The Associated Press June 13, 2011, 6:27PM ET

Government lifts Aetna Medicare suspension

Health insurer Aetna Inc. said Monday federal regulators have lifted a marketing and enrollment suspension for its Medicare products that started in April 2010.

The Hartford, Conn., said it will immediately begin selling its Medicare Advantage plans and Medicare prescription drug products and can start enrolling beneficiaries with effective dates starting July 1.

Medicare Advantage plans are privately run versions of the government's Medicare program. Subsidized by the government, the plans offer basic Medicare coverage topped with extras or premiums lower than standard Medicare rates.

Aetna has said regulators suspended it from enrolling customers in Medicare Advantage plans due to changes the health insurer made to its Part D prescription drug coverage. The company switched its coverage from an open formulary to a closed one, which involves payment tiers and in some cases favors generic drugs over brand names.

A letter from the Centers for Medicare and Medicaid Services said the insurer failed to properly transition some customers from drugs covered under the old formulary to those covered under the new one. It also said some customers received incorrect denials of medications, which delayed their prescriptions.

Medicare Advantage plans represent a relatively small slice of Aetna's business. The company had 17.8 million people enrolled in health insurance plans at the end of the first quarter. Of that total, only about 407,000 -- about 2 percent -- were enrolled in Medicare Advantage plans.

It also had about 447,000 people enrolled in just the Part D prescription drug coverage, without the Medicare Advantage health insurance.

Aetna shares fell 11 cents to $42.75 Monday.


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