Exchange Options
Aetna is participating in the Pa Exchange Marketplace and also offers plans through Coventry, a company it acquired last year. Coventry's rates are very competitive in most areas. UnitedHealthcare and Cigna, decided not to participate in the Exchange in 2014, although they can consider entering the Marketplace in the future. UnitedHealthcare has stated they will participate in many more states in 2015.
One of Coventry's most popular 2014 Marketplace plans was their Silver $10 Copay HMO policy. Primary care visits are subject to a low $10 copay while specialist visits are subject to a $75 copay. The generic prescription copay is only $5 and since it is a "Silver" plan, "cost-sharing" is provided based on your household income.
For instance, if you qualify for the 87% cost-sharing level, the deductible drops to $1,750 and the specialist copay reduces to $50. The maximum cost-sharing level of 94% totally eliminates the deductible and primary care physician visits. Additional cost-sharing is offered at the 73% and 87% levels. Any time a subsidy is available, the Silver Metal plans should always be considered first.
HMO Plans
In Pennsylvania, Aetna HMO policies are often used. Not only are their rates very competitive in most areas of the state (especially the Philadelphia and Pittsburgh areas), but they, like all companies, must offer affordable maternity coverage. The HMO 20 and HMO 30 policies from pre-2014 have been replaced by Affordable Care Act plans that comply with all required mandates. Prenatal benefits have also been vastly improved.
Details on these plans along with the lowest available prices can be found at this website. Pahealthinsurancecoverage.com is one of the state's most reputable websites for comparing and enrolling.
Since their is no waiting period, prenatal expenses can be covered very quickly along with most other accidents or illnesses. Maternity is now a mandated benefit, which means it is required on all Marketplace plans.
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| Aetna Offers Comprehensive Maternity Benefits |
Depending on which HMO policy you choose, a "per day" expense is required for maternity and certain other major claims. However, after five days, your "per day" expense ends and out of pocket expenses are much lower. HMO plans also benefit families with many dependents by keeping copays low on high-usage items such as office visits, lab tests/x-rays and specialist expenses. Typically, you pay between $20 and $40 on these types of visits.
PPO policies are the most popular individual plans offered to residents of Pennsylvania. A "Preferred Provider Organization" utilizes a network of health care providers to negotiate discounted costs for its users. Almost all insurers have this type of policy in their portfolio since it provides personal medical coverage at low costs. When Exchanges started operating in 204, this type of plan became even more popular so consumers could choose from a wide range of doctors.
Non-Network plans are also sometimes available that allow you to utilize any provider, regardless of their affiliation with an insurer. However, since the cost to your health care carrier is higher, you will pay a much higher premium. For that reason, these plans are not very common unless you are located in a non-service area. Naturally, we don't encourage the utilization of non-network providers unless absolutely necessary.
Deductibles
Aetna's plan options include deductibles ranging from $0 to just above $6,000. Usually, the higher limits are the most popular, since they tend to be very cost-effective over a long period of time. If the policyholder is not paying the premium, then the lowest possible out of pocket expense option is best. That would perhaps be a $750 deductible. But if you rarely utilize your coverage, it's simply a waste of money to choose lower deductibles and 0% coinsurance.
One of the major acquisitions for Aetna was the purchase of Coventry, which marketed plans in Pa under "HealthAmerica." Coventry also offers Medicare Advantage and additional Medicare products.
In addition to policies for applicants under age 65, contracts are also issued for persons 65 or older. Often referred to as "Medicare Supplement" plans, these contracts provide coverage to Seniors to help pay with expenses not covered by Medicare. There are many types of available options and an experienced agent is very helpful in explaining the specifics. Of course, with Seniors, a face-to-face meeting is more appropriate than email or phone.
Pennsylvania is the home to many health care companies. Of course, some are bigger than others. And some have better rankings and rates than others. But Aetna is a very reliable carrier that offers many affordable contracts to individuals and families. They will likely remain a very respected insurer for quite a while and have a major presence on the state Exchanges which started in 2014.
