Aetna 2023 Medicare plans put money back in members' pockets

A senior black couple, a man and woman, hiking on a heavily wooded trail

Featuring reductions in prescription drug costs and money-saving Medicare Advantage benefits and extras that make a difference

WOONSOCKET, R.I., Oct. 1, 2022 — Aetna®, a CVS Health® company (NYSE: CVS), announced its 2023 Medicare offerings, featuring more affordable medical and prescription drug coverage and expanded money-saving benefits that support members’ whole health and well-being. We’ll offer new Medicare Advantage plan options, including Dual Eligible Special Needs Plans in new markets, a new Institutional Special Needs Plan and expanded Aetna Medicare Eagle® plans designed with Veterans in mind.

“In addition to the health challenges that typically come with getting older, we recognize the heavy financial strain on older adults and people with disabilities, who often live on fixed incomes,” said Christopher Ciano, president of Aetna Medicare. “To help lower their health care costs, we expanded our Aetna Medicare Solutions portfolio of products to include improved prescription drug coverage that will save members money, more essential benefits that make a meaningful difference in members’ lives and plans that fit their unique needs and budget. As part of the CVS Health family, Aetna wants our 10.6 million Medicare members nationwide to feel protected and supported through every moment of their personal health journeys.”

Expanded Medicare Advantage plans to meet diverse needs

More than 3.2 million Medicare beneficiaries are currently enrolled in an Aetna Medicare Advantage (MA) plan, which often includes valuable benefits, such as prescription drug coverage, dental, vision, hearing and fitness. To keep plans affordable, Aetna continues to offer many $0 premium plan options. Aetna estimates 84% of the Medicare-eligible beneficiaries in the U.S. will have access to a $0 monthly premium Aetna MA plan.CMS Enrollment data, August 2022.

For 2023, Aetna is offering Medicare Advantage Prescription Drug (MAPD) plans in 46 states plus Washington, D.C. Aetna added 141 new counties across the country, providing 1 million more Medicare beneficiaries access to an Aetna plan. In total, Aetna will offer MAPD plans in 2,014 counties in 2023, accessible by 55 million Medicare beneficiaries.This number includes Aetna’s Joint Venture in Minnesota (with Allina Health).

For those who qualify for both Medicare and Medicaid benefits, Aetna expanded its Dual Eligible Special Needs Plan (D-SNP) offerings across 30 states, including new markets in South Carolina, South Dakota and Utah, and new PPO plan options in Georgia and South Dakota. All plans offer prescription drugs at no out-of-pocket cost and additional benefits for members who qualify for Low-Income Subsidy (LIS). Coverage varies by plan and may include healthy foods, utilities, over-the-counter items, additional transportation, companionship and fall prevention benefits.

New for 2023, Aetna will introduce the Aetna Medicare Longevity Plan, an Institutional Special Needs Plan (I-SNP), in Pennsylvania. This plan is specifically designed for people living in nursing homes. It includes prescription drug coverage and provides enhanced access to onsite care in the facility. Members receive extra benefits tailored to improve their quality of life by caring for their unique medical, social and emotional needs.

Aetna also expanded its Aetna Medicare Eagle MA plans to 42 states and 1,383 counties — reaching more than 6.1 million Veterans over age 65. These plans are designed with Veterans in mindThese plans do not include prescription drug coverage. They are available to all Medicare-eligible individuals and could be a good fit for beneficiaries who already have prescription drug coverage at least as good as Medicare Part D. to complement their VA health care coverage and ensure access to important benefits for this population. All 2023 Aetna Medicare Eagle plans will feature a $0 monthly plan premium, $0 primary care copay (including walk-in clinics), dental, vision, hearing, over-the-counter allowance, SilverSneakers® fitness program and $0 lab copay. 

Robust standalone prescription drug plans with lower copays

The Aetna standalone prescription drug plans (PDP) serve 6.1 million members. In 2023, Aetna Medicare will continue to offer three individual, standalone plans. SilverScript SmartRx (PDP) will be renamed SilverScript SmartSaver (PDP) in 2023 and will feature an average monthly premium of $5.92, along with $10 copays for select insulins at preferred pharmacies. SilverScript Choice (PDP) will be available to members with full Extra Help for a $0 monthly plan premium in all 50 states and D.C., while SilverScript Plus (PDP) has the most robust prescription drug coverage of our PDPs. All three plans are available in all 50 states and D.C and feature increased formulary coverage from 2022.Source: CMS 2023 PDP Landscape Source Files available at https://www.cms.gov/Medicare/Prescription-Drug-Coverage/PrescriptionDrugCovGenIn.

