Aetna 2025 Medicare plans focus on most important health needs for members

Rhea-AI Summary

Aetna, a CVS Health company, has announced its 2025 Medicare products, focusing on core benefits that support overall health. The plans offer value, choice, and affordability with options including:

- $0 monthly plan premium
- $0 primary care copay
- $0 copay for Tier 1 drugs
- Dental, vision, hearing, and SilverSneakers benefits in every county served

Aetna will offer Medicare Advantage Prescription Drug (MAPD) plans in 44 states plus Washington, D.C., expanding to 76 new counties. The company estimates that 83% of Medicare-eligible beneficiaries will have access to a $0 monthly premium Aetna MA plan. New offerings include Chronic Condition Special Needs Plans (C-SNPs) in select areas and expanded Dual Eligible Special Needs Plans (D-SNPs).

The plans are backed by CVS Health's resources, offering access to MinuteClinic locations, OTC benefits, and Healthy Home Visits through Signify Health.

Positive

• Expansion of MAPD plans to 76 new counties, reaching 662,000 more Medicare-eligible beneficiaries
• 83% of Medicare-eligible beneficiaries estimated to have access to a $0 monthly premium Aetna MA plan
• Introduction of new Chronic Condition Special Needs Plans (C-SNPs) in select areas
• Expansion of Dual Eligible Special Needs Plans (D-SNPs) to new states
• Integration of Aetna Medicare Extra Benefits Card for simplified member experience
• $2,000 out-of-pocket maximum for covered drugs in MAPD plans
• Access to CVS Health resources like MinuteClinic and OTC benefits

Negative

• Merger of three individual PDP products into a single plan, potentially reducing choice for some members
• SilverScript Choice (PDP) premiums ranging from $23.50 to $66 for members not receiving Extra Help

Insights

Financial Analyst

Aetna's 2025 Medicare plans announcement is moderately positive for CVS Health. The company is expanding its Medicare Advantage (MA) footprint to 44 states and D.C., adding 76 new counties and reaching 59 million potential beneficiaries. This growth strategy could drive revenue and market share gains in the competitive Medicare market.

Key points:

• Expansion of Dual Eligible Special Needs Plans (D-SNPs) and introduction of Chronic Condition Special Needs Plans (C-SNPs) target high-need, high-cost populations, potentially improving profit margins.
• 83% of Medicare-eligible beneficiaries will have access to a $0 premium Aetna MA plan, which could boost enrollment.
• Integration of CVS Health resources (MinuteClinic, OTC benefits, Oak Street Health) may enhance member satisfaction and retention.

However, the impact on profitability remains uncertain due to potential increased competition and regulatory pressures in the Medicare market. Investors should monitor enrollment numbers and profit margins in upcoming quarters to assess the success of these plan offerings.

Healthcare Policy Expert

Aetna's 2025 Medicare plans reflect several key trends in healthcare policy and market dynamics:

• Focus on value-based care: The emphasis on $0 copays for primary care and integration with CVS Health resources aligns with the industry shift towards preventive care and cost-effective delivery models.
• Addressing social determinants of health: The inclusion of benefits like the Aetna Medicare Extra Benefits Card and CVS Health Resources For Living program demonstrates a growing recognition of non-medical factors affecting health outcomes.
• Prescription drug affordability: The $2,000 out-of-pocket maximum for covered drugs and $35 cap on insulin costs align with recent policy changes aimed at reducing medication expenses for seniors.

These plan features suggest Aetna is adapting to evolving regulatory requirements and consumer expectations in the Medicare market. The expansion of Special Needs Plans also indicates a strategic focus on high-need populations, which could position CVS Health favorably as policymakers continue to emphasize care for vulnerable groups.

Backed by the strength of CVS Health

WOONSOCKET, R.I., Oct. 1, 2024 /PRNewswire/ -- Aetna®, a CVS Health® company (NYSE: CVS), today announced our 2025 Medicare products bring together what matters most to our members with a focus on core benefits that support their overall health. We offer value, choice and affordability with our Medicare Advantage (MA) plan options, including $0 monthly plan premium, $0 primary care copay, $0 copay for Tier 1 drugs, plus dental, vision, hearing and SilverSneakers® benefits in every county we serve. We'll also continue to provide an expansive product portfolio — including Medicare Advantage Prescription Drug (MAPD), MA-only, prescription drug plan (PDP), Special Needs Plan (SNP), Medicare Supplement and ancillary products — to support the diverse needs of consumers.

