Aetna

Which Aetna Coverage is Right for Me?

Aetna coverage is a hot commodity right now, and with good reason – Aetna coverage is among the most affordable types of health insurance available in Georgia today. There are several different types of Aetna coverage, so let’s have a look at what’s on the market.

Aetna Coverage Option One: Managed Choice Open Access & PPO First Dollar 30

The first thing you’ll notice about Aetna coverage is that the plans have frightfully long names.

The Managed Choice Open Access & PPO First Dollar 30 plans are the top of the line when it comes to Aetna coverage. There’s no deductible on these plans – instead, with this Aetna coverage option, you’ll pay 30% of your bills until $7500 comes out of your pocket. After that point, you’ll pay nothing and your Aetna coverage will pay 100%. Office visits are handled by a $30 copay ($40 for specialists). Visits to an urgent care center will run $50 under this Aetna coverage plan, and visits to the ER will cost you $300 flat-fee (unless you’re admitted, in which case this Aetna coverage waives the $300 and goes back to charging you 30% until you’ve reached your annual $7500 out-of-pocket limit).

Prescription drugs are subject to a $500 deductible. Generics are a $15 copay (deductible waived), so only preferred drugs ($40 copay) and non-preferred drugs ($60 copay) are subject to the deductible with this Aetna coverage.

The Verdict: This Aetna coverage is pretty magnificent, but it carries a magnificent price tag, too. If you want to spend this much on your health insurance, why not limit your out-of-pocket exposure a little more and get a Copay Select plan with Golden Rule?

Aetna Coverage Option Two: Managed Choice Open Access & PPO First Dollar 40

This Aetna coverage is essentially the same as the first, with the following modifications

This Aetna coverage pays 40% of your bills, not 30%
The maximum out-of-pocket is $12,500, not $7500
Office visit copays are each increased by $10
Brand name drugs are not covered
The Verdict: The lack of prescription benefits with this Aetna coverage really kills it. As always, I never recommend a plan with less than full prescription benefits.

Aetna Coverage Option Three: Managed Choice Open Access & PPO 1500

This Aetna coverage is more in line with what most people think of when they think “health insurance.” Here, we’ve got a $1500 deductible – once that’s met, this Aetna coverage will pay 80% of your bills and you’ll pay 20% until an additional $1500 comes out of your pocket. At that point, your Aetna coverage will pay 100% of your bills.

Office visits with this Aetna coverage are handled by a $25 copay ($35 for specialists). Generic prescriptions cost $15 without meeting any deductible. After a $250 prescription deductible, preferred drugs cost $35 and non-preferred cost $50.

The Verdict: This Aetna coverage is just about top-of-the-line and carries Aetna’s trademark affordability. This is an excellent option.

Aetna Coverage Option Four: Managed Choice Open Access & PPO 2500

This Aetna coverage is the same as the PPO 1500 with the following modifications:

There’s a $2500 deductible, then 20% coinsurance to an additional $2500 out-of-pocket (our previous Aetna coverage had $1500, 20%, and $1500)
Office visit copays are $30 ($40 for specialists)
Prescription drugs are handled in the same style, but this Aetna coverage carries a $500 prescription deductible instead of $250.
The Verdict: A more affordable version of the 1500 Aetna coverage without any significant holes. Again, an excellent option.

Aetna Coverage Option Five: Managed Choice Open Access & PPO 3500

Again, this Aetna coverage is the same as the PPO 1500 and 2500 with the following modifications:

There’s a $3500 deductible, then 20% coinsurance, then a $6500 out-of-pocket limit, making the total liability for this plan $10,000
Office visit copays are $35 ($45 for specialists).
Prescription drugs are handled in the same way as with the PPO 2500 Aetna coverage.
The Verdict: This Aetna coverage includes a $6500 out-of-pocket limit, making the total liability on this plan a little too high. The price difference between this Aetna coverage and the PPO 2500 is not large enough to justify the difference in liability.

