How to use your Aetna Medicare Advantage coverage: Making smart financial decisions

You took an important step when you signed up for an Aetna Medicare Advantage (MA) plan. Now there are some key things to keep in mind to get the most value from your plan. These tips can help you take advantage of your Medicare benefits and save you money at the same time.

Stay in network by finding an Aetna® Medicare-approved provider

Aetna Medicare Advantage members with some plans — preferred provider organization (PPO) or health maintenance organization with a point of service (HMO-POS) (for some services) — can see out-of-network providers. But you may still want to stay within your network to save the most money. Note that if you have a health maintenance organization (HMO) plan, you are required to stay in network for your care to be covered unless it’s an emergency.

Learn more about the differences between HMO, HMO-POS and PPO plans.

Learn more about the differences between HMO, HMO-POS and PPO plans (Español)

We contract with quality doctors, specialists, surgical centers, hospitals and other facilities. This takes the guesswork out of finding qualified health care providers. As a part of these contracts, these providers agree to offer services at a negotiated rate. That means when staying in network (for any Medicare Advantage plan type), you have known copayments and predictable costs. But if you go out of network, your portion of the medical bill may be larger.

For example, if you have a PPO plan and see an in-network doctor, you may have a predictable copayment, such as $10 per visit (depending on your plan). But if you go out of network, you may have a higher copayment or coinsurance for the visit. Find an Aetna-approved in-network Medicare provider, doctor or hospital.

When you have medical needs, the choices you make can also impact you financially. This is especially true if your condition isn’t serious or life-threatening. For example, you may save money by visiting an urgent care or walk-in clinic instead of an emergency room. Read more to understand the different immediate medical care options.

Use your additional Aetna Medicare Advantage benefits

All Aetna MA plans come with additional benefits that are designed to help you achieve your best health. Make good use of them and you may find that you save money on your overall health care costs.

If you’ve been paying for a monthly gym membership, you may be able to cut this expense. Most Aetna MA plans provide coverage for a basic SilverSneakers® membership to a participating fitness facility. (Some group plans may not include SilverSneakers® fitness programs. Check Group plan benefit details to determine coverage). The SilverSneakers program provides access to some 15,000+ locations and classes for all fitness levels led by trained instructors. And most Aetna MA plans include routine dental, hearing and vision benefits. Check your Aetna MA plan documents to learn more about them. “We know that people who go to the gym and dentist regularly are far healthier in the long term,” says Zach Bohler, Senior Director, Actuarial at Aetna®.

Some plans have additional benefits and services that you may want to explore. For example, an over-the-counter allowance for health and wellness items. You can use it to pay for things like sunscreen, bandages and more. You may also get help with quitting smoking and home-delivered meals for when you return from a hospital stay. And at no additional cost to you. Discover your Medicare coverage and benefits.

Review the choices at your preferred pharmacy

Does your plan include prescription drug coverage? If it does, you can save money by using a preferred pharmacy. Check the details of your Medicare Advantage plan to learn more. You can also sign up for mail-order prescription drug delivery and up to a 3-month supply to save time and trips to the pharmacy.

You may also want to review your formulary with your doctor to see if there are any lower-cost generic options for the prescriptions that you’re taking. Use our drug search tool to see your options.

Other financial considerations

Unlike Original Medicare, all MA plans have the additional benefit of a yearly maximum out-of-pocket limit. Once you reach this limit, you will not have to pay any out-of-pocket costs for Medicare-covered medical services for the rest of the year. Spending on copayments and coinsurance for covered medical services counts toward your limit. But not all health expenses are included. For example, any Medicare Part D prescription drug costs do not count toward your MOOP amount. Be sure to check your Evidence of Coverage (EOC) to learn more about the details of your plan’s MOOP.

Another thing to keep in mind is that very few people actually hit their MOOP. “But it can provide reassurance that your health care costs will be kept under a certain amount if you have unexpected illnesses. And it’s a benefit that you only get with MA plans,” says Erin Murphy, executive director, Medicare Advantage Product Strategy at Aetna

And finally, did you contribute to a health savings account (HSA) while you were working? If you did and still have funds remaining, you can put this money toward your Medicare costs. This includes qualified medical expenses as well as your Medicare Advantage premiums. Note that you can’t contribute to an HSA while enrolled in Medicare.

By choosing an Aetna MA plan, you’re off to a great start. When possible, use an Aetna Medicare provider to minimize your out-of-pocket costs. Get to know your additional benefits and use them. And if you have prescription drug benefits, review your Medicare formulary with your doctor. Following these tips can help you save money and get the most out of your plan. More importantly, they can put you on a path to better health.