Aetna single, family and Medicare medical insurance coverage is a popular type of healthcare coverage in the US. As a CVS company, rates are generally very affordable, and a wide range of off-Marketplace policies are available in selected states. We help you find low cost comprehensive, major-medical, temporary, Group, Medicare Advantage, and Medicare-Supplement policies that save you money and time. In many areas, rates are 15%-25% lower than most of the other insurers and $0 premium plans are offered. Dental and vision plans are also available.
As a trusted Aetna broker, the online quotes you view are the lowest available rates and enrolling in a plan is a simple process that is consumer-friendly and has no cost or fees. Since guarantee issue (Exchange) contracts are available, there is no underwriting, and all medical questions have been eliminated. A federal subsidy is offered to applicants whose income falls under 400% of the Federal Poverty Level. Employer-provided and Senior coverage is offered in most states, while private individual policies were previously available in only four states. The 2023 Marketplace now features many Aetna/CVS plans in 12 states. They are: California, Delaware, Illinois, New Jersey, Arizona, Florida, Georgia, Missouri, North Carolina, Nevada, Texas, and Virginia.
Medigap plans help Seniors reduce out-of-pocket expenses, including deductibles and copays. Generally, you can choose the physician, specialist, or hospital that treats you. Pre-certification and prior approval is not required. Since contracts are standardized, comparing options is easier. Additional products for persons age 65 and over include final expense, whole life, hospital indemnity, cancer, and heart attack benefit plans. Property and casualty (auto and home) products are not offered. MinuteClinic services are also offered in many states.
As a CVS entity and one of the nation’s largest companies, their services include, medical, dental, pharmacy, disability, behavioral health, and life plans. More than 39 million persons are presently covered and are provided services by a network of more than 1 million physicians, specialists, and other industry professionals. More than 5,000 hospitals are considered “in-network,” so regardless where you live, a local facility will always be available. More than 1,100 MinuteClinics are also conveniently located throughout the US. Marketplace plans were previously offered in four states (Virginia, Delaware, Nebraska, and Iowa) and 242 Counties, but Senior and Group products now represent a large portion of their portfolio.
The diversified portfolio includes the acquisition of Coventry Health Care, along with Schaller Anderson (Medicaid Management), Strategic Resource Company (coverage for seasonal and part-time employees), Aetna Capital Management (Hedge Fund investment advisor), ActiveHealth Management (Patient assistance with dangerous drug interactions and other safety issues), Cofinity (non-network claims administration and healthcare management), and Medicity (Secure sharing of information).
A proposed merger with Humana was successfully challenged by the Justice Department, who felt that the Medicare Advantage market would be drastically impacted (negatively) if the two carriers became one entity. Eventually, CVS and Aetna completed a $69 billion merger. Aetna/CVS Marketplace plans are now offered in many states (see below).
Aetna Marketplace Exchange Coverage
Consumers can compare plans from many different companies in most states. Aetna provides under-65 plans in the following eight states: Virginia, North Carolina, Georgia, Florida, Texas, Missouri, Nevada, and Arizona. Additional states are expected to be added in 2023 and 2024. Previously, Marketplace contracts (on-Exchange) were available in the District of Columbia, Ohio, Pennsylvania, North Carolina, South Carolina, Texas, Utah, Arizona, Florida, Iowa, Oklahoma, Illinois, Delaware, Kansas, Virginia, Missouri, and Nebraska. In some states, newly-purchased Coventry underwrote plans. Chief Executive Mark Bertolini had stated in the past that demographics of memberships would greatly determine how competitive pricing will be.
Important Note: Although on-Exchange coverage was not offered in all states (see below for specifics), “off-Exchange” plans were offered in almost all states. These policies did not involve the government website and were not eligible for federal subsidies. However, the mandatory 10 essential health benefits were included and a broader network of physicians and specialists were available. These policies were very popular for upper-income individuals and families that did not qualify for financial aid. The Aetna provider networks continue to serve all private and Group plans, and extend to all states.
