Medicare Advantage Plans
If you’re not eligible for Medicare, learn about our five medical plan options.
The Medicare Advantage plans offer additional benefits and coverage on top of standard Medicare. The coverage and cost details for both Medicare Advantage plans on this page are valid through December 31, 2023.
Coverage for Combined Medicare and Non-Medicare Families
If a retired DeKalb employee is eligible for the Medicare Advantage plans but their dependents are not, you can combine coverage by enrolling your dependents in one of our five non-Medicare medical plans . View coverage levels for more information.
Plan Highlights
Both our Medicare plan options provide quality medical and prescription drug coverage. Some costs, like copays and premiums, will vary depending on which plan you choose, and neither plan includes out-of-network coverage.
The main difference between the plans is who administers the plan: One plan is administered by Aetna and the other by Kaiser.
Quick comparison of key cost features for in-network coverage
| Aetna Medicare Advantage | Kaiser Senior Advantage | |
|---|---|---|
| Deductible Per individual |
$350 | $250 |
| Out-of-Pocket Maximum | $2,500 | $2,500 |
| Coinsurance | 100% | 100% |
| Primary Care Physician visit | $25 copay | $20 copay |
| Specialist visit | $40 copay | $35 copay |
| Hospital stay | $150 copay | $150 copay |
| Emergency Room | $100 copay | $65 copay |
| Urgent Care | $20 copay | $30 copay |
| Ambulance services | $100 copay | $75 copay |
| Diabetic supplies | Covered 100% | Covered 100% |
| Outpatient Surgery | $75 copay | Covered 100% |
| Outpatient Diagnostics Lab, x-ray, imaging |
$20 copay | Covered 100% |
| Outpatient Dialysis Treatments | $20 copay | $30 copay |
Non-Medicare-eligible dependents
If your dependents aren’t eligible for Medicare, you can enroll them in one of our five medical plan options.
Resources
Aetna
Kaiser Permanente
Documents & Tools
Monthly Medical Premiums – Medicare Only
- Aetna Medicare Advantage: $93.84
- Kaiser Senior Advantage: $93.60
Monthly Medical Premiums – Combined Medicare + Non-Medicare
| 1 Medicare & 1 Non-Medicare | 1+ Medicare & 2+ Non-Medicare | 2 Medicare & 1+ Non-Medicare | |
|---|---|---|---|
| Aetna Medicare Advantage & Blue Open Access POS | $682.73 | $1,619.06 | $776.57 |
| Aetna Medicare Advantage & Blue Open Access HMO | $954.09 | $2,321.89 | $1,047.93 |
| Aetna Medicare Advantage & Blue Open Access HSA | $314.58 | $665.57 | $408.42 |
| Kaiser Senior Advantage & Kaiser HMO | $414.31 | $635.62 | $452.72 |
| Kaiser Senior Advantage & Kaiser HSA | $324.91 | $549.82 | $407.17 |
*Health Savings Account (HSA) is applicable only to non-Medicare tiers. Medicare members have access only to the Medicare Advantage plans.
Prescription Drug Coverage
Prescription drug coverage is provided automatically when you enroll in one of DeKalb County’s Medicare Advantage plan options. The provider and coverage details will depend on the plan you choose.
View quick comparison of in-network prescription drug coverage.
| Aetna Medicare Advantage | Kaiser Senior Advantage | ||||
|---|---|---|---|---|---|
| Retail (30-day supply) | |||||
| Generic | $10–15 copay* | $10 copay | |||
| Preferred | $25 copay | $25 copay | |||
| Non-Preferred | $50 copay | $50 copay | |||
| Specialty | $50 copay | $50 copay | |||
| Mail Order (90-day supply) | |||||
| Generic | $30 copay | $20 copay | |||
| Preferred | $50 copay | $50 copay | |||
| Non-Preferred | $100 copay | $100 copay | |||
| Specialty | $100 copay | $100 copay | |||
*You’ll pay the $10 copay for generic drugs filled through a CVS Pharmacy. You’ll pay a $15 copay at all other network pharmacies.
Biweekly Medical Premiums
| Employee Only | Employee + 1 Dependent | Employee + Family | |
|---|---|---|---|
| Anthem Options | |||
| Blue Open Access POS | $81.06 | $209.96 | $251.30 |
| Blue Open Access HMO | $98.44 | $254.96 | $305.16 |
| Blue Open Access HSA | $30.26 | $78.37 | $93.79 |
| Kaiser Permanente Options | |||
| Kaiser HMO | $64.32 | $166.65 | $199.12 |
| Kaiser HSA | $25.38 | $65.64 | $78.43 |
Looking for easy ways to save?
- Stay in-network.
- Ask for generic prescription drugs whenever possible.
- Explore tax-advantaged accounts.