About Aetna

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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.

Aetna Managed Choice Open Access Plans

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.

MC First Dollar Open Access Plans

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 to discuss the plan in detail and confirm that it will meet your health insurance needs.

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