What Types of Medicare Part D Coverage Does Aetna Offer?
Last Updated : 05/28/20195 min read
What is Aetna Medicare Part D?
Congress authorized Medicare Part D Prescription Drug Plans under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, making Medicare prescription drug coverage available to beneficiaries for the first time in 2006.
Medicare prescription drug is available in one of two ways.
You can get Aetna Medicare Part D coverage through a stand-alone Medicare Prescription Drug Plan to supplement your Original Medicare (Part A and Part B) benefits or included in an Aetna Medicare Advantage plan (also known as a Medicare Advantage Prescription Drug plan).
Aetna Medicare plans are administered by Aetna, a private insurance company contracted with Medicare, but they must offer all the minimum prescription drug coverage benefits mandated by the Medicare program at the federal level. Some Aetna Medicare plans with prescription drug coverage may include coverage above the minimum requirements. For example, if you get your Medicare coverage through a Medicare Advantage Prescription Drug plan, some plans may offer extra benefits beyond Original Medicare, such as routine vision or dental, hearing, or wellness programs.
What types of Aetna Medicare Part D coverage are available?
As mentioned, you can get your Medicare Part D benefits in two ways, depending on whether you’re enrolled in Medicare Advantage plan or are getting your coverage through Original Medicare. An Aetna Medicare Advantage plan with prescription drug coverage gives you the flexibility of having all your Medicare benefits administered under one plan. Or, you can also get your Part D coverage through a stand-alone Medicare Part D Prescription Drug Plan that works alongside Original Medicare.
Some things to know about Aetna Medicare plans that cover prescription drugs:
- Covered drugs are limited to those included in the plan’s drug formulary, which is a list of medications covered by the plan and details about how much the plan will cover. Formularies may vary by plan and location and may change at any time. Your Aetna Medicare plan will notify you if necessary.
- You may be required to pay a copayment or coinsurance for your prescription drugs.
- Some Aetna Medicare Prescription Drug Plans and Medicare Advantage Prescription Drug plans use a “tiered” formulary, which means that you pay less for certain types of medications, usually generics, than you do for brand-name medications. Covered medications placed on higher tiers generally have higher copayments and coinsurance costs than those that fall on lower tiers.
- Aetna Medicare plans may change their formularies at any time, but they must notify you in writing before any change goes into effect. If you take a covered medication that is being removed from the plan formulary, you are entitled to a one-time 60-day supply of that medication under the same terms as before the formulary changed.
- Some Aetna Medicare plans that include prescription drug coverage require you to purchase your medications through a network pharmacy.
- Plan benefits may vary by the type of plan you purchase and where you live.
Stand-alone Aetna Medicare Part D Prescription Drug Plans cannot be combined with Aetna Medicare Advantage Prescription Drug plans. If you’re enrolled in a Medicare Advantage plan that doesn’t include prescription drug coverage (for example, a Medicare Savings Account plan), you may be allowed to enroll in a stand-alone Medicare Prescription Drug Plan for your Part D coverage.
You will pay a separate monthly premium for your stand-alone Medicare Part D Prescription Drug Plan in addition to your Part B premium and/or Part A premium (if you have one). Premiums for prescription drug coverage in Aetna Medicare Advantage Prescription Drug plans are included as part of the plan premium. Premiums may vary by location.
You should sign up for Medicare Part D coverage as soon as you become eligible in order to avoid a late-enrollment penalty later on. You could face a late-enrollment penalty any time you go without Part D coverage and don’t have creditable prescription drug coverage (insurance that is as good as Part D) for 63 consecutive days or more.
Aetna Medicare plans that cover prescription drugs may use different measures to control costs, such as limiting the quantity of pills you can acquire at one time or over a certain time period (also known as quantity limits) or using step-therapy, which requires you to try a less expensive similar medication for your condition first. After evaluating your response to treatment, the plan may approve a more expensive prescription drug if the first medication isn’t effective for your condition or it’s medically necessary for you to take the more costly medication.
If you’d like to learn more about Aetna Medicare Part D coverage, you can visit the Aetna page to find Aetna Medicare plan options that fit your prescription drug needs.
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