Aetna Medicare Advantage: Big Cuts for 2025

If you are currently enrolled in an Aetna Medicare Advantage plan: there’s some big news coming during the 2025 Annual Election Period that may affect you.

Aetna is one of the largest Medicare Advantage companies in the industry, and during this Annual Election Period, they’re making big changes and terminating certain plans in certain areas of the country. This change is expected to affect as many as 420,000 people across multiple states.

My advice to you is:

If you have an Aetna Medicare Advantage plan, be sure to check your mail for your Annual Notice of Change letter that you should be receiving any day now (also referred to as an “ANOC” or a “plan termination letter”).

Each year, during the Annual Election Period—which runs from October 15th through December 7th—these notifications are sent to all Medicare Advantage plan beneficiaries.

Unfortunately, most people receive these notifications and just throw them away because they’re happy with their plan and they don’t want to take the time to shop.

Well, this year is going to be very different. Keep an eye out for those notifications that are coming through the mail. The details enclosed in those notifications will let you know exactly if that change affects you or if you are simply experiencing a benefit change rather than a full plan loss.

I’ve been teaching people about Medicare for over 15 years. Today, I’m going to dive right into the changes that we’re seeing from Aetna when it comes to the 2025 plan year.

Update: If you have received notice that your plan is changing or ending, please call us to find an alternate option: 888-414-4547

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Aetna’s Statement - What’s Changing?

This statement was taken from an interview that Newsweek did with the CFO of Aetna:

“The goal next year is margin over membership.  Could we lose up to 10% of our existing Medicare members? It’s entirely possible. And that’s okay because we need to get this business back on track.”

Let me explain what he means by that.

All Medicare Advantage companies are reimbursed by CMS, and this year (for the 2025 year) that reimbursement amount was lower than companies expected.

So, when they receive a lower reimbursement rate, coupled with medical costs and the medical loss ratio, the two of those worlds are colliding this year.

Their medical loss ratio is not where it needs to be, and they’re receiving a lower reimbursement rate from CMS to compensate them for each member’s enrollment in one of their Medicare Advantage plans.

Let’s continue on with the Newsweek article:

“Currently, CVS is the third largest Medicare Advantage insurer in the country, with the company saying it had 4.2 million enrollees as of April.

So if 10% of those current plans are ended, that would leave 420,000 beneficiaries needing to switch to a different plan or go without coverage.”

So, the big question is: who will this affect?

Which Aetna Members Will Be Affected?

We know they’re talking about 420,000 people. But where are those people located? Which states? Which plans?

We have limited information on which plans and which locations, but I can tell you that:

• Florida is rumored to have over 90,000 affected members.
• States like Texas also have a high enrollment.
• States like California also have a high enrollment.

Those three states are probably positioned to receive the most losses because they have the highest enrollment in the Medicare Advantage space overall.

Again, I can’t emphasize enough to look for those notifications in the mail.

You may receive two notifications:

#1.  One that says your plan is not renewing, meaning you’re being dropped, or

#2.  One that says your plan is being renewed with benefit modifications (maybe the copays are going to change, if you have a premium, maybe that’s going to increase).

Now the question is raised – what can you do if you are dropped or negatively affected?

What if You Lose Your Medicare Advantage Plan?

If you receive notification of your plan dropping (or changing to an extreme that you don’t like anymore), you do have alternate options.

Here are some tips I’ve learned over the last 15 years.

#1.  If you’ve lost your plan and you want to stay with a Medicare Advantage plan: you can expedite the process by making a list of your doctors,hospitals, and prescriptions (including proper spelling and doses).  Having this information readily available is incredibly helpful when you shop for another plan with a different company.

#2.  If you’ve lost your plan and want to switch to a Medicare Supplement plan: this could be your golden opportunity. Because your Advantage plan will not renew, you will now have what’s called a Guaranteed Issue Right.

What does it mean to have a Guaranteed Issue Right?

This means you will receive a period of time when you can avoid medical underwriting when applying for a new Medigap plan. So, if you had wanted a Medicare Supplement plan in the past but have been unable to get one due to medical issues, you now have this period where you can enroll with no health questions asked.

Again, you should really consider this a golden opportunity to get a Medicare Supplement plan if you can afford it.

Here’s why:

• A Medicare Supplement plan provides far superior coverage.
• You will not deal with a company dropping you like this again.
• You will not deal with prior authorizations.
• Medicare Supplement plans benefits are fixed for life.
• They have no networks.
• They have far less out-of-pocket costs when compared to a Medicare Advantage plan.

I understand it’s not easy for everyone because Medicare Supplement plans have a monthly premium.

But if you can do the math and find that a Medicare Supplement is more beneficial, then capitalize on this situation of Aetna dropping you. Use that guaranteed issue right to get the Medicare Supplement that you’ve wanted in the past.

My Final Thoughts

Florida will probably be the biggest affected state, followed by Texas. Make sure to keep an eye out for these notifications in the mail.

If you have questions, my office and I would be happy to help identify if this is affecting you, or we can certainly help you look for an alternative plan.

If not, I hope this information has been helpful, and these tips and recommendations make the transition as smooth as possible for you during this Annual Election Period. Thanks!

Source:  Newsweek

FAQs

• How much of Aetna's existing Medicare members do they expect to lose in the 2025 plan year?

  They anticipate potentially losing up to 10% of their existing Medicare members due to lower reimbursement rates from CMS and higher medical costs.

• What should members do if they receive a notification from Aetna about their plan being dropped or changed?

  They should make a list of their doctors, hospitals, and prescriptions in order to shop for another plan with a different company. If they wish to switch to a Medicare Supplement plan, this may be an opportunity to do so during the guaranteed issue period. They can also reach out to experts for help in finding alternative plans.

• How does Medicare Supplement coverage compare to Medicare Advantage plans?

  Medicare Supplement plans typically have higher premiums but offer more comprehensive and fixed coverage than Medicare Advantage plans. They also do not have networks or prior authorizations, providing more freedom in choosing healthcare providers. It may be beneficial for some individuals to consider switching to a Medicare Supplement plan if they can afford it.