Your Texas clients need to understand your options when it comes to health insurance. With the changing landscape of healthcare, it’s essential for consumers to know if they are eligible for a Special Enrollment Period (SEP). It’s also important for your customers to understand their Aetna Medicare options in Texas.

A special enrollment period is a window of time outside of the annual Open Enrollment Period when a customer can enroll in a health plan. A qualifying event, such as the birth of a child, a move, or a change in employment typically triggers the SEP period.

The following are specific SEPs in Texas:

  1. Disaster SEP: If a customer is affected by a major disaster declared by the President, they may be eligible for a Disaster SEP.
  2. Medicaid/CHIP SEP: Medicaid and CHIP provide free or low-cost health coverage to eligible children in Texas. If a consumer is eligible, they may enroll in a Medicaid/CHIP SEP all year round.
  3. SEP for Indian tribes: If your client is a member of a federally recognized Indian tribe, they may be eligible for a SEP all year round.
  4. SEP for Alaska Native Claims Settlement Act (ANCSA) Corporations: If someone is an Alaska Native, they may be eligible for a SEP all year round.
  5. General SEP: This SEP is available to individuals who didn’t enroll during the Open Enrollment Period and are not eligible for any of the other SEPs listed above.
If your Aetna Medicare customers are eligible for a SEP, they may need to act quickly. You typically have 60 days from the event to enroll in a health plan.

If your customers are considering enrolling in an Aetna Medicare plan in Texas, they may be eligible for a SEP. Aetna offers a range of Medicare plans with different levels of coverage, so you can help them find the plan that best fits your needs.

Agility agents can access resources for selling Aetna Medicare plans here!

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Dual eligible special needs plans (DSNP) are a type of Medicare and Medicaid coverage that are tailored to meet the specific needs of certain individuals. DSNPs provides access to a wide range of services and benefits designed to help individuals with long-term care needs and help them maintain their independence in the home or in a care setting. DSNPs cover all Medicare-covered services, plus additional services and benefits, and are available for individuals who are eligible for both Medicare and Medicaid. With DSNPs, individuals can obtain the coordinated care, services, and supports that are best suited to their needs, and access quality care at a lower cost.

Knowing the difference between Aetna Medicare and Medicaid dual plans

Aetna Medicare and Medicaid dual plans provide a comprehensive healthcare solution for those who are eligible for both Medicare and Medicaid. These plans combine the benefits of both programs and often include additional benefits such as dental, vision, and prescription drug coverage. The plans also typically come with low copayments, coinsurance, and no annual deductible. However, it is important to note that these plans do not cover services and treatments that are not covered by either Medicare or Medicaid. Furthermore, Medicare and Medicaid dual plans are usually more expensive than plans offered by other private health insurers, as they require two separate premiums.

Which of your customers are eligible for dual eligible special needs plans?

Individuals who are entitled to both Medicare (title XVIII) and medical assistance from a state plan under Medicaid (Title XIX) are eligible for Dual Eligible Special Needs Plans. These plans offer many benefits, including a $0 monthly premium, a $0 Rx copay, and coverage for some Medicare costs depending on the individual’s state and eligibility. To be eligible for a Dual Eligible Special Needs Plan, individuals must qualify for Medicaid and/or receive financial help, have Medicare Parts A and B, and live in the plan’s service coverage area.

What your customers should know about Aetna D-SNP

Aetna Dual Eligible Special Needs Plans (D-SNP) are designed to provide tailored care and coverage for those who are eligible for both Medicare and Medicaid. These plans provide an array of additional benefits and services not covered under traditional Medicare, such as dental, hearing aids, contact lenses, and more. It is important to note that in order to remain a member of these plans, you must continue to reside in the plan service area. Additionally, be aware of any suspicious calls, texts, or emails about “free” coronavirus testing and report any scams to the appropriate authorities.

What your customers need to know about Dual Eligible Special Needs Plans in Texas

These plans offer Medicare zero-dollar cost sharing and are available in six Texas counties: Bexar, Dallas, El Paso, Harris, Hidalgo, and Tarrant. Individuals may be eligible for D-SNPs if they have a chronic condition, are living in an institution, or fail to qualify for other Medicare Advantage plans. D-SNPs also offer additional benefits not found in Original Medicare, such as vision, dental, and prescription drug coverage.

Are you contracted to sell Aetna Medicare yet?  Learn why thousands of health insurance agents love being a part of the Agility family! 