"For 2025, our continued focus is ensuring members have the peace of mind that comes with access to reliable, affordable health care when and where they need it," said Anand Shukla, president of Aetna Medicare. "Our plans are backed by our excellent customer service, deep experience and steadfast commitment to serving members at every stage of their health journey."

A pioneer in the Medicare industry, Aetna has served Medicare beneficiaries since 1966, when it paid the nation's first Medicare claim. Aetna now serves about 10.5 million Medicare members nationwide, including 4.3 million currently enrolled in an Aetna individual or employer group MA plan. Our Aetna Member Services team advocates for our members and stands ready to support them with any questions about their plans.

Individual MA plans to support diverse needs

In 2025 we will offer a wide variety of MA products, which include preferred provider organization (PPO) products for those who value flexibility, health maintenance organization (HMO) products for members focused on affordability and Special Needs Plans for those who need added support. Plan highlights include:

• Footprint: For 2025, Aetna will offer MAPD plans in 44 states plus Washington, D.C. We added 76 new counties across the country, providing 662,000 more Medicare-eligible beneficiaries access to an Aetna plan. In total, Aetna will offer MAPD plans in 2,259 counties in 2025, accessible by 59 million Medicare-eligible beneficiaries.¹
• $0 premium plan options: Aetna estimates 83% of the Medicare-eligible beneficiaries in the U.S. will have access to a $0 monthly premium Aetna MA plan.²
• Dual Eligible Special Needs Plans (D-SNPs): For members who qualify for Medicare and Medicaid, we're expanding D-SNP into a new state (OK) and bringing D-SNP PPO plan options to five new states (MI, NC, OK, SC, WV). Aetna D-SNPs offer benefits designed to help members address their unique health and social barriers, such as food and housing instability and access to care through transportation. All D-SNPs feature the Aetna Medicare Extra Benefits Card, which can be used to buy over-the-counter (OTC) products, healthy foods and other everyday items to promote good health.³
• New Chronic Condition Special Needs Plans (C-SNPs): Continuing our mission of offering products to support every phase of a member's health care journey, Aetna will launch C-SNPs in Illinois (Chicago) and Pennsylvania (Philadelphia and Pittsburgh). Aetna C-SNPs are designed to support members with diabetes, chronic heart failure and cardiovascular disease through collaboration with Oak Street Health®, a CVS Health company, and other high-quality primary care providers (PCPs) who specialize in caring for Medicare members like Dedicated Senior Medical Center in Pennsylvania and JenCare and One Medical Seniors in Illinois. The C-SNPs offer $0 copay for primary care visits, $0 copay for visits to certain specialists related to the eligible chronic conditions, an Aetna Medicare Extra Benefits Card and more. The prescription drug coverage includes lower copays for the drugs members need to manage their condition, including $0 copay for  covered Part D prescription drugs at in-network pharmacies for Low Income Subsidy (LIS) members on certain plans.   
• Expanded Aetna Medicare Eagle® MA-only plans: We'll expand these MA-only plans to 43 states plus D.C. (adding Rhode Island, Maryland and the District of Columbia) and 2,060 counties — reaching more than 7.1 million veterans over age 65 in 2025. These plans offer additional benefits for veterans or individuals who already have prescription drug coverage.⁴ All 2025 Aetna Medicare Eagle plans will feature a $0 monthly plan premium, $0 primary care copay (including walk-in clinics), dental, vision, hearing, OTC allowance and a SilverSneakers fitness benefit. These plans also offer $0 copays for labs, colonoscopies and routine eye and hearing exams. We also have MA-only plans with a Part B premium reduction benefit. 
• Aetna Medicare SmartFit plans: Available in 10 states, these plans are designed for prescription drug plan customers considering switching to a Medicare Advantage plan. These $0 monthly premium plans include dental, vision and hearing. There is also a variety of benefits like $0 in-network primary care visits and labs and a $0 copay for Tier 1 and Tier 2 drugs at preferred pharmacies and through mail order.