Although the cost of coverage varies, depending upon where you live, your age, your smoking status, and which level of benefits you choose, the federal subsidy is available in all states. The subsidy guidelines are the same, and are based on the size of your family and total income compared to the Federal Poverty Level (FPL). Typically, if you make less than 400% of the FPL maximums, a portion of your healthcare costs will be paid by the government. Medicaid, CHIP, and other state/local programs may be offered to help pay medical, dental, of vision expenses.
Provided below are several individual and family scenarios that illustrate the approximate cost of coverage. We are assuming, for reasons of comparison, all applicants are legal residents of the US. Areas shown below are cities where Aetna/CVS plans are offered. Plans are not always available in all counties, and prices will vary, depending on age, zip code, smoking status, and household income.
35 Year-Old Residing In Richmond, VA With Household Income Of $38,000
$106 – Aetna CVS Bronze 1
$122 – Aetna CVS Bronze
$127 – Aetna CVS Bronze 2 QHDHP
$156 – Aetna CVS Silver
$163 – Aetna CVS Silver ON Standard
$171 – Aetna CVS Gold
45 Year-Old Married Couple With One Child Residing In Richmond, VA With Household Income Of $65,000
$112 – Aetna CVS Bronze 1
$160 – Aetna CVS Bronze
$172 – Aetna CVS Bronze 2 QHDHP
$259 – Aetna CVS Silver
$282 – Aetna CVS Silver ON Standard
$307 – Aetna CVS Gold
30 Year-Old Residing In Charlotte, NC With Household Income Of $36,000
$41 – Aetna CVS Bronze 8700 100%
$89 – Aetna CVS Bronze 5500 50% QHDHP
$162 – Aetna CVS Silver $25 Copay 6000
$225 – Aetna CVS Silver $35 Copay 4000
$247 – Aetna CVS Gold $15 Copay 1450
40 Year-Old Married Couple With One Child Residing In Charlotte, NC With Household Income Of $64,000
$0 – Aetna CVS Bronze 8700 100%
$110 – Aetna CVS Bronze 5500 50% QHDHP
$323 – Aetna CVS Silver $25 Copay 6000
$509 – Aetna CVS Silver $35 Copay 4000
$573 – Aetna CVS Gold $15 Copay 1450
25 Year-Old Residing In Atlanta, GA With Household Income Of $25,000
$10 – Aetna CVS Bronze 8700 100%
$18 – Aetna CVS Bronze 5500 50% QHDHP
$79 – Aetna CVS Silver $25 Copay 6000
$155 – Aetna CVS Silver $35 Copay 4000
$136 – Aetna CVS Gold $15 Copay 1450
30 Year-Old Single Parent With One Child Residing In Atlanta, GA With Household Income Of $47,000
$131 – Aetna CVS Bronze 8700 100%
$147 – Aetna CVS Bronze 5500 50% QHDHP
$261 – Aetna CVS Silver $25 Copay 6000
$331 – Aetna CVS Silver $35 Copay 4000
$370 – Aetna CVS Gold $15 Copay 1450
45 Year-Old Residing In St. Louis, MO With Household Income Of $33,000
$103 – Aetna CVS Bronze 8700 100%
$106 – Aetna CVS Bronze 5500 50%
$194 – Aetna CVS Silver 2
$253 – Aetna CVS Silver 1
$314 – Aetna CVS Gold
50 Year-Old Married Couple With Two Children Residing In St. Louis, MO With Household Income Of $85,000
$388 – Aetna CVS Bronze 8700 100%
$399 – Aetna CVS Bronze 5500 50%
$719 – Aetna CVS Silver 2
$936 – Aetna CVS Silver 1
$1,156 – Aetna CVS Gold
Health Maintenance Organization (HMO) plans are available in selected states. Typically, an HMO policy will have low copays on covered office visits, lab tests and X-Rays, include maternity coverage and feature small or no deductibles on major hospital claims. Preventive benefits and utilization control are emphasized to reduce costs and a primary care physician (pcp) helps coordinate your treatment.
In several areas, “Coventry” or “HealthAmerica” (for Seniors) was the carrier offering coverage under the Aetna banner. Both companies were fully-owned subsidiaries of Aetna, and their plans were often offered in areas where they had significant market share. For example, in the Pittsburgh area, HealthAmerica plans featured very attractive rates compared to Highmark and UPMC. Coventry offered plans that were very popular in Central Pennsylvania.
