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Aetna® and Prisma Health announce new collaboration in South Carolina to offer Medicare Advantage Plan

Tuesday, October 19, 2021

GREENVILLE, S.C.—Aetna, a CVS Health® company, (NYSE: AET) and Prisma Health today announced a new Medicare Advantage (MA) 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 between October 15 and December 7, 2021. 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. 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 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 (OTC) products.
  • Rewards for healthy behavior.

“Aetna has a long history of working with provider groups to create solutions that improve the health care experience and outcomes for our members,” said Molly Schild, Chief Medicare Officer for Aetna in South Carolina. “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.”

About Aetna

Aetna, a CVS Health business, serves an estimated 34 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional, voluntary and consumer-directed health insurance products and related services, including medical, pharmacy, dental, vision and behavioral health plans, and medical management capabilities, Medicaid health care management services, workers' compensation administrative services and health information technology products and services. Aetna's customers include employer groups, individuals, college students, part-time and hourly workers, health plans, health care providers, governmental units, government-sponsored plans, labor groups and expatriates. For more information, visit www.aetna.com and explore how Aetna is helping to build a healthier world.

Aetna Medicare is a HMO, PPO plan with a Medicare contract. Our SNPs also have contracts with State Medicaid programs. Enrollment in our plans depends on contract renewal. Plan features and availability may vary by service area. Participating physicians, hospitals and other health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. The provider network may change at any time. You will receive notice when necessary. Other physicians/providers are available in our network.

About Prisma Health

Prisma Health is a not-for-profit health company and the largest healthcare system in South Carolina. With nearly 30,000 team members, 18 acute care and specialty hospitals, 2,947 beds, approximately 300 outpatient sites, and nearly 5,000 employed and clinically integrated network physicians and providers, Prisma Health serves more than 1.2 million unique patients annually in its 21-county market area that covers 50% of South Carolina. Prisma Health’s goal is to improve the health of all South Carolinians by enhancing clinical quality, the patient experience and access to affordable care, as well as conducting clinical research and training the next generation of medical professionals. For more information, visit PrismaHealth.org.

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