Supporting members with benefits that matter most to their health

Medicare members tell us they want to know their plan is there for them when they are sick, but also includes benefits to help keep them healthy. Highlights for 2025 include:

• Maintained core benefits: Every county where Aetna offers plans has options that include a $0 monthly plan premium, $0 primary care copay, $0 copays for Tier 1 drugs, plus dental, vision, hearing and SilverSneakers benefits. 
• Dental: All of our plans include a dental benefit. We have plans with an annual allowance for services like dentures and crowns. Allowances vary by plan.  
• Hearing: All plans include a $0 routine hearing exam and hearing aid benefits. 
• Vision: All plans offer a $0 routine eye exam. We also have plans with an eyewear benefit. Eyewear allowances vary by plan. 
• Integrated Aetna Medicare Extra Benefits Card: New for 2025, we're integrating our current cards (the Aetna Medicare Payment Card and the Aetna Medicare Extra Benefits Card) into one card, called the Aetna Medicare Extra Benefits Card, powered by CVS Health. The new Extra Benefits Card offers members a simplified experience with one card for all card-based benefits — also known as "wallets." The card gives members flexibility to use their wallet allowances on eligible products and services where and how they see fit — including CVS® and over 70,000 other retail locations. Card benefits vary by plan and can help members cover out-of-pocket medical expenses or pay for certain everyday items like healthy foods and OTC products. Some card benefits require members to meet eligibility. All 2025 Aetna D-SNPs and C-SNPs offer an Extra Benefits Card.³
• High-value primary care providers: These doctors specialize in caring for Medicare members. In certain markets, eligible members who choose a high-value PCP will receive extra bonus dollars on their Aetna Medicare Extra Benefits Card. Qualifying non-SNP members will also receive reduced cost-share on certain services, such as $10 in-network specialist/podiatry visit copays and $0 routine behavioral health visits.
• Fitness benefit: Our fitness benefit helps our members stay physically and mentally active, so they can keep enjoying their favorite activities as they age:
  • SilverSneakers: We'll continue to offer a SilverSneakers fitness membership to all individual MA members at no additional cost.⁵ Through SilverSneakers, members have access to over 15,000 fitness locations, as well as exercise programs outside of traditional gyms, such as recreation centers, medical centers and parks. Individuals can also connect to virtual resources, including mental enrichment and well-being classes.
• $0 cost-shares on select benefits: To ensure important services are affordable, we offer certain services at no additional cost to the member, including $0 copay for colonoscopies at in-network providers. In 2025, we have plans that offer $0 copay for primary care visits and labs.
• Member out-of-pocket costs limits: All Aetna MA plans include maximum out-of-pocket cost protection for covered medical services.

Continued refinements in prescription drug coverage across MAPD plans

We continue to refine our MAPD drug lists and benefit designs to increase transparency, reduce costs and lower obstacles to accessing medications. These changes help our members get the medications they need and follow their recommended treatment. Highlights for 2025 include:

• $2,000 out-of-pocket maximum: The maximum amount all MAPD members will pay for covered drugs is $2,000 per calendar year.
• $0 deductibles: All MAPD members will enjoy a $0 deductible on all Tier 1 and Tier 2 drugs. We also have plans with a $0 deductible on all tiered drugs (Tiers 1–5). 
• $0 copays at preferred network pharmacies: All of our MAPD plans will offer $0 copays on Tier 1 drugs. We also have plans with $0 copays on Tier 1 and Tier 2 drugs, for 30-, 60- or 100-day supplies. 
• Pharmacy network: We have MAPD plans that offer prescription drug coverage with access to over 63,000 network pharmacies, including more than 22,000 preferred pharmacy options that offer members additional savings. 
• 100-day supply: All MAPD plans will offer up to a 100-day supply⁶ for drugs on Tiers 1–4 at both retail and mail-order pharmacies. Extended-day supplies may save members money and help them stay on their medication treatment program. 
• Preferred mail-order pharmacy: Members can choose this convenient option to get their prescriptions mailed to their homes at no-cost standard shipping.
• $0 copays and $0 deductibles on D-SNPs: All D-SNPs will share one set of common features — robust drug coverage, $0 deductibles and $0 Part D prescription drug copays at in-network pharmacies. Members simply need to qualify for D-SNP enrollment to receive this benefit. 
• Insulin: Members will pay $35 or less for a one-month supply of each insulin product covered by our plan. 
• Vaccines: Most covered Part D vaccines will be available at $0 copay for Medicare beneficiaries. 

