New Aetna Health Insurance Plans Offer Maternity Coverage

Aetna was one of the major insurance companies that did not offer maternity coverage in California until July of 2012.  On July 1^st, a new California mandate began and required all plans offer maternity and autism care.  As a result of this, Aetna added these benefits to their existing plans and increased the rates slightly.

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Aetna announced they are leaving California individual and family health insurance marketplace at the end of 2013. Go here to learn about good Aetna health plan replacements.

If you are looking for maternity coverage, the Aetna plans are not a good choice because of their higher deductibles. Click this link to see the California plans that are currently the best maternity insurance plans.

The Aetna portfolio of plans is easy to understand and is composed of four primary plan types. Within each plan type, or family of plans, the benefits are the same with the main difference being the deductible of the plans in the family. Aetna’s portfolio covers the full spectrum of benefit levels, from low-end plans with basic benefits, to high-end plans with low deductibles and extensive benefits.

Aetna was the first health insurance company to provide free preventive care to customers.  This free care was in their plans long before Health Care Reform required this coverage.

In this review we’ll describe the benefits of each Aetna plan, and tell what kind of situations and people the plans are a good fit for. Then we’ll look at how the Aetna plans compare to the plans of the competition.

Open Access Managed Choice Value Plans

The Open Access Managed Choice (OAMC) Value family of plans is the lower benefit level plans that Aetna offers.  The OAMC Value plans provide 3 office visits for a simple copay of $50 , free preventive care, and coverage for generic prescriptions.  The family offers deductibles of 2500, 5000, and 8000.

To see more details about the benefits of these plans, click on the deductible links above.

The OAMC Value plans are a good fit for healthy individuals and families that don’t need brand name prescription coverage.

Aetna Open Access Managed Choice Plans

The Open Access Managed Choice family of plans is the highest benefit level that Aetna offers.  These plans offer unlimited office visits for a simple $40 copay ($50 copay for specialists), free preventive care, and both generic and brand name prescription coverage.  For brand name prescriptions the OAMC plans have a $750 prescription deductible that must be met before you have copays.  The family offers deductibles of 1750, 2750, 3500, and 5000.

To see more details about the benefits of these plans, click on the deductible links above.

The OAMC plans are a good fit for families with small children that need more office visits than the Value plans provide.  Aetna has more lenient underwriting requirement to qualify for their health insurance plans.  So these OAMC plans are good choice for people with existing conditions that other insurance companies might not accept.  For more help with this contact our office and an advisor will help you determine how the carriers will treat your existing medical conditions.

Open Access Managed Choice High Deductible Plans (HSA Compatible)

The Open Access Managed Choice High Deductible (OAMCHD) plans are Aetna’s Health Savings Account (HSA) compatible plans.  These plans provide free preventive screenings and all other benefits are part of your deductible costs.  The OAMCHD plans have deductible levels of 3500 and 5500.  Once you reach the deductible on the 5500 Aetna will pay 100% thereafter.  When you reach the deductible on the 3500, you begin sharing costs with Aetna paying 90% and you paying 10% until your out-of-pocket costs equal 5950.  At that point, Aetna pays for all further expenses

To see more details about the benefits of these plans, click on the deductible links above.

These plans are a good fit for individuals and families that want to “self-insure,” but have a safety net to protect them against loss, and can make use of the tax deductibility of contributions to a Health Savings Account.

Preventive & Hospital Care (HSA Compatible)

The Preventive & Hospital Care 2750 plan is the last remaining member of this family.  The plan provides free preventive care and all other benefits require that you meet the deductible first.  After reaching the deductible you begin sharing costs with Aetna paying 80% and you paying 20% until you reach the out-of-pocket maximum of $5950.  This plan does not provide coverage for office visits, lab tests, or prescription coverage.  This plan is also HSA compatible.

Click here to see more details about the benefits of these plans.

The Preventive & Hospital Care plan is not really a good fit for anybody.  The plan costs more than other plans with greater benefits, and the lack of office visits and lab tests means there is a fair amount of risk if you have this plan.  Therefore, we don’t recommend this plan for anybody.

Dental PPO Plan

Each Aetna health insurance subscriber can opt to add a dental PPO plan to their health coverage.  This dental plan has a $25 deductible and no limit to the yearly benefits.  The plan provides free annual checkups, x-rays, and cleanings.  Simple 1 and 2 surface cavity filings are also provided after you meet the deductible.  The Aetna Dental PPO plan does not provide any benefits for other restorative work such as root canals and crowns.

This plan is priced like an HMO plan, but has a PPO network of dentists, and covers 100% of the services it provides except for the $25 deductible.  For people wanting basic preventive coverage to have their teeth health maintained, this plan is a good fit.  If you know that you will periodically need dental work, then another dental plan is going to be a better fit.  See the Dental Information page of the website for more details, or get a dental insurance quote here.

Click here and look at the 2nd page to see more details about the benefits of the Aetna Dental PPO plan.

Summary

Three years ago, Aetna was one of the most competitive health insurance companies in California.  Their portfolio of plans provided preventive care for free at a time when other carriers were not, and was priced to be the best option for most people depending upon age and location in the state.

Today the Aetna plans are not very competitive.  They tend to have higher prices than their competitors, and the plan OOPMs are also higher.  Aetna provides no rate guarantee period, so the rates you start out with can be changed at any time.

For these reasons, the Aetna plans are not a good fit for most people.  The price versus benefits of the Aetna plans makes the competition a better option.  The main situation where Aetna’s plans can still fit are for people with existing health conditions that other carriers would decline, and for older individuals looking for high benefit plans like the Open Access Managed Choice family.

Aetna is one of the largest nationwide health insurance companies and should fare well during the changes that Health Care Reform will bring.  Their large customer base gives them the advantage of “large numbers” that will be critical to survival for insurance companies after 2014.  We expect to see changes from Aetna over the next couple years that will bring Aetna back in line with their competitors, so don’t count them out just yet.

To see the reviews for the other major insurance companies, click on these links:

Health Net Analysis
Blue Shield Analysis
Anthem Blue Cross Analysis
Cigna Analysis

If you would like to discuss your specific needs with one of our advisors please call us. If you want to see what health insurance plans are offered where you live, and what the pricing looks like, “click here” to get a health insurance quote.

 

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