Insurers
About Aetna
Although Aetna writes group health coverage in every state, they only write individual
health insurance plans in select states. Aetna has recently (7-1-2005) entered the
California individual health insurance market. The plans now offered in California
are very similar to their existing Ohio offering. Their current plans in California
include three classes of plans, HSA, PPO, and PPO Value plans. For more about Aetna,
and watch this fun and informative
movie about Aetna's commitment to
Healthcare transparancy and health plan literacy.
Unlike most other carriers in California, Aetna uses gender based underwriting.
Meaning they have different rates for male and female policy holders of the same
age. Aetna also offers Medicare HMO Supplement plans in California in some counties
through their Golden Eagle Medicare product. Other than this Medicare compatible
product, Aetna does not offer individual HMO plans in California.One feature of
this added level of pricing is the fact that they are able to target specific age
categories very effectively. Aetna's current health insurance rates are very favorable
for women over forty. However that is not to say the plan is not competitive for
other perspective age groups either. The plans set prices are currently among the
lowest priced individual health plans on the market.
The two most popular Aetna MC(Managed Choice) plans in California are the Aetna
MC Open Access 5000 and MC 2500 plans. The plan design is the same for both of the
MC Open Access plans, but the copay, deductible, and out of pocket max differ by
plan. The MC Open Access 2500 features a $30 copay for doctors office visits,
$40 copay for a specialist. The plan also has a $2500 deductible for labs, tests,
x-rays, and hospitalization. After the deductible, the plan goes to 30% coinsurance
until a max out of pocket of $7000, after which Aetna then covers 100%. The plan
also features full prescription drug coverage, covering generic, brand name, and
non-formulary brand name prescriptions. Learn more about
PPO Plans.
MC Open Access Value Plan
The next most popular Aetna California Individual Plan is the MC Open Access VALUE
Plans. They are very affordable but carry a large deductible before coveage at the
doctors office. For example, The MC Value 5000 plans deductible is $5000 and applies
before office visits, labs, tests, x-rays, or hospitalization would be covered by
coinsurance on the plan. The deductible is imbedded into the max out of pocket of
$8000, and the coinsurance is at 30%. This plan also has some of the best prescription
drug benefits of any individual plan covering generic, brand name, and non-formulary
brand name prescriptions.
MC High Deductible Plans (HSA)
The Aetna
health savings account
(HSA) plans, known as Plan 1 and Plan 2 are among the most popular H.S.A. compatible
plans available to the individual in California. They feature a managed tax deferred
account through Chase J.P. Morgan Bank.
The First dollar plans compete with the
Blue Cross Right Plan 40, and the
Blue Shield Active Start 35. These plans
from Aetna feature zero deductible, and low copay's for office visits. The Coinsurance
is 70% for Labs, tests, and x-rays. So you only pay 30% of the charges up to the
max out of pocket. These plans are more expensive than the competitor versions,
and with a higher out of pocket maximum. If Aetna can get the pricing lower, then
these plans would compete well with the above mentioned competition.
Our Recommendations
We do not generally recommend the PPO 5000 Value or the PPO 2500 Value plans with
Aetna. Although both those plans are less expensive than the other PPO plans Aetna
offer, the reduction in coverage is not commiserate with the reduced premium. In
other words, even though the plan is a little cheaper than the non-Value plans,
the coverage is drastically reduced. For example, the prescription drug benefit
only covers a maximum of $1000 a year, and deductible applies before the co-insurance
at the doctor's office. If you are considering one of the Value plans offered by
Aetna,
please call or email HealthInsurancePlus.com
to discuss the plan in detail and confirm that it will meet your health insurance
needs.
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