Aetna Benefits Mastercard Prepaid Card is the members’ option for healthcare. To conveniently pay the copayment account, they can simply swipe their card. To learn more about Aetna Whole Health, read this article.
The fourth-largest provider of Aetna Medicare Advantage plans in 2022 will be Aetna. Since it became a CVS Health firm in 2018, it has offered a wide range of benefits, including dental, Aetna vision, and hearing coverage, as well as numerous plans with extra (and beneficial) extras.
- Make sure that the participant only uses the card benefits for a personal contribution.
- The Aetna Resources For Living ® program helps address loneliness and other social needs by connecting users to key community resources, such as transportation, housing, food programs, caregiver support, and utilities, based on individuals’ needs.
- SilverSneakers ® fitness memberships are available at no additional cost to all individual Aetna MA members.
About Aetna, Part Of The CVS Health Family
Aetna Inc is one of the nation’s largest diversified health and wellness companies, American Medical Association, providing information and resources to approximately 37.3 million people to help them make more informed decisions about their health care.
It offers medical, pharmacy, dental, behavioral health, group life, and disability plans, as well as medical management capabilities, Medicaid health care management services, and health information technology services.
Clients include employer groups, individuals, students, part-time and hourly workers, health plans, healthcare providers, government units, government-sponsored plans, labor groups, and expatriates.
This is a brand name used for products and services offered by one or more Aetna group companies, including Aetna Life Insurance Company and its subsidiaries. Exclusions and restrictions apply to care allowance and health insurance.
Founded in 1853 in Hartford, Connecticut, the insurer became a subsidiary of CVS Health Corp. in 2018. Hartford is the company’s headquarters.
Medical, dental and pharmacy plans are available through Aetna. It offers Medicare Advantage plans (MAp), Medicare prescription drugs, and Medicare supplement insurance plans to individuals and groups. It will cover 10.6 million Medicare beneficiaries in the United States as of October 2022, including more than 3.2 million in Aetna MA plans and 6.1 million in standalone prescription drugs.
How does the Aetna Benefits Mastercard Prepaid Card work?
Beginning January 1, the card will be upgraded every quarter by $100. Members can use it to pay in-network copays when visiting a general practitioner (PCP), specialty office, and offices that provide certain other types of services.
If your branch accepts Mastercard® pre-paid , the participant can use it as a debit card (with or without PIN code) to pay his own amount. The member can pay the full amount in this way. Or, if your industry allows the use of more than one payment method, the participant can choose to pay part of the amount and use a different payment method for the rest of the amount.
What if the member forgets to bring their card or it doesn’t have enough money?
The member must pay the co-payment in another way and then request a manual refund. Or, if the member knows their balance, your affiliate can do a split payment where the member can pay part of the amount with the cards and use another payment method for the rest of the amount.
What if it doesn’t work or is rejected?
- Make sure that the participant only uses the card benefits for a personal contribution.
- The card is not activated. The member can activate his card by calling the number on his activation sticker. That number is 1-877-261-9951 (TTY: 711).
- The cost may not be eligible under the plan. The member should consult its Explanation of Coverage (EOC) document.
- Member must not be part of an eligible subscription. Eligible plans are Keystone Market Plans H3959-001, H3959-002, H3959-010, H3959-011, H3959-037, H3959-041, H3959-047, H3959-051, H3959-053, H5521-261, and H5522- 018 .
Aetna Medicare Advantage Service Pros And Cons
For 2022, Aetna added 83 new counties across the country, providing an additional 1 million additional Medicare beneficiaries with access to an Aetna plan. Aetna’s Medicare Advantage service offerings have pros and cons.
- Multiple Benefits: In addition to dental, vision, and hearing, many plans give Aetna beneficiaries access to benefits card, such as over-the-counter benefits, meal delivery services, and home visits.
- Strong $0 premium offering: By 2023, Aetna estimates that 84 percent of eligible beneficiaries in the US will have access to a $0 per month Aetna MA subscription.
- Wide Availability: Aetna offers an MA plan in 46 states and Washington, DC, as well as a standalone drug plan in all 50 states plus Washington, DC
- Drug Savings: All Aetna MA drugs have a $0 deductible for all Tier 1 drugs, and almost all of them offer a $0 copay for Tier 1 drugs. Aetna’s most popular formulary also moves nearly 300 drugs to less expensive levels.
