pros and cons of Aetna Medicare?

[bryan mccormick]

Open thread for good and back feedback on contracting and working with Aetna for MA/PDP.

 

[Chazm]

Too broad of a question. In FL, they have a pretty decent network, up there with UHC and FL Blue, but not quite there. Better benefits. Worse customer service.

 

[StevenjKSU]

They came in like a wrecking ball to Kansas City this AEP. They offered a ton of supplemental benefits like $160 of OTC and a 2K "Fitness Benefit". Mid year they had to pull back on the "Fitness Benefit" so that members wouldn't buy golf clubs and the put a nail in HRA's before any other carrier. They are good to have, because there are only so many carriers and they have brand recognition, but I don't think they will be setting the world on fire in our region in 2025.

I have really liked their PDP designs, but anymore their customer service is a half step above Wellcare and that isn't a compliment. They also performed the old commissionable to noncommissionable bait and switch with ther SmartSaver plan.

Their Med Sups have been a bit pricey, but they pay well and I don't switch very many of my clients off them.

 

[mullenryn]

Looking into the future I think a big con is the benefits of the plan for MAPD Smart Fit will look a lot different and not in a good way. Aetna got destroyed with how much they paid out. I know they fired the guy who came up with all the reimbursement stuff. So Ill be having to switch all my clients.

 

[vic120]

They came in like a wrecking ball to Kansas City this AEP. They offered a ton of supplemental benefits like $160 of OTC and a 2K "Fitness Benefit". Mid year they had to pull back on the "Fitness Benefit" so that members wouldn't buy golf clubs and the put a nail in HRA's before any other carrier. They are good to have, because there are only so many carriers and they have brand recognition, but I don't think they will be setting the world on fire in our region in 2025.

I have really liked their PDP designs, but anymore their customer service is a half step above Wellcare and that isn't a compliment. They also performed the old commissionable to noncommissionable bait and switch with ther SmartSaver plan.

Their Med Sups have been a bit pricey, but they pay well and I don't switch very many of my clients off them.

I will say as far as their drug cov I have a ref partner that prefers then for her clients who are usually on expensive meds, Because they approve meds faster than others

does not want clients on wellcare or humana

 

[LostDollar]

Worse customer service.

I have really liked their PDP designs, but anymore their customer service is a half step above Wellcare and that isn't a compliment. They also performed the old commissionable to noncommissionable bait and switch with ther SmartSaver plan.

Caveat, NOT and never have been, an agent.)

What I have quoted from agents above ^^^^^^^

The above represents my Pre Medicare EGH experience with them. Once the organization has made a coverage decision, the gates to the castle slam shut and every CSR will cite the decision as final and say sorry no help here when asked for review, change or appeal.

@somarco, in another thread, explained about Claims E&O, Tail coverage, and Occurrence E&O.

If I was suddenly to become an agent, I would be in one of @StevenjKSU's market states and might have to contract with Aetna in order to deal with consumers, but I would not sell their Medigap/MA policies without Occurrence E&O, or Tail coverage at the very minimum.

 

[wehotex]

Open thread for good and back feedback on contracting and working with Aetna for MA/PDP.

Is this a trick question?

In the areas that I work, there are only (2) PRO.
1) It has a unique provider network with a broad range of specialists (no “pods”)and PCPs that don’t want to be a part of the dominant medical groups.
2) It has ALWAYS upped renewal commissions to the current FMV as far back as I’ve been writing them.
To an agent, the CONs are:
1) outsourced Agent support line that asks too many verifying questions and don’t know much
2). Provider Network instability
3) They jumped the gun with eliminating HRA payments and the $600 physical activity reimbursements; not honoring its commitments to agents or members.
4) Clunky Commission statements
5) Inept Sales Director (kiss azz and unqualified)
6) introduction of “new, improved” options EVERY YEAR, forcing agents to rewrite his/her members every year.

 

[StevenjKSU]

I will say as far as their drug cov I have a ref partner that prefers then for her clients who are usually on expensive meds, Because they approve meds faster than others

does not want clients on wellcare or humana

I totally agree. If I have someone with a 20 meds and 5 of them brand, I have had incredible luck with the SS Plus PDP if the client can stomach the premium.

I have had to conference call clients with them more often this year than the last 3 combined due to CSR's that don't speak English fluently enough or have enough training to understand their drug plans beyond deductible and Tier 3.

 

[vic120]

I totally agree. If I have someone with a 20 meds and 5 of them brand, I have had incredible luck with the SS Plus PDP if the client can stomach the premium.

I have had to conference call clients with them more often this year than the last 3 combined due to CSR's that don't speak English fluently enough or have enough training to understand their drug plans beyond deductible and Tier 3.

Personally I find the cost plus copays to bne way higher but as far as approvals though

so really depends, if its xerelto or some more cancer drug ''wont put them on it it for reg daily stuff

 

[Chazm]

Caveat, NOT and never have been, an agent.)

What I have quoted from agents above ^^^^^^^

The above represents my Pre Medicare EGH experience with them. Once the organization has made a coverage decision, the gates to the castle slam shut and every CSR will cite the decision as final and say sorry no help here when asked for review, change or appeal.

@somarco, in another thread, explained about Claims E&O, Tail coverage, and Occurrence E&O.

If I was suddenly to become an agent, I would be in one of @StevenjKSU's market states and might have to contract with Aetna in order to deal with consumers, but I would not sell their Medigap/MA policies without Occurrence E&O, or Tail coverage at the very minimum.

LD - I am trying to follow but I have no idea what you are talking about. Your stories almost completely contradict each other lately. Pre Medicare plans have zero correlation to Medicare plans.

You said if you were to become an agent you said you would contract with Aetna but not sell their MA or med supps? Makes zero sense.