Big reductions in prescription drug costs across the MAPD portfolio

Aetna made major changes to our formularies (drug lists) for 2023 to remove many cost and access obstacles and help our members be more adherent with their medications. Prescription drug benefit changes will result in significant cost savings for our 2023 Individual MAPD members. Highlights include:

  • $0 deductibles: 100% of MAPD members will enjoy a $0 deductible on all Tier 1 drugs, with 74% of plans offering a $0 deductible on all tiered drugs (Tiers 1 – 5).

  • $0 copays at preferred network pharmacies: Over 97% of our MAPD plans will offer $0 copay on Tier 1 drugs, and 50% of our MAPD plans will offer $0 copay on Tier 1 and Tier 2 drugs, for 30-, 60- or 100-day supply.

  • Robust drug coverage: New for 2023, our most widely used formulary will move nearly 300 drugs from higher-cost drug tiers to lower tiers. This means direct cost-share savings for our members, giving them access to many more drugs for a $0 or low copay. Plans using our other formularies can count on similar savings. For example, a member who had a drug (like Ezetimibe/generic Zetia used to treat high cholesterol) down-tiered from Tier 3 in 2022 to Tier 2 in 2023 on a plan with a $0 Tier 2 copay in 2023 and a $47 Tier 3 copay in 2022 would save $564 next year.

  • Pharmacy network: 99.9% of our MAPD plans offer prescription drug coverage with access to nearly 66,000 network pharmacies, with 24,000 preferred options offering additional savings.

  • 100-day supply at no extra cost: All MAPD plans will offer 100-day supply,Not all medications are dispensable in 100-day supply due to unbreakable package sizing (e.g., inhalers), or as a result of being a controlled substance. for drugs on Tiers 1-4 at both retail and mail-order pharmacies with no increase in copay/coinsurance. Members who choose to use our preferred mail-order pharmacy to fill their 100-day supply prescriptions can count on convenient, no-cost standard shipping. Extended-day supplies will save members money and help them stay on their drug treatment program.

  • Tier 1/Tier 2 Coverage Gap: 99.3% of our MAPD plans provide robust Tier 1 and Tier 2 gap coverage at the same cost-share as in the initial coverage phase, allowing predictable copays through the donut hole and reducing the possibility of members reaching the catastrophic phase.

  • $0 copays and $0 deductibles on Dual Eligible Special Needs Plans: All D-SNPs will share one set of common features — robust drug coverage, $0 deductibles and $0 prescription drug copays. Members simply need to qualify for D-SNP enrollment to receive this benefit.

  • Insulin: Members won’t pay more than $35 for a one-month supply of each insulin product covered by our plan.

  • Vaccines: Many covered Part D vaccines will be available at $0 copay for Medicare beneficiaries.

Money-saving MA benefits and extras that make a difference

“We know our members want to feel confident that their Medicare plans offer the coverage they need, when and where they want it — and at a price they can afford,” said Ciano. “So, for 2023 we expanded some popular benefits and added new ones to empower members to get important preventive care, stay healthy and keep doing the things they enjoy most.” Individual MA plan features that will make care more affordable, convenient and accessible in 2023 include:

  • Aetna Medicare Extra Benefits Card (new):  Select plans will include a new, preloaded debit card with a quarterly allowance that can be used towards the purchase of over-the-counter (OTC) items and/or a combination of support servicesSome services may be limited to those with qualifying conditions. such as: healthy foods; utilities (including water, electricity, gas, phone and internet service); and transportation. The card can be swiped at thousands of participating retailers for OTC and healthy foods.

  • Aetna Medicare Payment Card: Aetna is expanding this debit card to more plans and states and making it more convenient. Qualifying members will receive a quarterly allowance to use towards either out-of-pocket expenses for in-network care; approved OTC wellness items; or both. Members whose benefit includes an allowance for OTC items can buy a wide selection of items at any CVS Pharmacy® retail locationExcludes CVS Pharmacy in Target locations. or place orders online through OTC Health Solutions, a CVS Health company.

  • Memory Fitness (new): Select Aetna Medicare plan members will get access to brain games, exercises and a huge library of information on activities that promote brain health. Memory Fitness can be accessed through BrainHQ on computers, smartphones and tablets.

