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Trying to decide whether to sign up for an Aetna Medicare Advantage Prescription Drug plan? Medicare prescription drug coverage is technically optional but be aware that Original Medicare doesn’t cover most of your prescriptions.

Aetna offers a variety of Medicare Advantage plans, many of which include Medicare Part D coverage for prescription drugs. If you are shopping for prescription drug coverage, here’s what you need to know about Aetna’s Medicare Advantage plans.

Aetna’s Medicare Advantage plans

If you decide to get your Medicare Part A and Part B benefits through a Medicare Advantage plan, you might be pleased to know that many of Aetna’s Medicare Advantage plans include prescription drug coverage. This type of plan is called a Medicare Advantage Prescription Drug plan.

Please note that not every plan or plan type is available in all locations.

What do Aetna’s Medicare Advantage Prescription Drug plans cover?

Medicare Advantage Prescription Drug plans must provide the minimum coverage required by the Medicare program. Plans must cover some medications in each of certain categories (such as cancer prescription drugs and antidepressants).

Aetna’s Medicare Advantage Prescription Drug plans may also choose to cover certain additional medications.

You can find out exactly what prescription drugs are covered under an Aetna Medicare Advantage Prescription Drug plan by reading the plan’s formulary. A formulary is a list of medications covered by the plan and how much you pay for them. But be aware that your Aetna Medicare Advantage Prescription Drug plan can change its formulary, adding and removing covered medications. You’ll be notified when and if that happens.

Aetna Medicare Advantage Prescription Drug plans generally use tiered formularies. In a typical tiered formulary, Tier 1 includes preferred generic drugs, which usually have the lowest copayment or coinsurance costs. Tier 2 includes other generic drugs that may have higher cost-sharing amounts. Tier 3 represents preferred brand-name medications that may have still higher cost-sharing amounts. Tier 4 drugs are usually non-preferred brand drugs. And it can go up to Tier 5, which typically includes specialty prescription drugs and other expensive treatments. These prescription drugs generally have the highest plan copayments or coinsurance amounts.

Aetna’s Medicare Advantage Prescription Drug plans may also cover certain commercially available vaccines, such as the shingles vaccine.

Are there any special rules for Aetna’s Medicare Advantage Prescription Drug plans?

To help keep your Medicare out-of-pocket costs low, Aetna’s Medicare Advantage Prescription Drug plans may include special rules such as:

  • Prior authorization for certain medications. You may need to get approval from your Aetna Medicare Advantage prescription drug plan first.
  • Step therapy. If your doctor prescribes a brand-name medication and a generic version is available, your doctor may need to prescribe a less expensive medication first to treat your condition before the plan will help pay for the more expensive brand-name version
  • Quantity limits, which restrict the number of doses of certain medications that you can get at one time.
  • Opioid safety checks, which may limit the amount of these prescription drugs your doctor can prescribe for you. Opioids are used to treat pain, but can be addictive, according to the U.S. National Library of Medicine.

Eligibility rules determine whether you qualify for an Aetna Medicare Advantage prescription drug plan, or any Medicare prescription drug plan.

  • You must first be enrolled in Medicare Part A and Part B.
  • You must live within the plan’s service area.

You need to continue paying your Medicare Part B premium, along with any plan premium. Some of Aetna’s Medicare Advantage plans may charge premiums as low as $0.

How much do Aetna’s Medicare Advantage prescription drug plans cost?

Aetna’s Medicare Advantage prescription drug plans may come with monthly premiums and other out-of-pocket costs, like deductibles, copayments, and coinsurance. Of course, this is true of any insurance company that contracts with Medicare to deliver benefits to members. These costs may vary among plans.

Plan premiums may depend on various factors, like where you live, and the type of plan you choose.

One thing to keep in mind: If you want Medicare prescription drug coverage, you may want to enroll under Part D as soon as you’re eligible, unless you have creditable prescription drug coverage from another source, such as an employer plan. If you don’t, you may have to pay a Part D late enrollment penalty based on the number of months you went without prescription drug coverage. You pay this penalty as long as you have creditable prescription drug coverage, so it can really add up over time.

When can I sign up for one of Aetna’s Medicare Advantage Prescription Drug plans?

You can sign up for one of Aetna’s Medicare Advantage Prescription Drug plans during your Medicare Initial Enrollment Period (IEP). For most people, your IEP begins three months before the month you turn 65, includes your birthday month, and ends three months after your birthday month.

If you already have prescription drug coverage through another insurer, or you didn’t sign up during your IEP, you can switch to an Aetna Medicare Advantage Prescription Drug plan during the Annual Enrollment Period (AEP). The AEP begins each year on October 15 and ends on December 7. There may be other opportunities to sign up for, or switch to, an Aetna Medicare Advantage plan.

How can you find an Aetna Medicare Advantage plan near you? Start by typing your ZIP code where shown this page.

The formulary may change at any time. You will receive notice when necessary See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area.


NR_0001_17097_C  09/2019

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