Backed by the strength and connected health resources of CVS Health

As a CVS Health company, Aetna offers a unique set of resources that enables us to bring together the quality care and services closer to home so members can get the most value from their plan. We'll provide individual MA members access to convenient and affordable benefits and programs in their communities, including:

• Nationally contracted retail health clinics, including MinuteClinic®: Members in PPO and HMO plans that do not require a PCP can visit either one of the nationally contracted retail health clinics, including MinuteClinic locations, and pay the same copay as a regular visit to a PCP.⁷ With approximately 1,000 locations nationwide and virtual on-demand care available, MinuteClinic offers convenient access for sick care, prevention and wellness services, and management for chronic conditions. For patients over 65, MinuteClinic delivers age-friendly care via the 4Ms framework: what matters, medication, mentation and mobility. Located in select CVS Pharmacy® stores, MinuteClinic locations are open seven days a week, including evenings.
• Over-the-counter (OTC) benefit: OTC benefits are offered through OTC Health Solutions®, a CVS Health company, and enable members to access certain over-the-counter health and wellness products like aspirin and bandages — in store, online or by phone. New for 2025, members on certain plans will receive an Aetna Medicare Extra Benefits Card to use their OTC benefit in-store at all stand-alone CVS Pharmacy or Navarro Discount Pharmacy® locations across 47 states and D.C. With some plans, members can also use the card at other participating retailers. For other plans, members can access their OTC benefit by presenting their member ID card at CVS Pharmacy and Navarro Discount Pharmacy locations.
• Healthy Home Visits through Signify Health®: All MA plans will offer an annual Healthy Home Visit from a licensed Signify Health clinician at no additional cost. It includes a comprehensive health assessment, which complements the member's primary care visit, from the comfort of their home. The clinician will also evaluate the home environment to identify fall risks and social support needs. The goal is to prevent and detect health problems early, improve care coordination and keep members healthy.
• Oak Street Health primary care network: With more than 230 locations nationwide, Oak Street Health enables us to offer holistic, coordinated and connected care — especially in underserved communities. The Oak Street Health innovative care model provides comprehensive primary care with a focus on prevention and wellness. Aetna MA members in these regions will have access to Oak Street Health primary care clinics as part of the extensive Aetna provider network. Aetna members have access to a robust provider network with many options for primary care.
• Fall prevention: For 2025, all D-SNPs (except the NY FIDE plan) will include a fall prevention benefit. We also have MA plans with an annual allowance for eligible members to get certain home and bathroom safety items that may help lower the risk of injury from falls in the home.
• Pharmacist support: We'll connect members who are CVS Pharmacy customers with their local CVS pharmacist. Our CVS pharmacists can deliver personalized advice to drive medication adherence, close medication gaps and administer immunizations. 
• CVS Health Resources For Living® (RFL®): This program⁸ helps address basic needs around social determinants of health by connecting members with important community resources, such as transportation, housing, food programs, caregiver support and utility assistance, based on individual member needs. RFL serves as an early point of intervention for the many issues that affect our members' physical and mental health, such as loneliness.

Simplified stand-alone prescription drug plan coverage

The Aetna stand-alone prescription drug plan (PDP) portfolio serves nearly 5 million members. In 2025, Aetna Medicare will merge its three individual PDP products into a single plan — SilverScript® Choice (PDP) — available in all 50 states and D.C. The SilverScript Choice (PDP) will offer a $0 monthly plan premium to members with full Extra Help in 33 states and D.C. SilverScript Choice (PDP) premiums will range from $23.50 to $66 for members not receiving Extra Help.⁹ New for 2025, we simplified the SilverScript Choice (PDP) network to a standard cost-share network of over 63,000 pharmacies — this means member cost-shares are consistent at every pharmacy in the network.

Competitive Medicare Supplement and ancillary plan options

To complete our portfolio of products, Aetna also offers Medicare Supplement plans for Medicare eligibles who choose Original Medicare. With approximately 1.3 million members, our competitively priced individual Medicare Supplement plans use a simplified underwriting process, are guaranteed renewable, are not subject to any network restrictions or preauthorizations, and are accepted anywhere Medicare is accepted. We also offer popular dental, vision and hearing products in 40 states. Other ancillary plan options cover 45 states, offering members personalized, add-on protection to their individual Medicare plans. In addition to dental, vision and hearing, ancillary plans include indemnity coverages for life insurance, cancer, heart attack and stroke, hospital stays and recovery care in the home or in skilled nursing facilities.  

Visit AetnaMedicare.com to learn more about our 2025 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, 2024. A licensed agent may answer your call.