- Average Star Ratings: The Centers for Medicare & Medicaid Services (CMS) gives Aetna’s 2023 Medicare Advantage coverage an average weighted rating of 3.67 out of 5 stars.
- Moderate member love: When it comes to member satisfaction, JD Power found that Aetna® Medicare Advantage scored 796 out of 1,000 points, below the industry average of 809.
Available Medicare Advantage Plans
Aetna offers different types, and they vary in structure, cost and benefit. Most subscriptions offer dental, vision and hearing benefits, as well as fitness benefits through SilverSneakers.
Generally, Aetna gives Medicare Advantage – Prescription Drugs or MAPDs, as well as standalone and MA plans with no drug coverage. The company has expanded this plan for veterans – the Aetna Medicare Eagle plan will cover 42 states by 2023.
The plan is intended to supplement the health insurance that veterans receive from the VA. The plans are designed with veterans to supplement their VA health care coverage and provide access to key benefits for this population
Aetna will also introduce the Longevity Plan in Pennsylvania in 2023. This is an Institutional Special Needs Plan designed for members living in nursing homes. Availability of subscriptions may vary by province. Other subscriptions can include the following types:
A health maintenance organization, or HMO, generally requires you to tap into a specific network of doctors and hospitals. You may need a referral from your GP to see a specialist, and out-of-network benefits are usually limited.
HMO POS Subscriptions
HMO point-of-service plans give you a little more flexibility than traditional HMO. While you have a primary care physician and may still need a referral, you have more freedom to see out-of-network providers, although you will pay more for out-of-network care.
Preferred Provider Organization, or PPO, offers the most freedom, so you see every provider that accepts the insurance. You may not need to choose a primary doctor and you don’t need referrals to see specialists. You can seek out-of-network care, although this may cost more than visiting an in-network doctor.
If you have Medicare and Medicaid and live in one of the 30 states, you may qualify for a Dual-Eligible Special Needs Plan, or D-SNP.
These plans combine hospital, doctor, and drug coverage with additional benefits such as a care coordinator to help you manage medical visits, a social worker to connect you with local and state programs, and an attorney to help you gain access to your state benefits.
Medicare Prescription Drugs
Aetna’s standalone prescription drug (PDP) services serve 5.7 million Medicare members. In 2022, Aetna Medicare will offer the same three separate standalone PDPs as in 2021. SilverScript SmartRx (PDP), with an average monthly premium of $7.08, will again be the cheapest Aetna plan available from Aetna.
SilverScript Choice (PDP) falls below CMS benchmark pricing in 49 states and DC, while SilverScript Healthy Benefits Plus has the most robust drug coverage. All three plans are available in all 50 states and DC and have lower Tier 1 and Tier 2 copays at favorite pharmacies. 3
Medicare Supplement Plans
With more than 1.2 million members, the discounted individual Medicare Supplement plan uses a simplified underwriting process. They also offer popular dental, vision, and hearing products in 37 states. The additional plan options cover 45 states and can provide users with lifetime coverage, benefits paid directly to them after a cancer diagnosis, or for hospital stays, and recovery care at home or in a trained nursing facility.
Aetna Medicare Advantage provides most users with access to routine vision, dental, and hearing coverage. Many of them are not available in other MAp. Here are a few notable things:
Fitness: Many plans include SilverSneakers, which provide access to participating gyms, community centers, online fitness classes, healthy living discounts, and a fitness app.
Home Health Visits: Some beneficiaries may request an in-person home health visit or telehealth for added convenience.
Concierge Services for Local Resources: Aetna’s Resources for Living program can help beneficiaries find the support they need, whether that’s home help, care resources, or help finding local activities.
Over-the-counter: Some plans include an OTC benefit that lets you pick up certain items, such as vitamins and cold medicines, at participating drugstores (or online) at no additional cost.
Meals at home: After you’re hospitalized, some plans will provide you with healthy meals to help you recover.
Telehealth: All 2023 plans offer virtual visits for primary care, urgent care, and specialty care, as well as mental health services. Telehealth is also available for physical, occupational, and speech therapy, substance abuse treatment, kidney disease education, and diabetes self-management training.
Extras With Limited Space
Aetna MA also offers some benefit programs available for just a few subscriptions in select locations, including the following:
Companion Benefit: In some D-SNP plans, Aetna pairs users with a companion who can help them run errands or keep them company for up to 10 hours per month.
