Aetna Medicare Plan (PPO) 2022 Annual Notice of Changes

The Annual Notice of Changes (NOC) is the official communication from Aetna that outlines all the updates to its Medicare Advantage PPO offering for the upcoming plan year. This page summarizes the most important 2022 changes so you can understand how they affect your coverage, costs, and choices.

Why the Notice Matters

Medicare Advantage plans are required by law to provide a clear, written notice each year that explains any modifications to benefits, premiums, copayments, and network rules. The NOC is the best source for comparing what you had last year with what you will have in 2022, helping you decide whether to stay with Aetna or explore other options during the Medicare Annual Election Period (AEP) (Oct15 Dec7, 2022).

Quick Reference Table

Major Benefit Updates for 2022

1. Premium Increase

A modest $15 per month premium will be added to the plan. This is the first premium charge since 2019 and reflects rising medical costs and expanded pharmacy benefits.

2. OutofPocket (OOP) Maximum

The OOP maximum for medical services is being lowered from $6,350 to $5,900, giving beneficiaries a lower ceiling on what they could spend in a worstcase year.

3. Primary Care and Specialist Copays

• Primary care visits: $25 copay (up $5).
• Specialist visits: remains $40.
• Emergency department (ED) visit: $150 copay (unchanged).

4. Hospital and Skilled Nursing Facility (SNF) CostShares

Inpatient hospital days will now cost $200 per day after the first 30 days (previously $150). SNF stays are unchanged at $100 per day after day 20.

5. Prescription Drug Coverage Enhancements

Tier1 (generic) drugs increase from $5 to $10 per prescription. Tier2 (preferred brand) remains $30, while Tier3 (nonpreferred brand) stays at $50. A new Limited Use list adds a $75 copay for certain highcost specialty drugs that previously required prior authorization.

6. Preferred Pharmacy Network

The network of preferred retail pharmacies is being streamlined to 150 locations nationwide. Members can still use any pharmacy that accepts Medicare, but using a preferred location will keep the lower copays. A map of participating pharmacies is available on the Aetna member portal.

7. Telehealth Expansion

All telehealth visits (both primary and specialist) are now covered with a $10 copay, down from $20. This includes video, phone, and econsultations.

How the Changes Affect You

Understanding the net effect on your personal budget is critical. Below is a simple example comparing a typical year of use:

While the premium increase and higher hospital day cost raise overall expenses, the lower OOP maximum and reduced telehealth copays offset some of those increases for members who use those services frequently.

What to Do Next

1. Review Your Current Utilization Look at the past years claims (available on the Aetna portal) to see which services you used most.
2. Compare Plans Use Medicare.govs Plan Finder or call Aetnas member services to see if another Aetna PPO option or a different carrier better fits your needs.
3. Check Pharmacy Preferences Verify that your preferred pharmacy is in the new network; if not, consider switching to a preferred location to keep lower drug copays.
4. Calculate Your Estimated Costs Use the example table above as a template; plug in your own usage numbers.
5. Make a Decision Before Dec7 If you decide to stay, no action is required; youll be automatically enrolled. To switch, submit your election through Medicare.gov or contact the plan directly.

Frequently Asked Questions

Q1: Will my current doctors stay in the network?

Yes. All providers who were innetwork for the 2021 PPO remain innetwork for 2022. However, a small number of specialists have moved to a different tier, which could affect copay amounts.

Q2: Do I need prior authorization for any drugs that were previously covered?

The new Limited Use list adds a priorauthorization requirement for a handful of highcost specialty medications. The list is available on the Aetna website; most generic and common brandname drugs remain unchanged.

Q3: How can I find a preferred pharmacy?

Log in to Aetnas member portal and use the Pharmacy Locator tool. You can also call the member services line at 18003311475 for assistance.

Q4: Is the plan still a true PPO?

Yes. The plan continues to allow outofnetwork visits, though outofnetwork costs are higher (typically 40% of the Medicareallowed amount after the deductible).

Q5: What happens if I miss the AEP deadline?

You will remain in the 2022 Aetna PPO for another year. You can still change plans during the Medicare Advantage Open Enrollment Period (Jan1Mar312023) if you qualify.

Contact Information

Aetna Member Services
Phone: 18003311475
TTY: 18005235085
Email: medicare@aetna.com
Hours: MondayFriday, 8am8pm ET

For a printable copy of the full 2022 Annual Notice of Changes, visit Aetnas official PDF.