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 thier plans visit their
website.
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.
PPO 2500 Plan
As of August 2006, the most popular of Aetna's California Individual Plan is the
PPO 2500. It features a $30 co pay for doctors office visits, $40 co pay 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.
PPO 5000 Plan
The next most popular Aetna California Individual Plan is the PPO 5000. It is very
similar to the PPO 2500 and less expensive than the PPO 2500. The PPO 5000 has a
$40 co pay for regular doctor's office visits, and $50 co pay for specialist. The
deductible is $5000 for labs, tests, x-rays, and hospitalization that you would
pay first before any coverage. 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.
Plan 1 and Plan 2 (Health Savings Accounts)
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.
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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