- Extra Card: Some people have access to a preloaded debit card that can be used for over-the-counter items, healthy eating, utilities, or transportation.
- Memory Fitness: Some have access to a library of brain games and exercises, as well as brain health information.
- Fresh Food Boxes: Certain users are eligible for a box of fresh fruits and vegetables at regular intervals, such as biweekly or monthly.
- Fall Prevention: Some users qualify for an annual allowance that they can use for safety items that can reduce the risk of injury from falls.
Offering Innovative New Programs And Benefits
Aetna provides individual member benefit plan access to convenient and affordable care through several benefits and programs new this year:
Extra support for people with a low income
Most D-SNP offer no-out-of-pocket prescription drugs and additional benefits for LIS-eligible members. Coverage varies by plan and may include healthy food or utilities, as well as companionship or fall prevention benefits.
Aetna understands that users requiring hospice services may require special care and support. As part of the expanded coverage of select MAp in Ohio and Pennsylvania, Aetna will be responsible for full medical coverage and hospice for members.
People who are enrolled in the Aetna Compassionate Care program and who use select healthcare providers can access additional benefits to support their end of life.
They receive ongoing temporary concurrent care, such as treatment for the diagnosis of terminal illness and related conditions, additional transportation, additional meals, home support, and access to a Personal Emergency Response System (PERS).
Aetna Medicare Debit
Aetna has teamed up with PayFlex ® to offer a new debit card that includes cash payments for in-network primary and specialist care and other medical and diagnostic services. Eligible users receive $100 per quarter with a maximum of $400 per year. This benefit is included with select individual MAp in Pennsylvania and Minnesota.
Expanding on the benefits of alternative medicine, select MAp in the Northwest region will cover up to 24 therapeutic massage visits per year.
Medical Clinical Policy
With MAp, which includes a dental network benefit, you are covered up front for specific dental services, but you may need to see a dentist within your network of providers.
Some Preferred Providers (PPO) and Preferred Provider Organizations (HMO-POS) and HMO-POS (Health Maintenance Organization) plans allow you to see any licensed dental provider, but you can save money by visiting an in-network provider. You can find a network provider by logging in as a member and going to the provider list.
Preventive services such as cleaning, oral exams, and x-rays are 100 percent covered with most plans. This means you pay nothing out of pocket if you stay in-network.
For advanced services, such as fillings, extractions, and crowns, coverage varies by plan and you may have to pay a portion of the cost. Consult your subscription for more information.
When planning your dental care, keep in mind that you may have limits on the number of preventive care visits you can make per year, as well as limits on coverage for extended services.
Most plans also have a maximum benefit, a limit on the amount the plan will pay out to cover dental services. This maximum benefit can range from about $150 to $6,000.
Dental Clinical Policy
This dental clinical policy covers many different aspects of dental care, including preventive care, basic procedures, and major procedures. Preventive care includes routine dental cleaning and exams. Basic procedures include fillings, extractions, and root canals. Major procedures involve more extensive work, such as bridges, implants, and dentures.
This policy is important for both patients and dentists as it provides guidance on what treatments are covered by Aetna dental insurance.
Medicare Benefit Providers
Learn more about some of the major providers below. These insurers provide coverage in most states. The plans available to you are determined by your zip code and state.
Here are the other medicare providers for your credentials: AARP, Anthem, Blue Cross Blue Shield, Cigna, Humana, Kaiser Permanente, UnitedHealthcare, Wellcare.
Addressing Social Health Determinants With New And Expanded MA Benefits
The MAp opts for a total approach to health that goes beyond clinical care. With this approach in mind, Aetna has extended the benefits with:
Telehealth: All Aetna 2022 MAp covers telehealth visits for primary care, emergency care and specialist care provided by a physician, including mental health services. Depending on location, people can schedule 24/7 telehealth visits through MinuteClinic Video Visit™, Teladoc®, or another network provider that offers this service.
Healthy Foods Card: To address food insecurity, the availability of the Healthy Foods Card is expanding to 77 MA plans in 28 states. Qualified users receive compensation that they can use to purchase nutritious food from more than 30,000 authorized retailers across the country.
