Aetna Health Insurance Leaving California – Recommended Replacement Plans

Aetna Health Insurance announced they are leaving the California marketplace for individual and family plans. The end date of all their plans is December 31, 2013. All 49,000 Aetna clients still have six months to figure out what health plan they should move to. In this article we’ll give you a simple mapping that recommends which plans you should move to based upon the Aetna health plan you currently have, a “gotcha” to watch out for, and a couple of silver linings to feel good about.

The simplest way to replace your Aetna Health Insurance is to simply look for an alternative plan with the same (or similar) deductible amount. The recommendations below will make that easy to do. With just a little more effort, you could re-think what you need in yearly medical benefits and pick a plan the is a better fit for your current needs. Either way, you should be able to find a good solution listed below.

Aetna Health Insurance Underwriting Is More Lenient

This will be the gotcha for some people. Aetna has always been more willing to accept people with some health conditions. I know a number of my clients are in Aetna plans because they had specific health conditions that the other carriers either would not accept, or would “rate” much higher than Aetna. So this is something you have to be aware of and be careful about.

If you have existing health conditions, or are “too short” (okay…a little over-weight), or have a rated plan with Aetna, then you should definitely talk to a broker before you apply with another health insurance company. You’ll want to have the broker do Pre-Screen Requests for you to see how the other insurance companies will treat your application.

It’s important to do the pre-screen step first, because if you just pick a health plan, apply for it, and then get declined or rated even higher, it will be very hard to get other insurance companies to consider your application.

Let’s start mapping replacement plans…

Aetna Open Access MC Value Plan Alternatives

The Aetna Open Access Value plans are Aetna’s low-cost option. The Value plans offer a number of different deductibles, $8,000, $5,000, $2,500, and provide 3 office visits for a simple copay, and coverage for Generic prescriptions.

This plan description matches very closely to what is offered in the Anthem Blue Cross SmartSense plans. If you only need two office visits rather than three, then the best choices are the Health Net PPO Advantage plans and the ClearProtection plan from Anthem Blue Cross.

If cost of the plan is one of your major factors, then here is how the alternative plans above should be used.

1. Health Net PPO Advantage 3500 – offers the best overall value (cost vs benefits)
2. Health Net PPO Advantage 6500 – is usually the lowest cost option
3. Anthem Blue Cross ClearProtection 3300 – Anthem’s lowest cost solution
4. Anthem Blue Cross SmartSense 6000 – closest match to Aetna’s Open Access Value 8000, but lower cost
5. Anthem Blue Cross SmartSense 3500, 2000, 1000 – if you feel more comfortable with lower deductibles

In the majority of cases, the alternative plans from Anthem and Health Net will be lower cost than the comparable Aetna Value plans. You’ll need to review health insurance quotes to see how the pricing looks for your location in California. Just click on the “Get Rates” button below to see.

Aetna Open Access MC Plan Alternatives

The Open Access plans are Aetna’s high-end offerings. These plans offered unlimited office visits for just a copay, provided both Generic and Brand name prescription coverage, and offered deductibles of 5,000, 3,500, 2,750, and 1,750.

The best mappings of the Open Access plans are the following:

1. Cigna Open Access Value plans – Cigna’s entry plans, but very similar to the Aetna plans but without brand name prescription coverage
2. Anthem Blue Cross Premier plans – these plans are the top of the line from Anthem
3. Cigna Open Access plans – the high-end Cigna plans
4. Blue Shield Shield Secure Plus plans – Blue Shield’s top end plans

Health Net does not have any plans that provide unlimited office visits and coverage of brand name prescriptions, so there are no options listed.

Aetna Open Access MC High Deductible Plan (HSA Compatible) Alternatives

These are Aetna’s entry in the Health Savings Account (HSA) compatible market. Like all HSA plans, they provide no benefits except zero-cost preventive care until after you reach the deductible. The plans come with two deductibles, either 5,500 or $3,500.

The mappings for these HSA plans is the following:

1. Health Net CFB HSA 4500 plan – this is the best value HSA plan in the market
2. Health Net CFB HSA 6000 plan – this is the overall lowest cost HSA plan
3. Blue Shield Saver HSA plans – these are lower cost than the other non-Health Net HSA plans
4. Cigna Health Savings 4900 plan – good general purpose plan
5. Anthem Blue Cross Lumenos 5950 plan – Anthem’s last remaining HSA plan

Are You Looking For Lower Out Of Pocket Risk?

Some shoppers may be looking to lower premiums AND lower the OOPM’s they have had in the past. If this is your wish, then here are a couple of options you should explore:

1. Health Net CFB PPO Standard plans – the OOPM in these plans is equal to the deductible, and 2 office visits for a copay
2. Cigna Open Access Value 5000/100% – the OOPM is the same as the deductible, and the plan offers unlimited office visits

These alternative plans will cost a little more than the direct replacement options listed in the sections above. However, the attractiveness of having lower risk if an accident or a medical condition starts is very compelling.

Silver Linings In The California Aetna Health Insurance Decision

I believe that Aetna is just the first in a line of large and small health insurance companies that will leave the California individual and family health insurance marketplace over the next 3-5 years. Aetna had a very small market share, and would have a hard time competing with the insurance companies that dominate the California market. So having Aetna leave now will reduce the turbulence we see during the Health Care Reform roll-out later this fall.

The first silver lining in all of this is that Aetna plans tend to have very high Out-Of-Pocket Maximums (OOPM). As an example, for a family, the Open Access Value 8000 plan has an OOPM of $25,000, while the Anthem Blue Cross SmartSense 6000 plan and the ealth Net PPO Advantage 6500 have a $19,000 OOPM.

This is one of the reasons people have stayed away from new Aetna plans unless no other health insurance company would accept them. There are plenty of plans from Health Net, Anthem Blue Cross, Cigna, and Blue Shield that will have lower OOPM’s than the Aetna plans.

The last silver lining of this change at Aetna, is that Aetna plans have not been very competitive the last couple of years. So changing to comparable plans will give you a reduction in premiums. To find out how much your rates will will be reduced, get an instant quote using the “Get Rates” button below.

To get answers to any questions, or to see if you need to get Pre-Screen Requests done, just call us at 858-613-3628, or send an email to info (at) spfinsurance.com.