Fortunately, there is a large nationwide network of health care providers, so regardless of where you are, you’re likely to be able to find a specialist, hospital or a facility that can treat you. An online directory is available upon request.
We’ll be happy to provide the online link that allows you to view providers in any area. Unless you live in an extreme rural area, you’ll have plenty of great physicians and hospitals to choose from. These types of contracts are “big sellers” in many states. A small copay for office visits drastically reduces what you pay, especially if you have a family that tends to utilize physicians and specialists quite a bit. However, the cost of coverage is higher and changing from a $10 copay for pcp office visits to $30, will save hundreds of dollars each year.
And the “no” or “0” deductible is extremely attractive when compared to a much larger PPO deductible that is often offered. Although commonly found on Group plans, generally, private individual and family plans will feature deductibles between $1,000 and $9,100.
The most popular personal health insurance policies are the PPO plans. Deductibles of $1,500, $2,500, $5,000 and $9,100 are available in most states (from all carriers), and most office visits and prescriptions are not subject to a deductible. Preventive benefits are included and are covered with no out-of-pocket expense. This type of policy is very popular for an individual or family with many office visits, including well-check visits and immunizations.
The office visit co-pay on PPO plans will generally be between $20 and $40. Specialist visits are usually $10-$50 higher. Unlike many other plans, there is no limit to the number of covered office visits. For the more budget-conscious consumers that don’t have many claims, a “Value” option limits many of the benefits (such as the number of office visits allowed each year). However, the yearly savings could be more than $1000, which should offset some of the potential out of pocket costs that could ensue.
When network plans like these are used, you can easily limit your spending on doctor visit and specialist charges. Here’s how: If you visit your physician for a typical illness such as a stomach virus or perhaps a flu, you can expect the fee to be approximately $75-$150, depending where you live. However, your cost will only be a fraction of that amount because of the copay. With multiple young children in the household, a copay plan can be very cost-effective.
Health Savings Accounts
Aetna HSA plans are a popular choice for those with very few medical claims and the self-employed. Premiums are often substantially lower than comparable comprehensive plans and benefits are covered at 100% once the deductible has been met. Preventive benefits are not subject to a deductible and they negotiate substantial repricing discounts for medical claims that are subject to a deductible. In most years, the deductible will not be met, so these discounts are very important. It’s not uncommon to save a large amount of money when your claim is renegotiated.
HSA plans should flourish under the future Administrations, although many details must be finalized. Currently, Aetna’s HDHP Standard and HDHP Premium plans are offered to groups in selected areas. Common annual deductibles are $1,500 for an individual, and $3,000 for a family. Maximum out-of-pocket expenses are also $3,000 and $6,000. Employer-contribution is flexible, although maximum IRS guidelines apply. The Marketplace (Aetna does not participate) maximum contribution limits are $3,850 for an individual and $7,700 per family. A $1,000 catch-up contribution of $1,000 is permitted for persons 55 and older. The minimum deductibles are $1,500 and $3,000 (single and family). Maximum out-of-pocket limits are $7,500 and $15,000.
An HSA is a catastrophic health plan (HDHP) coupled with a savings account that allows you to accumulate funds for future medical expenses. Funds in the HSA can be dispersed to pay for current medical expenses and also additional qualified dental and vision expenses that you pay “out of pocket.” You have complete control over the funds in your Aetna HSA and they can be withdrawn at any time, subject to policy and IRS guidelines.
You are also not required to make any contributions into the HSA account. We are a big proponent of this type of coverage and highly recommend it. Although premiums are typically less than most other Exchange plans, the option of accumulating tax-free funds is an additional attractive option.
Indemnity policies are fairly rare but may be the best choice for some consumers. The typical employee can receive treatment anywhere he/she wants. Often, in small or rural communities, there may be limited Network coverage forcing you to drive a great distance for treatment. Under an indemnity option, you choose where you get treated, and pay at the time of service. A request is then made to get reimbursed. Often, there is a discount applied which will vary, depending on the area. Unless your treatment consists of large hospital expenses, and continued care for a chronic illness or ongoing condition, and indemnity contract may provide quality benefits at a fairly-reasonable cost.
