Aetna is an insurance company that sells health coverage to millions of Americans across the country. The company was founded in 1853 and has since expanded to become one of the largest health insurance providers in the country. Aetna offers numerous insurance plans, including small business group plans and even Medicare plans. Over 22.1 million people are covered by Aetna health insurance plans, which have access to over 1.2 million providers.
Aetna Health Insurance Product List
Aetna has numerous products available for its customer base. Aetna offers the following products:
- Health insurance
- Dental Insurance
- Vision Plans
- Behavior Health Coverage
- Disability Insurance
- Health Expense Funds
- Prescription Coverage
- Health & Wellness Coverage
- International Insurance Plans
- Voluntary Insurance Benefits
Aetna Health Insurance Options
Aetna is best known for its health insurance plan options. With Aetna, the insured received items such as online access to help manage his or her health plan, over 1.2 million providers across the country, wellness services, and even personalized wellness and disease management programs.
There are several options for insureds to choose from. The Network only plans allow insureds to use doctors that are in-network only. It is a bit limiting, however, its is often more affordable than other plans available.
The Network Option Plans allow insureds to see doctors both in-network and out-of-network, however, co-pays for out-of-network physicians may be higher.
The indemnity plans offer no restrictions as to whom a person can visit for medical care. These offer the most flexibility, however, often come with higher premiums and co-pays.
Finally, Aetna offers Medicare and retiree insurance plans. These plans are available to anyone eligible for Medicare as private Medicare options.
Aetna Vision and Dental Plans
Much like Aetna health insurance plans, Aetna’s dental and vision plans offer options including Network Only Plans, Network Option Plans, and Indemnity Plans. However, Aetna offers the ability to mix and match your plans as a hybrid fund. This means you can have one plan that includes options of two different plans.
Another option available through Aetna is the DentalFund plan which allows you to use untaxed dollars to pay your co-pays and out-of-pocket expenses.
Aetna Health and Wellness Benefits
Aetna Insurance Plans know the importance of staying healthy. The philosophy is that a healthy person is in the office more often and needs less medical care. Therefore, Aetna offers health and wellness benefits to its insureds. Some of these benefits include:
- Aetna Maternity Program
- Infertility Precertification Unit
- Breast Health Education Nurse
- Cancer Support Centers
- BRCA Genetic Testing Program
- Personal Health and wellness coaching
- Mindfulness Programs
- Workplace Wellness
- Metabolic Syndrome Solution
- The Get Active Program
- Informed Health Line
Aetna Behavioral Health Programs
Behavioral health, in many ways, is as important if not more important that physical health. This is why Aetna has extensive coverage for behavioral health programs. Many of these programs are incorporated into Aetna’s numerous health insurance plans. These coverages include treatment, counseling, and even the trademarked “Resources for Living,” which helps individuals achieve well-being in all areas of their lives.
Aetna Health Insurance Changes for 2019
One of the biggest changes to Aetna plans to take effect on January 1, 2019 is what process will require precertification. The following procedures will begin to require precertification:
- Decompression surgery for Chiari malformation
- Laminectomy with rhizotomy
- Shoulder arthroplasty
- Site of Care for Actemra IV(tocilizumab), Entyvio (vedolizumab), Orencia (abatacept) and Simponi Aria (golimumab)
The following procedures will no longer require precertification:
- Actimmune (interferon gamma-1b)
- Gastrointestinal (GI) tract imaging through capsule endoscopy
- Temodar (temozolomide)
- Xeloda (capecitabine)
- Zaltrap (ziv-aflibercept
Finally, there will be several changes to Value Plus Prescription coverages. The full list is available here.
As far as Marketplace changes relating to Aetna, everything will remain the same. Aetna will not be pulling out of any states or changing coverages available through the Marketplace in the 2019 calendar year.
What states is Aetna pulling out of?
The company has made headlines over the last year because they’re pulling out of a number of states. These states include Nebraska, Iowa, Virginia, and Delaware. Therefore, residents in these states cannot purchase a plan with Aetna during the Open Enrollment Period.
