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How to use your coverage: Making smart financial decisions

Color portrait of Sachi Fujimori By Sachi Fujimori

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 benefits and save you money at the same time.

Stay in network 

Aetna MA members with some plans — PPO or 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 an 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


We contract with quality doctors, specialists, surgical centers, hospitals and other facilities. This takes the guesswork out of finding qualified 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 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 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.  

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 here to understand the different immediate medical care options.  


Use your extra benefits  

All Aetna MA plans come with extra 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 membership to a SilverSneakers® participating fitness facility (Some group plans may not include SilverSneakers®. Check Group plan benefit details to determine coverage). SilverSneakers provides access to some 16,000 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 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 added cost to you.  


Review your pharmacy choices 

Does your plan include prescription drug coverage? If it does, you can save money by using a preferred pharmacy. Check the details of your plan to learn more. You can also sign up for mail order delivery and up to a 100-day 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.  


Other financial considerations 

Unlike Original Medicare, all MA plans have the extra benefit of a yearly maximum out-of-pocket (MOOP) 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 MOOP. But not all health expenses are included. For example, any 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, senior 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, stay in network to minimize your out-of-pocket costs. Get to know your extra benefits and use them. And if you have prescription drug benefits, review your 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. 

How to get the most value out of your Medicare Advantage plan infographic
How to get the most value out of your Medicare Advantage plan infographic

About the author

Sachi Fujimori is a writer and editor based in Brooklyn who focuses on writing about science and health.  A good day is one where she eats her vegetables and remembers to live in the moment with her baby girl.


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Call us at 1-833-329-0413 (TTY: 711) to chat about any Medicare questions you have.