Planning for Medicare doesn't have to be a difficult or scary process. If you're approaching Medicare, or reviewing your options after a few years, simply taking the time to learn a little bit about the program, how it works, and how much you might have to pay for it, can help you make smart decisions about your coverage. As you learn about the basics of Medicare, you'll realize why so many people choose to use a private Medicare Plan to go with their Part A and B coverage. In this article, we’ll review Aetna Medicare Plans. We’ll review what they are, how they work, and how they can help you save money on your Medicare coverage.
Aetna is one of the oldest insurance companies in the United States, dating back to the 1850s. The company is actually named after Mount Etna in Italy, which is one of the largest volcanoes in Europe. The company began as a fire insurance company in Hartford Connecticut. Today, Aetna is owned by CVS health, and is one of the largest Medicare health plans in the nation. Aetna has over 22 million medical members, and an extensive network of physicians, providers, and facilities.
As you begin making your plans for Medicare coverage it is crucial to understand exactly how much you'll pay for the services you use while you’re covered. It's a surprise to many people to learn that Medicare is not free, and that you will be expected to pay for part of the cost of your care. Don't make this mistake, understand going in that you will have to pay out of pocket costs for some of your care.
The costs that you will pay are different between Part A and Part B of Original Medicare.
The biggest expense you'll face with Part A coverage is the Part A deductible. This amount is $1,600 in 2023. If you need Part A services, like a hospital stay or skilled nursing care, you will have to pay this amount first, before Medicare will start covering your costs. If you have lengthy hospital stays or skilled nursing stays, you will then have to pay a daily coinsurance amount for those services. It's possible to pay the Part A deductible more than once in a year, although that is a rare occurrence.
For Part B, you can expect to pay these costs:
As you can see, the deductible is quite small, especially when compared to the Part A deductible. The overwhelming bulk of your costs will be for Part B co-insurance, which is the 20% of cost that Medicare does not cover. Keep in mind that there is no cap or maximum spending protection with Original Medicare. You will pay the part A and B out of pocket costs all year long, regardless of how much you've spent during the year. This is a weakness in medicare's coverage, and one of the main reasons that people look to add a private option to their part A and B coverage.
There are three main kinds of private Medicare insurance plans available to help you save money: Medicare Supplement Insurance, Part D Prescription Drug Plans, and Part C Medicare Advantage plans. Aetna Medicare plans provide all three kinds of coverage.
Medicare supplement insurance, or Medigap as you will see it referred to, is the oldest kind of private Medicare coverage. Medigap plans date all the way back to the inception of Medicare in 1966. Medicare Supplement Plans have been standardized through 47 of the United States, which means that the benefits provided by them are the same in each of the states.
Medicare Supplement Insurance works with your Part A and B benefits from Original Medicare. It doesn't affect your benefits in any way, unlike Medicare Advantage plans, which we'll discuss later. A Medigap plan works by simply paying some or all of the amounts that you would normally have to pay out of pocket. So, when you have to receive medical care, you will use both your original Medicare benefits and your Medicare Supplement Plan benefits. Your providers will bill Medicare first, since Medicare remains the primary coverage. Once you have paid the part B deductible, if required, Medicare will pay the first 80% for the cost of your care, for Part B services.
In the case of Part A, your Medicare Supplement Plan will pay for some or all of the Part A deductible on your behalf, depending on which specific plan you choose. If you choose Medigap Plan A, though, that plan does not provide any coverage of the Part A deductible, so you would still have to pay it out of pocket. Normally, you would have to pay the remaining 20% of the cost for Your Part B care. However your provider will also bill your Medicare Supplement Plan. Again, depending on which level of coverage you chose, your Supplement Plan will pay some or all of your share of the cost. The most comprehensive Medigap plan available today, Plan G, will pay 100% of the cost for your care apart from the part B deductible.
When you have Medicare Supplement Insurance, you preserve your right to see any doctor in the country that takes Medicare patients. You also won't need referrals to see specialists. Medicare supplement insurance is popular because it provides maximum flexibility, as well as maximum protection against out-of-pocket spending.
Part D of Medicare provides prescription drug coverage to Americans. This kind of drug coverage is available in two forms: Medicare Advantage Prescription Drug Plans (MAPD), and standalone Prescription Drug Plans (PDP). The drug coverage and costs work the same for both types of coverage; since we'll discuss Medicare Advantage plans in the next section, we’ll focus on standalone drug plans in this section.
All Part D standalone drug plans will have a similar cost structure. There's a monthly premium for coverage, there is often (although not always) an annual deductible, and there are fixed co-payments and coinsurance amounts that you'll pay each time you fill a prescription, assuming that you've met the deductible, if any.
Every prescription drug plan also has what's called a formulary, which is an official list of every medication and vaccine covered by the plan. Medicines and vaccines that are not listed on the formulary are not covered by the plan. All the medications and vaccines that are covered by the plan are assigned a tier. The drug or vaccine tier determines the price that you'll pay for filling that prescription. As you fill prescriptions during the year, you will move through four coverage stages. The amount that you'll pay for each prescription changes as you move through these coverage stages. Currently there is no cap on your annual spending for prescription drugs under Part D, but this will change for plan Years starting in 2024.
The Medicare Advantage program is technically known as Part C of Medicare. Medicare Advantage plans are a way to receive your Part A and B benefits through a private insurance company. In many cases these plans also include built-in prescription drug coverage. Medicare Advantage plans work like traditional employer health insurance, or like the individual health insurance you may have bought before you entered medicare. Medicare Advantage plans tend to be either HMO or PPO based. HMO plans tend to be less expensive, but also more restrictive, while PPO plans provide more flexibility, but often at a higher cost.
Regardless of which type of Medicare Advantage plan you have, you can expect to pay coinsurance or co-payments throughout the year for every service and procedure you receive. The co-payments and coinsurance amounts tend to be similar to the cost you would pay if you use original Medicare only. However, an important feature of Medicare Advantage plans is that they have an annual out-of-pocket maximum (MOOP) limitation. This means that there is a limit to how much you can pay when you have Medicare Advantage coverage, even in the worst year, like if you had a multi-month hospital stay, or received chemotherapy treatments. You won't pay more than the annual out-of-pocket maximum. The plan will pay 100% of your costs beyond the limit.
Another attractive feature of Medicare Advantage plans is the extra benefits that are often provided. These extra benefits usually include things like vision, hearing, dental, and gym memberships designed for healthy living. These items are not covered by Original Medicare.
In some cases yes. You can combine Aetna Medicare Supplement Insurance coverage with an Aetna Part D prescription drug plan. However, you usually cannot combine a standalone prescription drug plan with Medicare Advantage coverage. If you want Medicare Advantage, and you also need drug coverage, you will need to use an Aetna Medicare Advantage Prescription Drug Plan.
Generally no. As long as you're actively enrolled in Medicare Parts A and B, you can easily get Aetna Medicare Advantage or prescription drug coverage. However, in some states you may need to be 65 years old to get Medicare supplement insurance.
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