Why is Aetna pulling out of the states? It’s not completely clear, but it appears that cost is a primary factor. A CNN report revealed the company predicted a loss of $200 million in 2017, and between 2014 and 2016, the insurance giant reported a loss of $700 million. So it seems this is a reactionary decision to help curb the effects of this financial loss.
Frequently Asked Questionssometi
Does Aetna offer PPO or HMO plans?
The difference between the two types is that a PPO provides fewer restrictions. You can see any specialist without having to go through your primary care practitioner. HMO plans tend to be less expensive, but you can only visit hospitals and doctors that are on the network.
Does Aetna Cover Birth Control?
Aetna does provide birth control coverage. Patients need to obtain a prescription from a medical doctor before heading to a pharmacy. Most plans cover the generic drug formulas, although it’s important to check the plan details to understand the full scope of your coverage.
Does Aetna Cover Abortion?
Certain Aetna plans do cover elective abortion, although this depends entirely on where the patients live. In some states, elective abortions are illegal unless there’s a serious medical issue with either the fetus or the mother.
An elective abortion is a surgical procedure that removes the embryo from the woman’s uterus. In certain situations, women can also take a pill that contains the drug mifepristone, which induces a miscarriage. Mifepristone can be equated to an elective abortion under certain plans.
Does Aetna Cover Invisalign?
Some Aetna plans do cover Invisalign treatment, although it’s important to read the fine lines of your policy. Some plans have an age cap for both dependents and beneficiaries and only cover a certain amount. The standard plan covers up to 50% of the cost of a treatment plan valued at $2,500.
Does Aetna Cover Acupuncture?
Some Aetna plans do cover acupuncture, but only if it’s used as an alternative to pain management. Therefore, if a licensed doctor recommends acupuncture as opposed to surgery, the insurance will pay for it. It’s important to note you should always read the fine print on your insurance policy and call to ask questions before moving forward with this treatment.
Does Aetna Cover Weight Loss Surgery?
Aetna plans do cover weight loss surgeries. However, there are stipulations. Under most plans, the patient has to be experiencing chronic pain for the operation to be covered. It’s also important to note that HMO plans do not include weight loss surgery as a means to combat obesity.
Does Aetna Cover Lasik?
No, a basic Aetna plan does not cover Lasik. Also called refractive eye surgery, this procedure involves a laser to reshape the cornea to improve either nearsightedness or farsightedness. For those who already have a basic Aetna plan, you could purchase an Aetna Vision Plan, which partially covers the cost of the procedure.
Does Aetna Cover Braces?
It depends. Not all plans provide orthodontics coverage, which is why it’s important to ask questions to your insurance broker and read all documents. The plans that do offer orthodontics typically cover 50% of the costs of the treatment for individuals under the age of 18.
Does Aetna Cover Therapy?
Yes, most Aetna plans offer therapy to members, although there are certain restrictions. Certain plans cap out at a maximum, and if you’re on an HMO plan, you’ll have to see you primary care practitioner to get a referral to a psychologist.
Does Aetna Cover Viagra?
The answer is no. Viagra is considered a lifestyle or performance-enhancing drug. Therefore it does not meet Aetna’s requirements. Individuals still need to obtain a prescription from a medical doctor, but they’ll pay full price at the pharmacy.
Does Aetna Cover Breast Pumps?
Yes, Aetna plans typically cover breast pump rentals. The pump is only covered if a) the newborn is hospitalized b) the newborn has a condition that interferes with feeding. In the last case, the breast pump can be covered for a period up to 12 months.
Does Aetna Cover IVF?
Basic Aetna plans do not cover in vitro fertilization. However, Aetna does cover diagnostic tests to discover the reasons behind infertility. On the higher end plans, Aetna does provide infertility treatment, including multiple rounds of IVF.
Does Aetna Cover IUDs?
Most Aetna plans cover IUDs as a form of contraception or for heavy menstrual bleeding. An intrauterine device (otherwise known as an IUD) is a form of birth control, and it’s essentially a device that’s inserted into the uterus and prevents the woman from getting pregnant. They come in two forms; hormonal or copper.