Aetna Employees: Navigating Your Retirement Journey When Medicare Isn't Enough

Healthcare Provider Update: Healthcare Provider Information for Aetna Aetna, part of the CVS Health family, has been a key player in the Affordable Care Act (ACA) marketplace, providing health insurance plans to individuals and families. However, significant changes are on the horizon for 2026, as Aetna will exit the ACA marketplace in 17 states, impacting approximately 1 million members. This withdrawal is attributed to the company's challenges in maintaining competitiveness and providing value in a rapidly evolving healthcare landscape. Potential Healthcare Cost Increases in 2026 As the healthcare landscape shifts, substantial premium hikes are anticipated for those enrolled in ACA marketplace plans, with projections of up to 75% increases in out-of-pocket costs due to the potential loss of enhanced federal subsidies. In some states, insurers have filed for rate increases exceeding 60%, driven by surging medical costs and the expiration of premium tax credits established under the American Rescue Plan. For Aetna's former members, this change further complicates their healthcare landscape as they seek new insurance options amid heightened financial pressures. Click here to learn more

The need for long-term care, especially in nursing homes, becomes increasingly pressing for many as the population ages. For Aetna employees, the increasing expenses of this type of care plus the fact that Medicare does not cover long-term nursing home stays make financial planning even more complicated.

The Increasing Need for Extended-Term Care

Studies reveal a notable increase in the need for long-term care.  A Department of Health and Human Services research from 2022 found that 56% of Americans who reach 65 today will later have problems and require long-term care.   As per the National Academy of Social Insurance, the number of elderly individuals in need of this type of care is expected to rise by over 50% by 2050, from 6.3 million in 2015.  This trend highlights the importance for Aetna employees to plan ahead.

The Cost of Care in Nursing Homes

One of the most intimidating aspects of nursing home care is the financial factor.  According to data from Genworth's 2022 Cost of Care Survey, a semi-private room in a nursing home typically costs $107,146 per year, while a private room costs roughly $120,304 annually.   In sharp contrast, the average monthly Social Security retirement payment is $1,907 as of January 2024, which comes to just $22,884 annually—a far cry from enough money to meet these expenses.

Choices In Case Medicare Is Insufficient

Medicare offers limited reimbursement for stays in skilled nursing facilities under certain conditions, but it does not cover long-term stays in nursing homes. For example, Medicare Part A pays for the whole first 20 days of care in a skilled nursing facility after a qualifying hospital stay of at least three days in a row, as long as care starts within 30 days of hospital release.  Beyond this, the patient is responsible for a $204 daily coinsurance from the 21st to the 100th day, with up to 100 days of care covered per benefit period.

Getting Around Medicaid Coverage

Medicaid becomes a vital resource for many, including Aetna employees, as, provided certain strict eligibility requirements are satisfied, it can pay for nursing facility expenses in full. These requirements cover both financial thresholds and level-of-care requirements. For example, in order to satisfy the level-of-care requirements, a person may have to exhibit substantial cognitive, physical, or behavioral demands. States establish financial thresholds for income and assets, which if surpassed, may still permit eligibility through a 'Medicaid spend down' procedure. This entails using the extra cash for medical bills up until the point at which eligibility is satisfied.

Long-Term Care Insurance's Function

An additional option for controlling the expense of nursing home care is long-term care insurance. The coverage provided by policies varies greatly; some may cover both skilled and non-skilled care. Because life expectancies fluctuate by gender, the cost of these plans typically rises with the policyholder's age. For example, at age 55, a guy may pay, on average, $900 a year for an insurance with $165,000 of coverage; at age 60, that amount could increase to $1,200. Because women often live longer, they tend to pay more.

As an Alternative, Home Care

Aetna employees who would rather stay at home may benefit from Medicare Parts A and B, which may fund qualified home health services for people who are homebound and in need of part-time skilled care. This covers treatments including occupational therapy, physical therapy, and skilled nursing care. But it's crucial to remember that Medicare does not pay for custodial services like washing and dressing, meal delivery, or 24-hour home care unless they are combined with professional nursing care.

Non-Profit Choices

Investigating non-profit facilities can be a good idea as well. These facilities are worth considering for Aetna employees who are struggling financially because they frequently offer financial aid programs along with rehabilitation services.

In summary

Considering insurance and eligibility for government help, assessing the range of care alternatives and related expenses, and taking individual preferences for the type of care facility are all part of planning for long-term care. Strategic financial planning becomes essential when expenses rise and government assistance becomes more limited. Being aware and ready is more crucial than ever as the demand for long-term care rises.

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It is critical for Aetna employees who are getting close to retirement to comprehend the possible tax advantages of long-term care insurance. Subject to certain limits, premiums paid on qualified long-term care insurance policies may be claimed as deductible medical costs. More specifically, an individual's age determines how much of the premium is deductible.  In 2023, for example, people who are between the ages of 61 and 70 can deduct up to $4,510 of these costs.  For people planning for future care needs, this tax factor may increase the attraction and financial viability of acquiring long-term care insurance.

Having to figure out how to pay for nursing home care without Medicare's assistance is like trying to plan a long trip in a car that breaks down. In the same way that a road tripper would arrange for a dependable car and possibly even roadside help in case of emergency, Aetna employees who are getting close to retirement should also make long-term care plans. Purchasing long-term care insurance acts as a safety net to guarantee the continuation of care in spite of high prices and probable obstacles, much like having that roadside help. The next step is to investigate Medicaid eligibility and other financial solutions. This will act as a map to help you navigate the less-traveled routes and arrive at your goal safely and debt-free.