What Aetna Medicare is and who offers it

Aetna Medicare is a set of health insurance plans sold by Aetna, a major insurance company owned by CVS Health. Aetna offers Medicare Advantage plans (also called Part C) and Medigap plans (also called Supplement plans) to people age 65 and older who have Original Medicare. These are not government plans — they are private insurance products that work alongside or instead of Original Medicare.

Aetna is one of several large insurers offering Medicare plans. Other major competitors include UnitedHealthcare, Humana, and regional plans in your state. Aetna operates in most states, though the specific plans available and their costs vary by location.

Key Takeaways

  • Aetna offers Medicare Advantage plans that replace Original Medicare and usually include prescription drug coverage, and Medigap plans that work alongside Original Medicare to cover costs it does not pay.
  • Medicare Advantage plans have lower monthly premiums but higher out-of-pocket costs when you use care, while Medigap plans have higher premiums but more predictable costs.
  • You can only enroll in an Aetna Medicare plan during your Initial Enrollment Period (the three months around your 65th birthday) or during the annual Open Enrollment Period (October 15 to December 7).
  • Aetna Medicare plans have networks — you may pay more or cannot use doctors and hospitals outside the network, depending on the plan type.
  • You must have Original Medicare Part A and Part B before you can buy an Aetna Medigap plan, but Medicare Advantage plans replace Original Medicare entirely.

Medicare Advantage plans from Aetna

Aetna Medicare Advantage plans (Part C) replace your Original Medicare coverage. Instead of going to any doctor who accepts Medicare, you choose doctors and hospitals within Aetna's network. Most Aetna Medicare Advantage plans include prescription drug coverage (Part D) built in, so you do not buy a separate drug plan.

These plans typically have lower monthly premiums than Medigap plans — some have zero premium — but you pay more when you actually use care. You will see copays (a fixed dollar amount per visit), coinsurance (a percentage of the cost), and deductibles (an amount you pay before the plan starts paying). Aetna Medicare Advantage plans also have an out-of-pocket maximum, a yearly cap on what you pay. Once you hit that limit, the plan pays 100 percent of covered services for the rest of the year.

Most Aetna Medicare Advantage plans are HMOs (Health Maintenance Organizations) or PPOs (Preferred Provider Organizations). HMOs require you to use in-network doctors and usually require referrals to see specialists. PPOs let you see out-of-network doctors but charge you more. Some Aetna plans also offer dental, vision, or hearing coverage, which Original Medicare does not cover.

Medigap plans from Aetna

Aetna Medigap plans (Supplement plans) work differently. You keep your Original Medicare Part A and Part B, and the Medigap plan pays some of the costs that Medicare does not — like copays, coinsurance, and deductibles. Medigap does not include prescription drug coverage; you buy that separately through a standalone Part D plan.

Medigap plans have higher monthly premiums than Medicare Advantage, but your out-of-pocket costs are more predictable because you know your copays and deductibles upfront. You can see any doctor or hospital in the United States that accepts Medicare — there is no network restriction. This flexibility appeals to people who have established relationships with specific doctors or who travel frequently.

Medigap plans are standardized by the federal government. Aetna offers several of these standard plans (Plan A, Plan B, Plan C, Plan D, Plan G, Plan K, Plan L, Plan M, and Plan N are the most common). The benefits are the same no matter which insurance company sells them — the difference is price. You can compare Aetna's prices against other insurers selling the same plan letter.

How to enroll in an Aetna Medicare plan

You can enroll in an Aetna Medicare plan during two main windows. Your Initial Enrollment Period is the three months before the month you turn 65, the month you turn 65, and the three months after. If you miss this window, you can enroll during the annual Open Enrollment Period, which runs from October 15 to December 7 each year. Plans you enroll in during Open Enrollment start on January 1.

To enroll, you can visit Medicare.gov and search for plans in your area, call Aetna directly at 1-800-MEDICARE (1-800-633-4227) to speak with a representative, or visit an Aetna office in person. You will need your Medicare card and information about your current doctors and prescriptions so you can check whether they are in the Aetna plan's network.