Utility Map: Selected DNSP subscriptions in 2022 will offer a new utility map. This debit card provides a monthly contribution towards the healthcare costs of utilities such as water, electricity, sewerage and gas.
Companionship: Aetna is expanding its companionship benefit to address social isolation to select MAp in eight states. In partnership with Papa Inc. adult companions connect with qualified users to help with household chores and technology for up to 10 hours per month at no extra cost. Remote guidance can be done via telephone or secure video.
Fall Prevention: Aetna is expanding its fall prevention benefit through CVS Pharmacy to other states and plans. In selected MAp, eligible users will receive annual compensation for certain clinically appropriate safety items that help reduce the risk of injury from falls in the home.
Making healthcare more affordable, accessible and convenient
$0 Cost Sharing for Select Benefits: To ensure key services are affordable, three of the four Aetna Individual MAp now offer no cost sharing for people for primary care or lab visits. In addition, all Aetna MAp offer $0 copay for A1c, urine protein and COVID-19 tests and $0 copay for diabetes eye exams including retinal x-ray.
OTC: Aetna is expanding the availability of its over-the-counter (OTC) benefit through OTC Health Solutions, a CVS Health Company, and is increasing the OTC stipend available to people of many MAp. The OTC benefit allows users to choose certain healthcare products for home delivery via phone, catalog or online.
They can also present their ID to receive items directly from 3,000 select CVS Pharmacy ® or Navarro Discount Pharmacy ® locations in 37 states. In line with CVS Health’s commitment to helping people lead smoke-free lives, Aetna is pleased to offer all members the OTC benefit of providing access to nicotine replacement therapy (NRT).
Eligible users can choose from a variety of FDA-approved smoking cessation products, such as gums, lozenges, or patches.
Reducing Insulin Costs: Aetna is expanding its participation in the Part D Senior Savings model to offer people in some individual MAPD plans and all SilverScript Plus Part D plans affordable, predictable out-of-pocket payments of no more than $35 for a daily supply of 30 months of selected insulins.
SilverScript is a Medicare-approved prescription drug plan with a Medicare contract marketed by Aetna Medicare.
Prescription Drugs: All Aetna individual MAPD plans will increase the daily prescription drug supply to a maximum of 100 days for Levels 1-4 drugs. People can take advantage of the new increased daily supply without increasing copay/coinsurance.
Innovative Dental Design: Aetna Medicare is introducing a new Total Choice dental benefit available on many individual MA HMO-POS and PPO plans. This dental reimbursement provides cover for preventive and comprehensive dental care up to a maximum of the reimbursement and allows the participant to choose a qualified dentist, within or outside the network.
Lower cash costs: Aetna has reduced the maximum cash costs of members in the network in approximately one-third of its individual MAps for 2022.
Member Rewards Program: In 2022, they will expand the rewards program to all Aetna individual Medicare Advantage members. The program helps them improve their health and well-being with personalized reward activities.
They can earn $150 or more by completing activities such as preventive screenings and annual physicals that are already covered by their benefits. In addition, Aetna will continue to offer the following benefits or other services as part of its Medicare Advantage plans:
All MAp offer an annual internal assessment at no additional cost, including a comprehensive health risk assessment and non-invasive physical exam from the comfort of the member’s home. The clinician also assesses the home environment for potential fall risks so that the member can stay home safely.
The Aetna Resources For Living ® program helps address loneliness and other social needs by connecting users to key community resources, such as transportation, housing, food programs, caregiver support, and utilities, based on individuals’ needs. The program serves as an early intervention point for the many issues that affect physical and mental health.
SilverSneakers ® fitness memberships are available at no additional cost to all individual Aetna MA members. Through SilverSneakers, people have access to more than 16,000 fitness locations.
SilverSneakers FLEX ® also gives them access to training programs outside of traditional gyms, such as recreation centers, shopping centers and parks. Individuals can also connect to a support network and virtual resources through SilverSneakers LIVE™, SilverSneakers On-Demand™ and the mobile app, SilverSneakers GO.
Aetna continues to provide most Medicare Advantage members with access to routine facial, dental, and hearing coverage.
Visit AetnaMedicare.com to learn more about Aetna Medicare’s plans for 2022. Or call 1-844-588-0041 (TTY: 711) 7 days a week from 8 a.m. to 8 p.m. The annual Medicare enrollment period is October 15 through December 7. 2021. An authorized agent can answer your call.
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