Aetna was founded in 1850 in Hartford, Connecticut, and has continued to be one of America’s key insurance companies for life, medical, dental, vision, disability, and other lines of coverage. Aetna Health Inc., a subsidiary based in Pennsylvania, operates HMO plans in many states, while Aetna Life Insurance COmpany offers PPO and supplemental plans nationwide and in Pennsylvania.
With a national network of more than 1 million providers and 5,400 hospitals, Aetna serves 18 million health insurance members, and 30 million members in all markets combined. Aetna holds an accreditation from the National Committee for Quality Assurance with a Commendable rating for their commercial plans, and an Excellent rating for Medicare coverage.
Pennsylvania residents of all types are served by Aetna, from those who are eligible for Medicaid to individuals and families in need of a private plan. Those shopping for an individual policy have their choice of various PPO plans, ranging from catastrophic coverage to comprehensive, and a selection of HMOs, as well.
Aetna individual HMOs are offered exclusively in Pennsylvania. With low deductibles, HMO plans restrict members to one network, yet are busting with upfront benefits. Such plans are ideal for those who plan to use their health care coverage. PPOs are also a great choice, and offer lower premiums.
Aetna Individual Plans in Pennsylvania
Health Maintenance Organization (HMO)
For members who want a lower copay, in high number, on commonly used healthcare services, HMO 1500 plans offer unlimited office visits, prescription drugs, and home health care before deductible. All other plans are offered with no deductible, therefore covering all services for a predictable copay. Know how much each of your services such as hospital care and emergency services, far in advance. Members are required to select a primary care doctor to administer their care.
High Deductible PPO
Available with a deductible of either $3,000 or $5,000, these plans offer HSA-compatible coverage with free preventive care from the day your plan starts. Benefit from a low monthly premium and add funds to your health savings account, or just use the plan to save money each month. However, be conscious that you will pay everything out of pocket before you meet your deductible. Members do have access to Aetna wellness discounts and programs, as well as other perks. Coverage is 90 percent after deductible.
PPO plans from Aetna offer traditional coverage in a variety of deductibles, ranging from $750 to $7,500 (which includes dental coverage and unlimited office visits). Most plans cover primary care and specialist visits without limits, though some offer a certain number of covered visits. Pennsylvanians pay out of pocket on hospital services until their deductible, and then receive 80 percent coverage when using in-network providers. Premiums are lower than HMOs, yet higher than high deductible plans, so you get a fair amount of upfront coverage for a decent price.
A bit less costly each month, PPO Value plans provide up to three covered visits with a primary care doctor or specialist, as well as generic drugs. These are an affordable alternative to the traditional PPO, and great for those who may not need so many covered visits for illness and injury. After deductible, these plans cover 60 to 80 percent of your medical costs, though generics stay at a $15 copay and preventive care is free throughout your plan.
Preventive & Hospital Care
This is a catastrophic plan and only offers limited coverage for preventive care and several services received in the hospital. Benefits include inpatient services, emergency care, skilled nursing, and home health care at 20 percent coinsurance after deductible. Preventive services are always free when using Aetna PPO network doctors and facilities, and plans are also HSA-qualified.
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