  • Fresh Food Boxes (new): Qualifying members of select Individual Aetna MA plans can receive a produce box containing fresh fruits and vegetables delivered to their homes either biweekly, monthly or quarterly.

  • Dental, vision and hearing: Aetna believes benefits like dental, vision and hearing care are essentials and not simply extras. Aetna will continue to offer most MA members access to routine dental, vision and hearing coverage.Level and type of coverage vary by plan.

    • Improved dental: In 2023, 95% of our MA plans will include a comprehensive dental benefit. Aetna will expand the Total Choice dental benefit introduced in 2022 to additional Individual MA HMO-POS and PPO plans. This benefit provides coverage of preventive and comprehensive dental services up to a benefit maximum and allows the member to choose any licensed dentist, in or out of network. Members may save money when visiting a dentist within our network. As one of the nation’s largest MA dental networks, Aetna is continuing to expand the Aetna Dental® PPO network across the country to meet our members’ need to find affordable dental care. We’re also improving the member experience by removing dental deductibles from some other dental benefit plans.

    • Vision: In 2023, 96% of our MA plans will include an eyewear benefit.

    • Hearing: In 2023, 93% of our MA plans will include a hearing aid benefit.

  • Telehealth: All Aetna MA plans will continue to cover telehealth visits for primary care, urgent care and specialty care provided by a doctor, including mental health services. In 2023, additional telehealth services will be available including physical, occupational, and speech therapy, substance abuse and opioid treatment, kidney disease education and diabetes self-management training services. Depending on location, members will be able to schedule telehealth visits 24/7 via MinuteClinic®, Teladoc® or another network provider offering this service.

  • Meals: In 2023, 85% of MA plans will include home-delivered meals after an inpatient stay.

  • OTC: Aetna is making its OTC benefit offered through OTC Health Solutions, a CVS Health company, available to more members and increasing the OTC allowance amount on many MA plans. With the OTC benefit, members can choose certain health care products by phone, catalog or online for home delivery. They'll also be able to present their ID cards to receive items directly from 3,800 select CVS Pharmacy or Navarro Discount Pharmacy® locations across 39 states. Select Aetna plans will offer an OTC kit mailed directly to the member's home. These kits contain curated OTC items that help support our members’ health.

  • $0 cost-shares on select benefits: To ensure important services are affordable, Aetna continues to expand services available at no extra cost to the member. Most MA plans will have $0 copay for primary care visits and many plans will offer labs at no cost to the member.

  • Stable or reduced member out-of-pocket costs limits: All Aetna MA plans include maximum out-of-pocket cost protection for covered plan services. Aetna will keep member in-network maximum out-of-pocket costs limits the same or decrease them in 82% of its Individual MA plans for 2023.

  • Fall prevention: Aetna continues to expand its fall prevention benefit through CVS Pharmacy to additional states and plans. In select MA plans, eligible members will receive an annual allowance for certain clinically appropriate safety items that help lower the risk of injury from falls in the home.

  • Hospice: Aetna understands some members may need extra support at critical points in their lives. So, we’re expanding the number of plans that offer our Compassionate Care Transitions program. On select MA plans in Ohio and Pennsylvania, Aetna will be responsible for members' full medical coverage and hospice services. Members enrolled in this program will have access to supplemental benefits to support their end-of-life journey. These benefits include extra transportation, additional meals, in-home support and access to a personal emergency response system.See Evidence of Coverage for details.

In addition, Aetna will continue to offer the following supplemental benefits and programs as part of its MA plans:

  • Healthy Rewards Program: The program helps members improve their health and well-being with personalized reward activities. All Individual MA members will be able to earn $150 or more annually, depending on plan, to use at an expanded set of merchants, such as local grocery and national restaurant chains, by completing certain healthy activities.

  • SilverSneakers® fitness memberships are available to all Individual MA members at no additional cost.Exception: SilverSneakers is not available with the Aetna Medicare Longevity Plan (I-SNP). Through SilverSneakers, members have access to over 15,000 fitness locations. SilverSneakers FLEX® also gives members access to exercise programs outside of traditional gyms, such as recreation centers, malls and parks. Individuals can also connect to a support network and virtual resources through SilverSneakers LIVE™, SilverSneakers On-Demand™ and our mobile app, SilverSneakers GO™. New in 2023, members can access mental enrichment and well-being classes through GetSetUp.

