New Medicare options available through Prisma Health, Aetna partnership


Medicare beneficiaries in Sumter County are among a group eligible to take advantage of a new partnership between Prisma Health and Aetna.

The health care system and Aetna, a CVS Health® company, announced a new Medicare Advantage Plan that will be available to Medicare beneficiaries in Anderson, Fairfield, Greenville, Kershaw, Laurens, Lexington, Newberry, Oconee, Pickens, Richland, Spartanburg and Sumter counties. The plan is being offered during the Medicare Annual Enrollment Period, which opened Oct. 15 and closes Dec. 7. Coverage will become effective January 2022.

"The Aetna Medicare Prime Plan (HMO-POS) was designed based on insights from Prisma Health physician leaders who understand our community and who have deepened the level of trust with our patients and the communities where they live. Care is local, and we feel strongly that Prisma Health and its network of community physicians are making a difference in the lives of South Carolinians," said Shawn Armstrong, senior vice president, Payor Strategies and Value Based Care at Prisma Health. "Both Aetna and Prisma Health believe that a national insurance carrier and a local physician network working together can improve quality, make the health care experience easier, make health care more efficient and reduce health care costs. We're looking forward to this new collaboration."

The Aetna Medicare Prime plan combines national expertise in health plan administration from Aetna with the Prisma Health care management model, which encompasses an expansive network of providers and medical facilities. Together, Aetna and Prisma Health are developing innovative ways to enhance health care, according to a news release.

This new product will be available to the 460,000 individuals eligible for Medicare in much of the Upstate and Midlands regions of South Carolina. The goal is to connect consumers with an integrated solution to their health care needs. The focus is to improve the coordination, clinical performance and efficiency of care for members of this plan.

Medicare Advantage plans provide the same benefits as Original Medicare Parts A and B. However, consumers may choose this new Medicare Advantage plan for meaningful extra benefits, lower cost-sharing and an annual out-of-pocket cost limit on covered medical services. This medical and prescription drug plan gives members access to in-network care with Prisma Health physicians and facilities and many aligned independent providers.

Some of the Aetna Medicare Prime Plan (HMO-POS) benefits, according to the news release, include:

- No medical or prescription drug deductibles and copays ranging from $0-12 for in-network doctor visits, including specialists;

- A limit on the maximum out-of-pocket expenses for covered medical services for members to no more than $5,900 per year;

- Allowances for dental, vision and hearing services;

- Transportation and an allowance for over-the-counter products; and

- Rewards for healthy behavior.

"This plan was designed specifically with Prisma Health patients in mind, in collaboration with Prisma Health clinicians and leaders. Aetna Medicare Prime is an option for patients currently on Medicare Advantage or Original Medicare. This plan allows them to keep their Prisma Health doctor while enjoying potentially richer benefits and lower out-of-pocket costs," said Molly Schild, chief Medicare officer for Aetna in South Carolina.