Aetna Updates MA and Drug Programs for Medicare in 2025

In 2025, Aetna, the health insurance company of CVS Health, has added several new programs to Medicare for 2025.

Aetna will launch new Chronic Condition Special Needs Plans (C-SNPs) in Illinois (Chicago) and Pennsylvania (Philadelphia and Pittsburgh). Aetna’s new programs will provide diabetes, chronic heart failure and cardiovascular disease through collaboration with Oak Street Health, as well as through Dedicated Senior Medical Center in Pennsylvania and JenCare and One Medical Seniors in Illinois. Oak Street Health is a primary care network owned by CVS Health with 230 locations nationwide.

About two-thirds of Medicare enrollees have multiple chronic conditions requiring coordination of care among primary providers and specialists, inpatient and outpatient facilities and ancillary services, according to the Centers for Medicare & Medicaid Services.

Aetna’s program offers beneficiaries $0 copay for primary care visits, $0 copay for visits to certain specialists related to the eligible chronic conditions and an Aetna Medicare Extra Benefits Card. The prescription drug coverage includes lower copays for the drugs members need to manage their conditions, including $0 copay for covered Part D prescription drugs at in-network pharmacies for Low Income Subsidy (LIS) members on certain plans.

Aetna’s Dual Eligible Special Needs Plans (D-SNPs) is being expanded to a new state (Oklahoma). Aetna has also expanded its PPO program for D-SNP beneficiaries to five new states, including Michigan, North Carolina, Oklahoma, South Carolina and West Virginia. These programs are available for members who qualify for Medicare and Medicaid and offer benefits designed to help members address their unique health and social barriers, such as food and housing instability and access to care. About 12.9 million people received health coverage under both Medicare and Medicaid in 2021, according to KFF.

Aetna has also expanded its Medicare Eagle MA-only plans to Rhode Island, Maryland and the District of Columbia. These plans offer additional benefits for veterans or individuals who already have prescription drug coverage. (These plans don’t include prescription drug programs.)

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.

On the prescription drug side, Aetna has added 76 new counties across the country to the Medicare Advantage Prescription Drug (MAPD) plan. In total, Aetna will offer MAPD plans in 2,259 counties in 2025, accessible by 59 million Medicare-eligible beneficiaries. All of Aetna’s MAPD members have $0 deductible on all Tier 1 and Tier 2 drugs. The company also offers plans with a $0 deductible on all tiered drugs.

In 2025, Aetna will also merge its three stand-alone prescription drug plans (PDP) into a single plan — SilverScript Choice (PDP) — that will be available in all 50 states and D.C. The SilverScript Choice will offer a $0 monthly plan premium for beneficiaries who qualify for full Extra Help in 33 states and D.C. For members not receiving Extra Help, SilverScript Choice premiums will range from $23.50 to $66. New for 2025, the standard cost-share network of more than 63,000 pharmacies, meaning that member cost-shares are consistent at every pharmacy in the network.

Next year, out-of-pocket costs on prescription drugs in Part D will be capped at $2,000 as part of the Inflation Reduction Act. This cap is expected to benefit about 3.2 million people, or 8.4%, of the Part D plan enrollees, according to recent research commissioned by AARP. That number will increase to 4.1 million, or 9.6%, or Part D enrollees in 2029, according to AARP, which hired Avalere to conduct the research.

Medicare annual enrollment runs from Oct. 15, 2024, to Dec. 7, 2024.