Aetna offer several types of Medicare plan, including Part D. These plans provide coverage for prescription drugs.
People who qualify for original Medicare (Part A and Part B) may choose to get a Part D plan through private insurance companies such as Aetna.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Aetna are a healthcare company who administer various types of health insurance plan through employer-paid plans and Medicare.
The company began life in Hartford, CT, in 1853. They are now a subsidiary of CVS Health.
Aetna offer various Medicare plans, including:
- Medicare Advantage plans: These plans provide an alternative to original Medicare (parts A and B). They may include additional benefits such as hearing, vision, and dental care. Learn more about choosing a Medicare Advantage plan here.
- Medicare supplement plans: Supplemental plans, known as Medigap, provide coverage for healthcare costs that original Medicare does not cover in full. These plans may help with the cost of deductibles, copays, and coinsurance. Learn more about how Medigap plans work here.
- Medicare Part D plans: These plans cover the cost of prescription drugs. Learn more about Medicare Part D plans here.
Aetna offer three types of Part D plan, including:
- SilverScript Smart Rx: Smart Rx offers prescription drug coverage for a wide variety of generic medications. It has the lowest monthly premium of the three Aetna plans, at an average of $71.15 and with $0 copays for tier 1 generic drugs.
- SilverScript Choice: This plan offers many generic and brand-name drugs and a $0 copay for tier 1 drugs. It has a higher monthly premium than the Smart Rx plan but offers a lower deductible.
- SilverScript Plus: This plan offers enhanced coverage, including a $0 copay for tier 1 drugs and a $2 copay for tier 2 medications. Although the monthly premium is higher than that of the other two plans, the plan offers a wider variety of covered drugs. It also provides additional coverage for mineral and vitamin supplements. It is not available in Alaska.
Covered drugs
According to Medicare guidelines, each Aetna plan must offer at least two medications in each class of drug. However, the complete list of covered drugs may vary by plan.
All Part D plans must cover certain classes of medications, including:
- anticonvulsants to treat or prevent seizures
- antidepressants to treat depression
- antineoplastics to limit tumor growth
- antipsychotics to treat mental health conditions
- antiretrovirals for HIV treatment
- immunosuppressants to prevent organ transplant rejection
All three Aetna Part D plans provide coverage for generic and some brand-name medications. Each Part D plan provides a list of covered drugs, usually arranged in tiers that determine the cost. Drugs in the higher tiers usually cost more than those in the lower tiers.
Costs vary among Aetna plans, depending on plan type, medications, and location. For example, some Aetna Part D plans may require a different copay for tier 1 and tier 2 drugs, as shown in the table below.
| Costs | SilverScript Smart Rx | SilverScript Choice | SilverScript Plus |
| average monthly premium | $7.15 | $28.49 | $69.52 |
| deductible in tier 1 | $0 | $0 (tiers 1 and 2) | $0 |
| tier 1 copay | $0 | $0 | $0 |
| tier 2 copay | $19 | $5 | $2 |
Costs for Aetna Medicare Part D plans may also vary depending on whether a person uses a preferred or standard retail pharmacy or a mail-order pharmacy.
A preferred retail pharmacy is a physical location in the plan’s network. A preferred pharmacy provides covered medications at costs lower than those at standard pharmacies. Standard retail pharmacies may still participate in a plan’s network but charge higher copays. Usually, retail pharmacies provide a 1-month supply of prescription medications.
Costs may also be different when an individual uses a mail-order pharmacy, which may provide several months’ worth of medications.
Anyone eligible for Medicare Part D plans may get an Aetna plan. For an individual to qualify for a Part D plan, they must meet one of the criteria below:
- be 65 years of age or above
- be entitled to Medicare parts A and B or have already enrolled
- be younger than 65 years of age but have certain disabilities and be in receipt of at least 24 months of financial support from the Social Security Administration or Railroad Retirement Board
- have end stage renal disease or amyotrophic lateral sclerosis
Similar to other plans, Aetna Medicare Part D plans have certain coverage conditions that vary among plans. These conditions may include:
- Prior authorizations: Aetna plans may require an individual to get prior authorization for certain medications. This means that the doctor must get approval from Aetna before filling the prescription.
- Quality limits: Plans may also limit the amount of covered medication, such as providing coverage for a certain number of pills per month.
- Step therapy: Some plans may require a person to try a certain drug to treat a medical condition before the company covers a different medication for it. For example, if two drugs are available that treat the same condition, the company may require an individual to try a specific drug first. If that does not work, however, they will cover the other medication.
Aetna are a private insurance company who administer different types of Medicare plan, including Part D plans that cover many prescription medications.
Aetna offer three different Part D plans. Each plan differs in the cost of the monthly premium, deductible, and copays. Before selecting a plan, it is helpful to get a list of the medications the plan covers.