Aetna Expands Support for Medicare-Medicaid Beneficiaries
Aetna, a CVS Health company (NYSE: CVS), is set to enhance healthcare services for residents eligible for both Medicare and Medicaid. Recently, Aetna was recommended for a new contract that will allow it to provide critical support to individuals who often face complex health care needs.
New Contract Benefits for Dually Eligible Residents
With this new contract, beneficiaries in Michigan will gain access to an Aetna Highly Integrated Dual Eligible Special Needs Plan (HIDE SNP). This plan encompasses all necessary Medicare benefits while also covering most Medicaid provisions. Additionally, it integrates essential long-term services and supports (LTSS) specifically designed for dually eligible members.
Expansion of Services Across Counties
Currently, Aetna supports dually eligible individuals across 10 counties in Michigan. However, under the new contract, Aetna will expand its services to an additional 29 counties starting in 2027. This move underscores Aetna's commitment to ensuring all eligible individuals receive the healthcare services they need.
Importance of Coordinated Care
Jason Smith, Vice President of Duals Markets at Aetna, emphasizes the importance of coordinated benefits for those dually eligible for Medicare and Medicaid. "Individuals dually eligible often have complex health care needs, making coordination of benefits essential for positive health outcomes," said Smith. Aetna's new contract represents a significant opportunity to facilitate access to quality healthcare for these vulnerable populations.
Aetna's Proven Experience in Michigan
Aetna has an extensive history in serving dually eligible beneficiaries in Michigan, operating a Medicare-Medicaid Plan (MMP) for over a decade. Currently, the company manages the healthcare benefits for approximately 8,500 members. The transition to the new contract reflects a shift from the previous MMP plan design, which functioned as a demonstration program.
Contract Timeline and Implications
The new contract is anticipated to begin on January 1, 2026, following the conclusion of the state's protest period and readiness review. It is set to last until December 31, 2033, with potential renewal options. Notably, this new agreement will not disrupt Aetna Better Health of Michigan's existing contract dedicated to serving the Medicaid-eligible population under the Comprehensive Health Care Program (CHCP).
About Aetna
Aetna, as part of CVS Health, provides health insurance services to an estimated 36 million individuals. The company offers an extensive array of plans, including traditional, voluntary, and consumer-directed health insurance options alongside pharmacy, dental, and behavioral health services. Aetna has tailored its offerings to meet the needs of diverse customer groups?
Healthcare Services and Customer Focus
Aetna's commitment to enhancing health care includes personalized service and access to a wide variety of resources tailored to its customers' needs. The company continues to innovate in response to changing healthcare demands, ensuring that customers receive the best care possible.
Frequently Asked Questions
What is the new contract between Aetna and the State of Michigan?
The new contract allows Aetna to provide enhanced services to residents eligible for both Medicare and Medicaid, including integrated health plans.
How will Aetna's services expand in Michigan?
Aetna will expand its services from 10 to 39 counties, improving access for many more dually eligible residents starting in 2027.
What types of benefits will the HIDE SNP provide?
The HIDE SNP will cover all Medicare benefits, most Medicaid benefits, and offer long-term services and supports for beneficiaries.
When is the new contract expected to begin?
The new contract is expected to take effect on January 1, 2026, pending the state’s protest period and readiness review.
What experience does Aetna have serving dually eligible members?
Aetna has over 10 years of experience providing Medicare-Medicaid Plan services to dually eligible individuals in Michigan, currently managing care for around 8,500 members.