Medicare Supplement – Availability depends on the state where you reside. Generally, policies provide benefits for Part B coinsurance and outpatient hospital service costs, hospice (Part A), 365 days of hospital coverage and coinsurance, and three pints of blood. Additional coverage is provided on several other plans. Plans A, B, F, G, and N are available in most states, and any physician or facility that accepts Medicare, is acceptable. The cost of Aetna Medigap options will vary, depending on the applicant’s age, zip code, and level of benefits.
Part D Prescription Drug – If you are covered through Original Medicare, or an Advantage plan that does not cover prescriptions, this valuable benefit is highly recommended. Several popular options include Medicare RX Saver, First Health Part D Value Plus, and First Health Part D Premier Plus.
Advantage – Plans are offered in many states. Premiums are typically lower than Supplement options. Several popular plans are listed below. Rates, plan availability, and benefits can vary from state to state.
Aetna Medicare Eagle – HMO plan with $0 deductible and $5,900 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Premier – HMO-POS plan with $0 deductible and $5,200 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Premier 1 – PPO plan with $0 deductible and $5,500 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Premier 2 – PPO plan with $0 deductible and $4,800 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Premier Plus 1 – PPO plan with $0 deductible and $4,900 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Premier Plus 2 – Regional PPO plan with $505 deductible and $5,100 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Value – HMO-POS plan with $0 deductible and $6,700 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Aetna Medicare Value Plan – PPO plan with $0 deductible and $5,500 maximum out-of-pocket expenses. $0 and $35 office visit copays.
Individual dental plans are offered in Illinois, Pennsylvania, Arizona, Alaska, and Delaware. Group plans are available in most states. Two plans (PPO Plus and PPO) provide comprehensive coverage, including preventative and diagnostic benefits, cleanings, denture repair, root canals, oral surgery, and periodontics. Plan deductibles are $50 and $100, and maximum yearly benefits are $1,200 and $1,000.
“Vital Savings” is a dental discount plan that provides cost reductions for many major and minor services. However, it is not considered “insurance.” Rates vary, with the least-expensive plan priced at approximately $8 per month. Discounts are approximately 15%-50%, although savings will depend on your state of residence, and type of service provided.
Fixed Benefits Plans
Fixed benefits contracts are not considered “primary” coverage. They are actually deigned to supplement existing plans, by paying fixed-dollar benefits to help pay for primary-care physician, specialist, Urgent-Care, inpatient and outpatient hospital stays, and prescription drugs. Often coupled with plans with high deductibles ($3,000 or more), out-of-pocket expenses can be effectively reduced, while maintaining qualified coverage.
Our website continues to be considered as the veteran authority for affordable Health Savings Accounts (HSAs). We represent Aetna and most of the major carriers that offer coverage. We feel it is important to carefully research which individual plans will best your objectives, but still offer needed protection. It is possible that future reform legislation will affect HSAs, although it is likely policy features will be enhanced. We’ll continue to offer our expertise, dedicated support, and time so that you’re always kept current with any proposed changes.
International medical plans may be suitable if you need worldwide coverage, and do not have an active policy. If you live abroad permanently, or most of the year, an expatriate or international plan is often the most cost-effective option that will pay comprehensive benefits. Emergency medical evacuation, maternity, office visits, prescription drugs, dental benefits, and preventive coverage can all be included. For US citizens that are traveling abroad for vacations, many additional options are offered through specialty carriers. Certain countries, however, may require higher premiums because of political instability or lack of sufficient number of medical facilities.
Managed Medicaid plans (including CHIP) are offered in the following states: New York, Pennsylvania, West Virginia, Ohio, Kentucky, Virginia, Illinois, Missouri, Maryland, New Jersey, Michigan, Nebraska, Florida, Texas, and Arizona. In many states, Medicaid-eligibility has expanded, providing government-provided benefits to more lower-income families. If Medicaid expansion continues, more single persons and families will subsequently receive their medical coverage from the government, rather than private plans. However, insurers will administer many of the benefits.