Your Aetna Smart Fit PPO Comparison
Thank you for being a valued Aetna Member. New in 2025 Medicare is changing how your prescription drugs are going to be covered. Next year Medicare is capping prescription drug costs at $2,000. Meaning no individual on Medicare can spend more than $2000 out of their pocket on medication costs. This is a wonderful change as many Americans will see their Rx costs significantly drop. With this benefit starting next year, all of the insurance companies have had to make adjustments to their plans to accommodate for this extra cost. Aetna is no different. Aetna’s goal was to keep the core benefits of your insurance policy as close to what they were in previous years. You are going to see very minimal changes in Copays with your plan. Where you will see changes are on the prescription drugs & extra benefits like dental and vision. As an Aetna member you will still have access to Ascension, Aurora, Froedtert, Pro Healthcare and Aetna’s nationwide network and have urgent care and emergency coverage worldwide. If you are happy with your coverage, there is nothing you have to do. Your plan will automatically renew for next year. We have included some links below that we hope you will find useful. We have also attached a PDF of your insurance plan to review all of next years benefits’. We encourage you to review the chart and reach out to our office and your agent if you have any questions or would like to discuss other options. When you call our office you will get a real person, no voicemail jail. You will undoubtably receive solicitations in the mail and unwanted calls on your phone. Many of these mailers are illegal and misleading. It is also illegal for anyone to call you on your phone. No one from Medicare or Social Security will ever call you, these are scams. As a reminder, FHK Insurance and your agent represent all of the insurance plans in the area and if you have any questions on anything, we look forward to hearing from you
EyeMed link: AetnaMedicareVision.com
Nations Hearing Link: >Aetna.Nationsbenefits.com/Hearing
Dental link: AetnaMedcare.com/Dental
Find a Doc: Aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
SOB link:
2024
2025
Smart Fit
Smart Fit
H5521-403
H5521-403
Southeastern
Southeastern
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 / $35
$0 / 50%
Specialist
$30 / $55
$40 / 50%
Physical Therapy
$35 / 50%
$40 / 50%
Urgent Care
$35
$35
Hospital
$280 days 1-8
$315 days 1-8
Out of Network
50%
50%
MOOP Cap
$4,200 / $8,250
$4,700 / $8,250
Outpatient Surgery
$300 / 50%
$315 / 50%
Ambulance
$275 / $325 (air)
$275 / 20% (air)
Emergency
$110
$125
Lab Services
$0 / $30
$0 / 50%
X-Rays
$0 / 50%
$0 / 50%
Complex Diagnostic
$290 / 50%
$300 / 50%
Part D
$0 / $10 / 20% / 50%
$0 / $0 / 24% /25%
100 Day- Mail Order
$0 / $10 / 20% / 50%
$0 / $0 / 24% / 25%
Part D Deductible
$250
$590
(applies to 3,4,5)
(applies to 3,4,5)
Hearing Aid
$500 / ear
$500 / ear
OTC
$90 / quarter
$60 / quarter
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$2,600 DMR
$2,200 DMR
Dental Network
Aetna / 80% OON
Aetna / 50% OON
Vision
$200 (Eye Med)
$160 (Eye Med)
Extras
$1,200 fitness DMR
$100 payflex card/qtr
$90/qtr fitness DMR
Your Aetna Smart Fit PPO Comparison
Thank you for clicking onto this page to learn about some of the changes with your Aetna SmartFIT PPO plan for 2025. As you will see, most of the changes are better or the same for next year. No change is great news for 2025. With Aetna, you still get access to most of the Doctors and Hospitals in WI, Froedtert, ProHealth, Aurora, Asension, and many more nationwide remain in network for 2025. Since the Inflation Reduction Act has changed how these plans can provide benefits, the Part D program and the extras are a little different for next year. In this case, there is a $590 deductible for Part D in 2025, this only applies to Tiers 3,4,5. New Rule for 2025, the most you can pay for drugs that are listed on the formulary is $2,000 for the year. The $0 copays for Tier 1and Tier 2 medications remain along with the CVS centric pharmacy network. Express scripts will remain for Mailorder medications.
Aetna continues to have some of the strongest dental benefits, for 2025 it is $2200 benefit, but a much bigger emphasis on being in-network in 2025 as the benefit goes to 50% if your dentist does not participate in Aetna’s Dental network. Click here to check if your dentist is in network.
In closing, all the companies are a little bit tighter for next year and If you would like to review these changes we encourage you to reach out to your agent. For a full listing of Aetna benefits, see below for the summary of benefits. If you would like to review these changes we encourage you to reach out to your agent. For a full listing of Aetna benefits, see below for the summary of benefits.
2024
2025
Smart Fit
Smart Fit
H5521-403
H5521-403
Southeastern
Southeastern
In Network / Out of Network
In Network / Out of Network
Premium
$0
$0
Primary Doctor
$0 / $35
$0 / 50%
Specialist
$30 / $55
$40 / 50%
Physical Therapy
$35 / 50%
$40 / 50%
Urgent Care
$35
$35
Hospital
$280 days 1-8
$315 days 1-8
Out of Network
50%
50%
MOOP Cap
$4,200 / $8,250
$4,700 / $8,250
Outpatient Surgery
$300 / 50%
$315 / 50%
Ambulance
$275 / 20% (air)
$275 / $325 (air)
Emergency
$110
$125
Lab Services
$0 / $30
$0 / 50%
X-Rays
$0 / 50%
$0 / 50%
Complex Diagnostic
$290 / 50%
$300 / 50%
Part D
$0 / $10 / 20% / 50%
$0 / $0 / 24% / 25%
100 Day- Mail Order
$0 / $10 / 20% / 50%
$0 / $0 / 24% / 25%
Part D Deductible
$250
$590
(applies to 3,4,5)
(applies to 3,4,5)
Hearing Aid
$500 / ear
$500 / ear
OTC
$90 / quarter
$60 / quarter
Gym Membership
Silver Sneakers
Silver Sneakers
Dental
$2,600 DMR
$2,200 DMR
Dental Network
Aetna / 80% OON
Aetna / 50% OON
Vision
$200 (Eye Med)
$160 (Eye Med)
Extras
$1,200 fitness DMR
$100 payflex card/qtr
$90/qtr fitness DMR
EyeMed link
AetnaMedicareVision.com
Nations Hearing Link
Aetna.Nationsbenefits.com/Hearing
Dental link
AetnaMedcare.com/Dental
Find a Doc
Aetnamedicare.com/en/find-doctors-hospitals/find-provider.html
SOB link: