settlements. This positive feedback reflects Aetna’s dedication to customer satisfaction in the claims process.

Aetna Insurance Digital Features: Embracing Technological Solutions

Mobile App Features and Functionality

Aetna offers a user-friendly mobile app that provides policyholders with easy access to their insurance information and a range of useful features. The app allows users to view their policy details, track claims, find healthcare providers, and even access telemedicine services. Its intuitive design and functionality make managing insurance on the go convenient and hassle-free.

Online Account Management Capabilities

Aetna’s online account management portal offers policyholders a comprehensive platform for managing their insurance policies. Users can log in to their accounts to review policy documents, update personal information, make premium payments, and track claim statuses.

The portal is designed to streamline the insurance management process and empower policyholders with self-service options.

Digital Tools and Resources

In addition to its mobile app and online account management portal, Aetna provides policyholders with a range of digital tools and resources to support their healthcare and insurance needs. These resources may include educational materials, cost estimators, health and wellness information, and tools to find in-network healthcare providers.

Aetna’s commitment to leveraging technology enhances the overall customer experience and empowers policyholders to make informed decisions about their healthcare.

Are the ratings and consumer reviews positive?

Medicare star ratings vary by state, but the overall rating for 2021 is 4 out of 5 stars.

The National Committee for Quality Assurance rates Aetna solidly across all states for Medicare, with a 4.5 rating across the board. Although the underlying ratings in each state vary, there is not one state where they offer coverage that ranked any lower. That is a very positive sign for Aetna.

The Better Business Bureau (BBB) gives Aetna, Inc. an A+ rating. There is a total of 568 customer complaints on file in the past three years. Given that those customer complaints cover all of Aetna’s approximately 23 million policyholders in all areas of health insurance, that is a really low complaint volume. Only 177 of those customer service complaints were closed in the past 12 months.

Consumer Affairs has 789 reviews of the health insurer, with an overall 1.5-star rating. That rating is based only on the 106 ratings by policyholders submitted in the past year. Bearing in mind again the size of this company, and the fact that these ratings apply to all of the company’s insurance products and not only Medicare, those numbers are again quite low.

What are the pros and cons?

Let’s break it down into a short list of pros and cons to help you make a decision.

Pros

• A large company that is financially stable with a strong financial rating
• Several $0 premium health insurance plans to choose from
• All Aetna Medicare Advantage plans include hearing, vision insurance, and dental coverage

Cons

• All of the $0 premium plans are HMO, and there is only one PPO option
• Not all of the company’s ratings are as high as we’d like

Aetna Medicare: What’s the bottom line?

With the acquisition by pharmacy giant CVS complete, we have not seen much change in the way Medicare plans are handled. As of the time of this review, Aetna has some good plans at good prices and appears to have a pretty good reputation as well. Those in the market for Medicare coverage will find their approach straightforward and their options affordable and easy to choose from.

If you have found an affordable Aetna Medicare plan, that’s great news. But make sure it’s really the best deal before you buy.

Get free Medicare quotes right now.