If you enroll outside your Initial Enrollment Period and outside Open Enrollment, you may face a late enrollment penalty — a permanent increase to your monthly premium. The only exceptions are if you have a may have access to life event (like losing employer coverage or moving to a new state) or if you are a current Aetna member switching to a different Aetna plan.

Network and coverage limits

Aetna Medicare Advantage plans have networks, meaning you pay less (or nothing) when you use doctors, hospitals, and pharmacies that are in-network. Using out-of-network providers costs more or may not be covered at all, depending on the plan. Before you enroll, check whether your current doctors and preferred hospital are in the Aetna network for the specific plan you are considering.

Aetna Medigap plans have no network — you can use any doctor or hospital that accepts Medicare. However, some doctors and hospitals may not accept Medigap insurance, so it is still worth calling ahead to confirm they will see you.

All Aetna Medicare plans cover the same core services that Original Medicare covers: hospital stays, doctor visits, and preventive care. The difference is how much you pay and which additional services (like dental or vision) are included. Read the plan's Summary of Benefits and Coverage document before you enroll — this is the official document that lists exactly what is and is not covered.

Costs and how to compare plans

Aetna Medicare plan costs vary widely by location and plan type. Medicare Advantage premiums can range from zero to several hundred dollars per month, and out-of-pocket costs depend on how much care you use. Medigap premiums are typically higher upfront but do not vary based on how much care you use.

To compare Aetna plans against other insurers, use the Medicare Plan Finder tool on Medicare.gov. Enter your ZIP code, current doctors, and prescription medications. The tool shows you all available plans, their premiums, deductibles, copays, and whether your doctors are in-network. You can also call 1-800-MEDICARE to speak with a counselor who can walk you through the comparison.

Do not choose a plan based on premium alone. A plan with a zero premium may have high copays and deductibles. A plan with a higher premium may save you money overall if you use a lot of care. Look at the total estimated cost for the year, including premiums, copays, deductibles, and coinsurance.

When to contact Aetna or your doctor

Contact Aetna if you have questions about what a plan covers, whether a specific doctor is in-network, or how to file a claim. You can reach Aetna customer service through the phone number on your insurance card or by visiting Aetna.com. If you are not yet enrolled, call 1-800-MEDICARE for help comparing plans.

Contact your doctor if you are unsure whether a treatment or test is covered by your plan, or if Aetna denies a claim you believe should be covered. Your doctor's office can often contact Aetna on your behalf to get a prior authorization (approval before you have a procedure) or to appeal a denial.

Seek emergency care when ready if you have chest pain, difficulty breathing, severe bleeding, signs of stroke, or any other life-threatening symptom. All Aetna Medicare plans cover emergency care regardless of whether the hospital is in-network.

Frequently Asked Questions

Can I switch from Aetna Medicare Advantage to Medigap later?

Yes, but timing matters. If you switch within 12 months of first enrolling in Medicare Advantage, you have may provide issue rights — Aetna and other insurers must sell you a Medigap plan without medical underwriting. After 12 months, insurers can deny you or charge more based on your health history. You can switch during Open Enrollment (October 15 to December 7) any year.

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

Aetna Medicare plans are state-specific. If you move, your current plan may not be available in your new state. You can enroll in a new Aetna plan (if available) or a different insurer's plan without penalty because moving is a may have access to life event. Contact Aetna or Medicare.gov to see what plans are available in your new location.

Do I still pay Medicare taxes if I have an Aetna Medicare plan?

No. Once you are enrolled in Medicare, you do not pay Medicare payroll taxes. If you are still working, you and your employer still pay Social Security and other payroll taxes, but not the Medicare portion (2.9 percent combined).

Can I have both an Aetna Medicare Advantage plan and a Medigap plan?

No. You can have either a Medicare Advantage plan or a Medigap plan, but not both at the same time. If you have Medicare Advantage and want to switch to Medigap, you must disenroll from Medicare Advantage first, then enroll in Medigap during Open Enrollment or within 12 months of first enrolling in Medicare.

What if Aetna stops offering my plan?

If Aetna discontinues your plan, you receive notice by October 31 of the year before it ends. You can then enroll in a different Aetna plan or switch to another insurer without penalty. This counts as a may have access to event, so you can enroll outside the normal Open Enrollment Period.