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It is not uncommon for companies to receive praise for their customer service, and Aetna is no exception. Aetna is a healthcare company that provides a variety of services, including insurance coverage for medical, dental, and prescription drugs. Many customers have reported positive experiences with Aetna’s customer service, praising the company for its helpful and knowledgeable representatives, as well as its convenient and user-friendly website and mobile app. If you are considering getting contracted with Aetna, the stellar praise from customer reviews and ratings should give you an idea of how easy Aetna is to work with.

Are you contracted with Aetna yet?

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Aetna, CVS Health to enter the Affordable Care Act (ACA) individual insurance marketplace in Texas for January 1, 2022

This combines the health coverage of Aetna®, a CVS Health company, with local care at CVS Pharmacy®, MinuteClinic® and CVS® HealthHUB™ locations to deliver a quality, affordable health care experience.


WOONSOCKET, R.I., Aug. 4, 2021 /PRNewswire/ — Aetna and CVS Health (NYSE: CVS) will enter the individual insurance marketplace in Texas (specifically in select counties in the Austin, El Paso, Houston and San Antonio
markets) with the first Aetna CVS Health hybrid-branded insurance
product, providing access to health care for more Texans. Aetna and CVS
Health bring together quality along with convenience and expanded
services to meet consumer health needs, simply and affordably. 

“With the combined strength of Aetna and CVS Health, we’re uniquely
positioned to provide greater value for consumers, particularly the
millions of Americans who are uninsured or underinsured,” said Dan Finke,
Executive Vice President, CVS Health, President, Aetna. “We are taking a
human-centered approach to health care by connecting people to the
services and support they want – in their neighborhood, home and
virtually anywhere they need us.”

With these plans, members will have access to Aetna’s high-quality
network of health care providers and telemedicine services.
Additionally, the plan provides members with unique and convenient
health care offerings at MinuteClinic, HealthHUB and CVS Pharmacy
locations across the country.

Along with an enhanced direct enrollment experience via Aetna’s website, the plans feature:

  • No-cost or low-cost visits at any of the more than 50 MinuteClinic locations in Texas and over 1,100 MinuteClinic locations across the country.
  • Access to a Care Concierge at CVS HealthHUB locations, who is
    available to assist members by helping them navigate health care
    services and products.
  • 20% off select CVS Health Brand health and wellness products at any one of the 10,000 CVS Pharmacy stores. 
  • 90-day refills members can have delivered directly to their door for free.
  • Simplified member experience that lets members pay their premium at the store and manage their account with our mobile app or through the web.

“A key priority is providing people with access to the care they
need – simply, easily and affordably,” said Neela Montgomery, Executive
Vice President, CVS Health and President, CVS Pharmacy. “Whether it be
through our health plan, MinuteClinic, CVS HealthHUB, CVS Pharmacy or
any of our virtual care options, we are committed to helping simplify
health care and enable healthier outcomes.”

Additional CVS Health services include:

  • Added convenience with access to virtual care, including through MinuteClinic
  • Quality guidance and treatment for maternity care, as well conditions such as diabetes, hypertension, kidney disease
  • Help staying on track to better health with Pharmacy Advisor counseling and data-driven Next Best Actions or health nudges
  • Convenient, total health support with Destination Behavioral Health
  • Care in the comfort of the member’s home with Coram Home Infusion

The select Texas counties this new offering will be available in include Bexar, Brazoria, Comal, El Paso, Fort Bend, Galveston, Guadalupe, Harris, Hays, Kendall, Montgomery, Travis, and Williamson.

In addition to Texas, CVS Health is entering the individual exchange market in Arizona (Banner | Aetna), Florida, Georgia, Missouri, Nevada, North Carolina, Northern Virginia (Innovation Health) and Virginia.*

*Filings in each state are complete. Final approval to entry is pending state and federal reviews/certifications. 

About CVS Health

Health is the leading health solutions company, delivering care in ways
no one else can. We reach more people and improve the health of
communities across America through our local presence, digital channels
and our nearly 300,000 dedicated colleagues – including more than 40,000
physicians, pharmacists, nurses, and nurse practitioners. Wherever and
whenever people need us, we help them with their health – whether that’s
managing chronic diseases, staying compliant with their medications, or
accessing affordable health and wellness services in the most
convenient ways. We help people navigate the health care system – and
their personal health care – by improving access, lowering costs and
being a trusted partner for every meaningful moment of health. And we do
it all with heart, each and every day. Learn more at

About 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 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 and explore how Aetna is helping to build a healthier world.


ACA Contracting Available Here > 


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Aug 04, 2021, 08:30 ET

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