Beginning in 2020, Aetna will be selling Coventry Medicare plans. While Aetna began integrating Coventry since acquiring it in 2013, this is the first major change announced for 2020.
2020 Aetna Coventry Medicare Plans – The Basics:
With over 39 million people insured, Aetna is one of the top healthcare insurance companies in the country. In addition to receiving an A+ rating from Better Business Bureau (BBB), the company ranked fourth for overall satisfaction in the J.D. Power Medicare Advantage Study (2019).
So, what can you expect if you decide to choose an Aetna Coventry Medicare plan in 2020?
Aetna offers three types of Medicare plans:
- Medicare Advantage plans
- Medicare prescription drug plans (Part D)
- Medicare Supplement insurance plans (Medigap)
Medicare Advantage Plans
Also known as Medicare Part C, Medicare Advantage plans offer the same coverage found with Medicare Part A (hospital insurance) and Part B (medical insurance), along with extra benefits.
Aetna offers a range of standard Medicare Advantage plans which are classified as:
- HMO plans – Aetna’s Health Maintenance Organization (HMO) is quite standard as it provides you with a network of doctors and hospitals you can visit. You will, however, need a referral from a primary care physician for specialist visits as well as hospital care. Moreover, the company offers limited out-of-network benefits with this plan.
- HMO-POS plans – Point-of-service (POS) plans go beyond traditional HMO offerings to allow you to select healthcare providers outside of network. Keep in mind that you’ll need to pay more by not opting for an in-network physician.
- PPO plans – If you wish for the flexibility to choose any healthcare service provider who accepts Medicare, you should consider preferred provider organization (PPO) plans. With this plan, you won’t need a referral from your primary care physician before visiting a specialist or hospital. You can, however, save by choosing a provider in your plan’s network.
Here’s a quick comparison of all three plans based on their offerings:
|HMO Plans||HMO – POS Plans||PPO Plans|
|Using a network provider is required|
(unless it’s an emergency)
|Having a primary care physician is required||Yes, in most plans||Yes, in some plans||No|
|Getting a referral before seeing a specialist is required||Yes, in most plans||Yes, in some plans||No|
|Monthly premiums||$0 – $178||$0 – $33||$0 – $214|
|Medical deductible||$0 – $1,180||$0 – $500||$0 – $1,800|
|Prescription drug coverage is included||Yes, in most plans||Yes||Yes, in most plans|
|Dental, vision, and hearing coverage||Yes, in most plans||Yes, in most plans||Yes, in most plans|
|ER and urgent care worldwide||Yes||Yes||Yes|
|Over-the-counter benefit (to get OTC at no charge)||Yes, in most plans||Yes||Yes, in most plans|
|Transportation benefit (e.g. trips to doctor)||Yes, in some plans||Yes, in some plans||Yes, in some plans|
|Meals at home (to deliver meals home after a hospital stay)||Yes, in some plans||Yes, in some plans||Yes, in some plans|
In addition to the benefits and services listed above, you can opt for the following with a Medicare Advantage plan:
- Resources for Living concierge services
- SilverSneakers fitness membership
- 24/7 access to a registered nurse
- Prescription drug home delivery
Aside from standard plans, Aetna Coventry Medicare offers the dual special needs plan (DSNP) with personalized care to individuals with both Medicare and Medicaid plans. This plan can be customized according to your health needs to include dental, vision and hearing coverage, wellness programs like acupuncture therapy, and meals after a hospital stay.
You may qualify for assistance for paying for your prescription drugs if your total income is less than $18,735 (or $25,365 for married couples), and your assets amount to less than $14,390 ($28,720 for couples).
DSNP, however, is limited to 14 states, including Florida, Texas, Kansas, and Virginia. Call your local Aetna Coventry Medicare to check if it’s offered in your state.
Ready to find a Medicare Advantage plan? We recommend speaking with a licensed insurance agent to understand all of the coverage and benefits options available to you.
SilverScript Part D Coverage
As a result of CVS Health acquiring Aetna, SilverScript became part of Aenta’s Medicare portfolio. SilverScript is one of the largest Medicare Part D insurers according to a CMS Monthly Enrollment by Plan report. It serves over 6 million Medicare policy holders, offering them convenience, round-the-clock customer service, and access to pharmacies nationwide.
In 2020, Aetna Coventry Medicare will offer two standalone prescription drug plans (PDPs) from SilverScript:
- SilverScript Choice – This affordable prescription drug plan offers coverage for a wide range of generic and brand-name drugs. It offers $0 copays on Tier 1 drugs at 28,000 preferred pharmacies out of 65,000 pharmacies in total. You can also avail mail delivery and $0 copays on 90-day supplies of Tier 1 drugs.
- SilverScript Plus – This plan is more suitable for individuals who take more medications and/or are concerned with Medicare’s coverage gap. In addition to offering a $0 deductible on all tiers, it offers more drug coverage, immediate access to copay and coinsurance benefits, and up to $435 in savings on deductible costs.
If you’re worried about costs, check to see if you qualify for the Medicare Part D Extra Help to lower your premiums and costs. Also known as low-income subsidy (LIS), this program offered by the Social Security Administration helps individuals with limited incomes. It covers 25%, 50%, 75% or 100% of your monthly Part D plan premium.
If you’re already enrolled in a prescription drug plan or a Medicare Advantage prescription drug plan (MA-PD), call 1-800-MEDICARE (1-800-633-4227) to check if you qualify for the Extra Help program.
Medicare Supplement Insurance Plans (Medigap)
Medigap, or Medicare Supplement insurance plans, are also offered through Aetna. Medigap plans complement Original Medicare coverage while helping you pay for costs of healthcare products and services such as:
- 20% of Medicare-approved costs or copayments for outpatient services
- Hospitalization per day coinsurance along with coverage for 365 days after benefits end
- First three pints of blood annually
- Part A coinsurance for hospice services
- Skilled nursing facility care
- Foreign travel emergency
To apply, you need to be 65 or older (in some states, under 65 due to disability or end-stage renal disease), enrolled in Medicare Parts A and B, and live in a state which offers this policy.
Already Have a Coventry Medicare Plan?
If you’ve already enrolled in a Medicare plan from Coventry, you may have several questions on how the new changes affect you. You can talk to an Aetna Coventry licensed agent on 1-855-423-5971 (TTY: 711) between 8 a.m. and 8 p.m., seven days a week. Alternatively, you can request a call or schedule an in-person visit.
To help you get all the answers you need, here are some of the important questions you should ask:
- Does the latest plan meet your needs better than your current one?
- Will the changes affect your current plan and the services you use?
- Will your drugs be covered?
- Will there be changes to the tier and cost-sharing of the drugs you need?
- How much can you save on out-of-pocket costs for the services and drugs you use?
- If you plan to switch plans, is there a deadline for doing so?
The Bottom Line
With so much to offer, Aetna Coventry Medicare plans may be just the thing to help you get the healthcare coverage you need without worrying about rising costs. Make sure to do your homework and get a quote from a licensed Medicare insurance agent before selecting a plan.