  • All MA plans will offer an annual healthy home visit at no extra cost that includes a comprehensive health risk assessment and non-invasive physical exam from the comfort of the member’s home. The clinician will also evaluate the home environment to identify social support needs and risks that could result in early detection of health problems. Follow up with the member’s doctor can lead to treatment and a better quality of life.

  • The Aetna Resources For Living® program helps address loneliness and other social needs by connecting members with important community resources, such as transportation, housing, food programs, caregiver support and utility assistance, based on individual member needs. The program serves as an early point of intervention for the many issues that affect our members’ physical and mental health.

Competitive Medicare Supplement and ancillary plan options

To complete our portfolio of products, Aetna also offers Medicare Supplement plans. With more than 1.3 million members, our competitively priced Individual Medicare Supplement plans utilize a simplified underwriting process. We also offer popular dental, vision and hearing products in 37 states. Our ancillary plan options cover 45 states and can provide members with life insurance coverage, benefits paid directly to them after being diagnosed with cancer, or for hospital stays, and home or skilled nursing facility recovery care.

Visit AetnaMedicare.com to learn more about the 2023 Aetna Medicare plans. Or call 1-844-588-0041 (TTY: 711), 7 days a week, 8 AM to 8 PM. The Medicare Annual Enrollment Period runs from October 15 through December 7, 2022. A licensed agent may answer your call.

About CVS Health

CVS Health® is the leading health solutions company, delivering care like no one else can. We reach more people and improve the health of communities across America through our local presence, digital channels and over 300,000 dedicated colleagues – including more than 40,000 physicians, pharmacists, nurses and nurse practitioners. Wherever and whenever people need us, we help them with their health – whether that’s managing chronic diseases, staying compliant with their medications or accessing affordable health and wellness services in the most convenient ways. We help people navigate the health care system – and their personal health care – by improving access, lowering costs and being a trusted partner for every meaningful moment of health. And we do it all with heart, each and every day. Follow @CVSHealth on social media.

About Aetna

Aetna, a CVS Health business, serves an estimated 34 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit www.aetna.com.

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our DSNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Plan features and availability may vary by service area. The formulary, provider and/or pharmacy network may change at any time. You will receive notice when necessary. Aetna Medicare’s pharmacy network includes limited lower cost, preferred pharmacies in Suburban Arizona, Suburban Illinois, Urban Kansas, Rural Michigan, Suburban Michigan, Urban Michigan, Urban Missouri, Suburban Utah, Suburban West Virginia and Suburban Wyoming. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-833-278-3928 (TTY: 711) or consult the online pharmacy directory. Other pharmacies and providers are available in our network. Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services. Members who get “Extra Help” are not required to fill prescriptions at preferred network pharmacies in order to get Low Income Subsidy (LIS) copays. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. Medicare rules don’t allow earned rewards to be used for Medicare-covered goods or services, including medical or prescription drug out-of-pocket costs. Earned rewards may not be used to pay for medical copays, prescription costs, or any other Medicare covered good or services. Earned rewards may also not be used on alcohol, tobacco or firearms or be converted to cash. This material is for informational purposes only and is not medical advice. Health information programs provide general health information and are not a substitute for diagnosis or treatment by a physician or other health care professional. Contact a health care professional with any questions or concerns about specific health care needs. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna is not a provider of health care services and, therefore, cannot guarantee any results or outcomes. The availability of any particular provider cannot be guaranteed and is subject to change. Information is believed to be accurate as of the production date; however, it is subject to change. For more information about Aetna plans, refer to our website. The benefits mentioned are a part of special supplemental program for the chronically ill. Not all members qualify.

SilverScript is a Prescription Drug Plan with a Medicare contract marketed through Aetna Medicare. Enrollment in SilverScript depends on contract renewal. 

Aetna, CVS Pharmacy and MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded walk-in clinics) are part of the CVS Health family of companies.

Resources For Living  is the brand name used for products and services offered through the Aetna group of subsidiary companies.

SilverSneakers is a registered trademark of Tivity Health, Inc. ©2022 Tivity Health, Inc. All rights reserved. GetSetUp is a third-party service provider and is not owned or operated by Tivity Health, Inc. (“Tivity”) or its affiliates. Users must have internet service to access GetSetUp service. Internet service charges are the responsibility of the user. Charges may apply for access to certain GetSetUp classes or functionality.

©2022 Aetna Inc.

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