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Member Payment Estimator

Taking the guesswork out of health care costs

The Member Payment Estimator lets employees — our members — estimate how much they'll pay out of pocket for medical tests, office visits and procedures ahead of time. No more surprise bills. Or bills that are higher than expected.

About 43 percent of households put off care because of costs.* Our online tool lets employees compare costs for up to 10 doctors or facilities at once. This helps them avoid paying more than they have to.

Encourage your employees to use Member Payment Estimator. When they save money and get the care they need, it helps lower your overall health plan costs. It can also make for healthier, more informed and more productive employees.

*Kaiser Family Foundation, Health Tracking Poll, January 5, 2016.

Personalized, accurate health care costs 

Employees can get real-time personalized estimates for more than 650 medical tests, procedures and office visits. Member Payment Estimator uses the employee's plan information, such as deductible, coinsurance and copay. It generates estimates using the same claim engine that pays Aetna member claims. And it uses our negotiated rates with providers. So employees get a solid estimate to use for planning and budgeting for health care.

Member Payment Estimator includes costs for services that go along with a procedure. For example, an estimate for a knee replacement will include costs for blood work and anesthesia.

Helping lead the way toward health care transparency

Smart shoppers do their homework before they buy. They want to know what they'll pay before they walk through the door. And know they're getting the best price. That's what transparency means.

People may not know that two providers can give the same quality of care at very different costs. With a tool that lets them see prices and quality, people can choose the option that works best for them.

Now members can do even more with Member Payment Estimator. They can see more than 1.5 million provider ratings and reviews left by other patients. That means they have a full view of cost, quality and patient experiences when choosing a doctor. Plus they can leave their own review of a doctor.

Since it first launched in 2010, the Member Payment Estimator has been used more than 8.8 million times. It’s one of our most popular member tools.

More savings, better choices

Our research shows that after getting an estimate, members are more likely to choose lower-cost doctors, hospitals and facilities. 

We’ve also found that members save an average of $612 on allowed expenses and $170 in out-of-pocket costs by using the Member Payment Estimator.**

**For 34 common procedures. Member Payment Estimator Study, Aetna Informatics and Product Strategy, August 2012.

Awards and recognition

The payment estimator has received several honors:

  • In 2013, the National Business Coalition on Health recognized it for innovation.  
  • In 2012, the Commonwealth Fund cited the payment estimator for its contribution to greater health care transparency.
  • In 2011, the U.S. Government Accountability Office recognized it as the only tool from a private health insurance company that gives estimates of a consumer's complete costs.

Get started today

Join the other employers who are helping their employees make smart health care decisions and save money.

Contact your Aetna representative

This material is for information only.  Health benefits and health insurance plans contain exclusions and limitations. Estimated costs not available in all markets.  The tool provides an estimate of what would be owed for a particular service based on the plan at that very point in time.  Actual costs may differ from an estimate, if, for example, claims for other services are being processed after the estimate is provided but before the claim for this service is submitted.  Or, if the doctor or facility performs a different service at the time of the visit.  HMO members can only look up estimated costs for doctor and outpatient facility services.  Providers are independent contractors and are not agents of Aetna.  Provider participation may change without notice.  Aetna does not provide care or guarantee access to health services. Information is believed to be accurate as of the production date; however, it is subject to change.

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