¹This number includes the Aetna Joint Venture in Minnesota (with Allina Health).
²Centers for Medicare & Medicaid Services (CMS) Enrollment data, July 2024.
³Members in a CA D-SNP receive an OTC allowance. Those with a qualifying condition also receive an allowance for healthy foods. Members in NJ and NY FIDE plans can use the allowance for OTC products only. Those with a qualifying condition can use the allowance for all of the other Extra Supports spending categories. 
⁴These 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 ("creditable coverage").
⁵Exception: SilverSneakers is not available for members with Institutional Special Needs Plans (I-SNPs).
⁶Not 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.
⁷Members have a choice of providers and can elect to go to their PCP or a nationally contracted clinic of their choice.   
⁸RFL is not available for members with Aetna Part D (prescription only) plans, Dual Eligible Special Needs Plans (D-SNPs), Chronic Special Needs Plans (C-SNPs), Institutional Special Needs Plans (I-SNPs) or Medicare Supplement plans.
⁹CMS: https://www.cms.gov/medicare/coverage/prescription-drug-coverage.

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 more than 36 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 Aetna.com.

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our D-SNPs 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 /or pharmacy network may change at any time. You will receive notice when necessary. The Aetna Medicare pharmacy network includes limited lower cost, preferred pharmacies in Suburban Arizona, Rural California, Urban Kansas, Rural Michigan, Urban Michigan, Urban Missouri, Rural North Dakota and Suburban West Virginia. 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. Participating 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. Eligibility for the Model Benefit or Reward and Incentive (RI) Programs under the Value-Based Insurance Design (VBID) Model is not assured and will be determined by Aetna after enrollment, based on relevant criteria (e.g., clinical diagnoses, eligibility criteria, participation in a disease state management program). For mail-order, you can get prescription drugs shipped to your home through the network mail-order delivery program. Typically, mail-order drugs arrive within 10 days. You can call 1–866–235–5660 (TTY: 711), 24 hours a day, 7 days a week, if you do not receive your mail-order drugs within this timeframe. Members may have the option to sign up for automated mail-order delivery. The benefits mentioned are part of a special supplemental program for the chronically ill. Eligibility is determined by whether you have a chronic condition associated with this benefit. Standards may vary for each benefit. Conditions include Hypertension, Hyperlipidemia, Diabetes, Cardiovascular Disorders, Cancer. Other eligible conditions may apply. Contact us to confirm your eligibility for these benefits.

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

Aetna, MinuteClinic, LLC (which either operates or provides certain management support services to MinuteClinic-branded retail health clinics), CVS Pharmacy, Signify Health and Oak Street Health 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. ©2024 Tivity Health, Inc. All rights reserved.

©2024 Aetna Inc.
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Media contact
Ethan Slavin
860-273-6095
SlavinE@CVSHealth.com

Investor contact
Larry McGrath
800-201-0938
investorinfo@CVSHealth.com

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SOURCE CVS Health

FAQ

What are the key features of Aetna's 2025 Medicare Advantage plans?

Aetna's 2025 Medicare Advantage plans offer $0 monthly plan premium, $0 primary care copay, $0 copay for Tier 1 drugs, plus dental, vision, hearing, and SilverSneakers benefits in every county served. The plans also include a $2,000 out-of-pocket maximum for covered drugs and access to CVS Health resources.

How many states will Aetna offer MAPD plans in for 2025?

Aetna will offer Medicare Advantage Prescription Drug (MAPD) plans in 44 states plus Washington, D.C. for 2025, expanding to 76 new counties.

What new types of plans is Aetna introducing for 2025?

Aetna is introducing new Chronic Condition Special Needs Plans (C-SNPs) in select areas of Illinois and Pennsylvania, and expanding Dual Eligible Special Needs Plans (D-SNPs) to new states including Oklahoma, Michigan, North Carolina, South Carolina, and West Virginia.

What changes are being made to Aetna's standalone prescription drug plans for 2025?

For 2025, Aetna is merging its three individual PDP products into a single plan called SilverScript Choice (PDP), available in all 50 states and D.C. The plan will offer a $0 monthly premium to members with full Extra Help in 33 states and D.C.

How is CVS Health (NYSE: CVS) integrated into Aetna's 2025 Medicare plans?

CVS Health resources are integrated into Aetna's 2025 Medicare plans through access to MinuteClinic locations, OTC benefits at CVS Pharmacy stores, and the Aetna Medicare Extra Benefits Card powered by CVS Health for various health-related expenses.