Meet Bill.* Bill is getting ready to choose an Aetna® Medicare plan. He’s been nursing bad knees, is taking daily medication to help regulate his blood pressure and sees a cardiologist to check on his heart health.
Let’s compare Bill’s health care costs over the next year between Original Medicare and a Medicare Advantage PPO plan with a premium. You will see the cost of Medicare can be very different based on the care you need and the coverage you choose.
How to save money on your Medicare costs
Bill wants to save money on things like seeing his heart doctor or getting new glasses. Let’s show him how much he will save on an Original Medicare + Part D Rx plan compared to a Medicare Advantage* plan.
Total cost summary
Here are the total costs for each plan.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
| Premium cost $2,662 | Premium cost $2,424 |
| Medical/dental/vision cost $4,453 | Medical/dental/vision cost $2,567 |
| Prescription cost $360 | Prescription cost $0 |
| Gym membership cost $600 | Gym membership cost $0 |
| Total cost $8,075 | Total cost $4,991 |
Plan details
Let’s show Bill the details for each plan.
Premium costs
A premium is the amount that Bill will pay each year for his Aetna Medicare plan.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
Medicare Part B premiums $2,220 ($185 x 12) | Medicare Part B premiums $2,220 ($185 x 12) |
Prescription drug plan premiums $442 ($36.78 x 12) | N/A |
| N/A | Medicare Advantage plan premiums $204 ($17 x 12) |
| Premiums subtotal $2,662 | Premiums subtotal $2,424 |
Medical costs
Bill is seeing a cardiologist, which is a doctor that helps keep his heart healthy. He also needs to see an orthopedic doctor to help him with his bad knees.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
| Overnight hospital stay $1,578 | Overnight hospital stay $312 |
Cardiologist (4 visits) $200 ($250 x 4 = $1,000 @ 20%) | Cardiologist (4 visits) $140 ($35 x 4) |
Orthopedic surgeon (5 visits) $300 ($300 x 5 = $1,500 @ 20%) | Orthopedic surgeon (5 visits) $175 ($35 x 5) |
X-rays (both knees) $40 ($100 x 2 = $200 @ 20%) | X-rays (both knees) $30 ($15 x 2) |
Outpatient hospital knee surgery (arthroscopy with meniscus repair on each knee) $1,105 ($2,763 x 2 = $5,526 @ 20%) | Outpatient hospital knee surgery (arthroscopy with meniscus repair on each knee) $850 ($425 x 2) |
Physical therapy (3 visits a week for 8 weeks) $480 ($100 x 24 = $2,400 @ 20%) | Physical therapy (3 visits a week for 8 weeks) $960 ($40 x 24) |
| Medical costs subtotal $3,703 | Medical costs subtotal $2,467 |
Prescription costs
Bill takes two prescription medications a day. He wants to make sure his plan will pay for his medications.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
Two monthly prescriptions @ $15 each ($15 x 2 x 12 = 360) | Generic drug (two monthly prescriptions @ $0 copays) ($0 x 2 x 12 = 0) |
Prescription costs subtotal: $360 (Cost estimates are based on prescriptions received at a preferred pharmacy*) | Prescription costs subtotal: $0 (Cost estimates are based on prescriptions received at a preferred pharmacy*) |
Dental costs
Bill needs to see a dentist. He might need to get a tooth pulled. This is also called a tooth extraction.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
| Extraction $450 | Extraction $600 $600-$500 dental allowance |
| Dental costs subtotal: $450 | Dental costs subtotal: $100 |
Fitness costs
Bill wants a plan that will pay for a gym membership.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
Gym membership $50* ($50 x 12 = 600) | Gym membership $0 |
| Fitness costs subtotal: $600 | Fitness costs subtotal: $0 |
Glasses costs
Bill goes to the eye doctor every year. If he needs new glasses, he wants a plan that will pay for them.
| Original Medicare + Part D Rx plan | Medicare Advantage plan |
|---|---|
Glasses $150 | Glasses $0 |
| Glasses costs subtotal: $150 | Glasses costs subtotal: $0 |
Remember that everyone’s health needs are different. Think about yours. This can help you decide on the plan that works best for you. Also, there may not be plans available where you live. And the costs may be different. So be sure to review the plans offered in your area.
Before choosing your own plan, it’s important to do your research. Aetna Medicare’s website and the Medicare Plan Finder are good places to start.
Tips for finding the Medicare plan with the most value for you
When you find a Medicare plan, you want to get as much as you can out of your coverage. Here are some things to think about:
- Do you understand other costs besides your premium? Original Medicare (Medicare Parts A and B) may have lower monthly costs than some Medicare Advantage plans, but other costs can offset that. Unlike Medicare Advantage plans, there’s no yearly limit to out-of-pocket costs with Original Medicare. If you have a lot of health problems in a single year, your costs could be very high.
- Do you want a wider choice of providers? Medicare Advantage plans usually cover care from in-network providers. But with Original Medicare and Medicare Supplement, you can use any provider that accepts Medicare.
- Do you take prescription medications? Prescription drug coverage is not automatically included if you have Original Medicare. You’ll need to add a Medicare Part D prescription drug plan. If you have a Medicare Advantage plan, this coverage is often included. Note that if you sign up for Part D after your initial enrollment period, you may be given a late-enrollment penalty. This increases your monthly premium as long as you have the coverage.
- Will you travel to different parts of the country? If so, think about the doctors you want to see in those places. Original Medicare and Medicare Supplement let you see any doctor in the country who accepts Medicare. Medicare Advantage plans may only let you see in-network providers, but those networks are usually nationwide.
Have the right plan, but need help paying? Find out if you can get help.
Disclaimer
See Evidence of Coverage for a complete description of plan benefits, exclusions, limitations and conditions of coverage. Plan features and availability may vary by service area. Participating health care providers are independent contractors and are neither agents nor employees of Aetna. The availability of any particular provider cannot be guaranteed, and provider network composition is subject to change. The Aetna Medicare pharmacy network includes limited lower cost, preferred pharmacies in: Rural Nebraska, Rural North Dakota, Suburban West Virginia, Urban Kansas, and Urban Missouri. The lower costs advertised in our plan materials for these pharmacies may not be available at the pharmacy you use. For up-to-date information about our network pharmacies, including whether there are any lower-cost preferred pharmacies in your area, members please call the number on your ID card, non-members please call 1-855-338-7027 ${tty} or consult the online pharmacy directory at AetnaMedicare.com/pharmacyhelp.