Medicare Part D helps pay for heart medications. Some examples are drugs for high blood pressure, arrhythmia and heart failure. If you have Original Medicare (Parts A and B), you can join a separate Part D plan. If you choose a Medicare Advantage plan with drug coverage, your medical and prescription coverage is included in that plan.
Which Aetna® Medicare plans cover my heart medications?
Aetna Medicare has three kinds of plans that may help pay for heart medications:
Aetna Medicare Advantage prescription drug (MAPD) plans
An Aetna Medicare Advantage Prescription Drug (MAPD) plan combines your medical and drug coverage in one plan. It helps pay for some heart medications, doctor visits and some heart tests.
Aetna Medicare prescription drug plans (PDPs)
An Aetna Medicare prescription drug plan (PDP) is a plan that helps pay for covered medications. You can get this plan on its own if you have Original Medicare (Parts A and B.) It can help pay for heart medications.
Aetna Medicare Chronic Condition Special Needs Plans (C-SNPs)
An Aetna Medicare C-SNP is a Medicare Advantage plan with drug coverage. If you qualify, it helps pay for medications for some heart conditions, like heart failure or an irregular (uneven) heartbeat.
Which Aetna Medicare plan should I choose to cover my heart medications?
The plan you choose depends on the Medicare coverage you need. No matter which plan you pick, make sure your heart medication is covered. You can check the plan’s formulary to find out. A formulary is a list of drugs the plan covers. Not all medications are covered by each plan.
Some plan options, like HMO and HMO-POS and PPO may have different rules for coverage. You should also think about the doctors and pharmacies you want to use.
- An Aetna Medicare MAPD gives you medical and drug coverage in one plan. This includes visits to a heart doctor, called a cardiologist. This plan may also cover tests like echocardiograms, which take pictures of your heart using sound waves.
- If you have Original Medicare (Parts A and B), you can add an Aetna Medicare PDP to help pay for heart medications you take at home. This may be a good choice if you want drug coverage without joining a Medicare Advantage plan.
- An Aetna Medicare C-SNP is made for people who have certain long-term conditions, including some heart conditions. It includes medical and drug coverage in one plan.
What is heart medication used for?
Your doctor may give you heart medication to help with different heart conditions. Here are some reasons people take them:
- High blood pressure: They help lower your blood pressure, so your heart does not have to work as hard.
- High cholesterol: They help lower the fat in your blood, so blood can move through your body more easily.
- Chest pain: They help with pain or pressure in your chest, so you can feel more comfortable.
- Arrhythmia: They help your heart beat in a steady way, so it can work the way it should.
- Heart failure: They help your heart pump blood better, so your body can get the blood it needs.
- After a heart attack or stroke: They help protect your heart and brain, so they can heal.
- To lower the risk of blood clots: They help stop blood clots from forming, so blood can flow better.
How does Aetna Medicare drug coverage work?
Medicare drug plans use a few simple tools to decide what medications are covered and what you may pay.
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Formulary
Each plan has a drug list called a formulary. This list shows the drugs the plan covers.
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Drug tiers
Drugs are put into tiers, or cost levels. Drugs in lower tiers may cost less.
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Pharmacy networks
Plans also have pharmacy networks. You need to use a pharmacy in your plan’s network to make sure your medication is covered.
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Medication Therapy Management (MTM)
Medicare drug plans offer MTM. This program can help you understand your medications and get extra support.
How can I check if my heart medication is covered?
To check if your heart medication is covered under your Aetna Medicare plan, follow these steps:
- Look at your plan’s formulary.
- Search for a drug.
- If your drug is not on the list, a drug that is similar may be covered.
- Find the tier it’s in to see the cost and whether there are any special rules.
Can I get a 3-month supply of heart medication?
Some plans may let you get a 3-month supply of certain heart medications you take at home. This depends on your plan, the medication and the pharmacy you use.
A 3-month supply can mean you won’t go to the pharmacy as often. Some plans may also offer mail order, home delivery or pickup at a retail pharmacy.
What can affect my medication coverage and costs?
A few things can change what your plan covers and what you pay:
- Your monthly premium: This is the amount you pay each month for your plan.
- Your yearly deductible: This is the amount you pay first before your plan starts to help.
- Your copay or coinsurance: This is your part of the cost for a covered drug.
- The tier your drug is in: This is the cost level for your drug. Drugs in lower tiers may cost less. Learn more about tiers.
- Which pharmacy you use: You need to use a pharmacy in your plan’s network to make sure your medication is covered. If you use a pharmacy that’s out-of-network, your drug may not be covered so you’ll pay more.
- Prior authorization: The plan must approve some drugs before it will cover them.
What to check before you enroll
If you take heart medications, an Aetna Medicare MAPD, PDP or C-SNP may help pay for some of them.
Before you enroll, check the formulary and see what tier your medication is in. You should also check to see if your pharmacy is in network and any coverage rules. This can help you choose a plan that works for you.
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Disclaimer
The Aetna C-SNP is available to Medicare members who have at least one of the qualifying chronic conditions. To ensure a successful enrollment process, we’ll confirm with your healthcare provider that you have one of these eligible conditions. If verification of eligible condition is not received, involuntary disenrollment will occur.