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Aetna reports higher inpatient admissions and pharmacy spend in Medicare Advantage book
Summary
Aetna told the commission that inpatient admissions per 1,000 members rose 15.6% and pharmacy paid totals reached $72 million for its Medicare Advantage book covering 9,186 members (average age 75.6) for the reported period.
Aetna presented its Medicare Advantage performance for claims incurred Feb. 1, 2025–Jan. 31, 2026, reporting 9,186 members with an average age of 75.6. The vendor said inpatient admissions per 1,000 members increased 15.6% from the prior period and emergency-room cases rose 0.8% per 1,000.
Aetna reported total pharmacy paid of $72 million, a change of 18.8% from the prior period, and pharmacy paid per member of $7,872 (a 15.9% increase). There were 226 high-cost claimants (defined in Aetna’s presentation as members with $75,000 or more in medical costs); those members accounted for $31 million in paid medical amount. Aetna identified oncology, cardiac and musculoskeletal diagnoses as the top diagnostic spend categories.
The presentation included program-utilization details (Silver Sneakers enrollment, transportation and meal-delivery participation) and telemedicine trends: telemedicine paid amounts rose 11.8% to $473,000 with 3,952 visits and an average paid amount of $120 per visit.