Aetna Coverage Option Six: Managed Choice Open Access & PPO 5000

Once again, we have a plan that works the same as our previous few options with a couple of modifications:

This plan has a $5000 deductible, 20% coinsurance, and then a $5000 out-of-pocket limit. This means that the total liability is the same as with the PPO 3500 option, but the deductible is larger.
Office visits are handled with a $40 copay ($50 specialist).
Prescription drugs have a $500 deductible and work the same as our last two Aetna coverage options.
The Verdict: If your budget restricts you to this or the PPO 3500, the 3500 will give you greater flexibility and value. However, it’s very much worth the slight price increase to move up to the PPO 2500 and cut your liability in half.

Aetna Coverage Option Seven: Managed Choice Open Access & PPO Value 2000

This Aetna coverage option has the word “Value” in the name, which loyal readers of Georgia Insurance Options will know is code for “watch out – limited benefits ahead.” However, Aetna breaks the mold a bit by offering a robust coverage option and only limiting unnecessary benefits.

Here, you’ll have a $2000 deductible. Once you meet that, you’ll pay 30% of your bills until an additional $2000 comes out of your pocket. At that point, your Aetna coverage will pay 100%.

You’ve got six office visits per year covered by a copay ($40, or $50 for specialists). Specialist and non-specialists share those six visits under this Aetna coverage option, so budget those visits wisely.

Generic prescriptions are again a $15 copay, and the deductible is waived. Other prescriptions, however, are subject to a $200 prescription deductible with this Aetna coverage option. After that’s met, you’ll pay a $25 copay for preferred drugs and a $40 copay for non-preferred drugs.

The Verdict: Extremely affordable with low liability means this Aetna coverage option is a great choice for just about anyone. The only people I wouldn’t recommend this plan to are parents with very young children – those six visits will dry up quickly with them.

Aetna Coverage Option Eight: Managed Choice Open Access & PPO Value 5000

Not to sound like a broken record, but this Aetna coverage option is the same as the previous plan with the following modifications:

You’ll have a $5000 deductible, then 30% coinsurance to an additional $5000 out-of-pocket.
The prescription deductible is $500, not $200.
Aside from that, this Aetna coverage option is identical to the previous plan.

The Verdict: This Aetna coverage option is decent if you’re on a budget, but the Value 2000 is far superior and the prices aren’t that far apart. I suggest looking at the Value 2000 Aetna coverage option more closely if you’re considering the Value 5000 plan.

Aetna Coverage Option Nine: Managed Choice Open Access & Value 10000

This Aetna coverage option is flat-out bad.

First, you’ve got a $10,000 deductible. Once you meet that, you’ll pay 30% of your bills until you pay an additional $2500 out of pocket for a total liability of $12,500.

You’ve got two office visits per year covered by a $30 copay. After that, under this Aetna coverage option your office visits begin falling to your deductible.

Generic drugs under this Aetna coverage option cost $20, no deductible. After a $500 deductible you can get preferred drugs for $40, but non-preferred drugs aren’t covered. On top of that, there is a maximum prescription benefit of $5000 per year for prescription drugs – meaning if you’re on $8,000 a round outpatient cancer treatment drugs, you’ll be out of pocket for everything after the first round.

As a final straw, this Aetna coverage option has a $1,000,000 lifetime maximum benefit. Seems like a lot until you realize that the standard is usually $5,000,000 and some plans in Georgia go up as high as $25,000,000

The Verdict: This Aetna coverage option is bad, bad, bad. However, admittedly, it’s the cheapest health insurance plan in the state of Georgia. If you absolutely, positively cannot afford anything else, then this Aetna coverage option is technically better than nothing.

Aetna Coverage Option Ten: Managed Choice And Open Access Preventative and Hospital Care 1250

This one’s no good either.

First, you’ll have a $1250 deductible with this Aetna coverage option. After you meet that, you’ll pay 20% until an additional $3000 comes out of pocket. At that point, you’ll be covered at 100%.

Office visits are not covered expenses, meaning that with this Aetna coverage option you’ll not only pay for the entire bill for your doctor’s visits, but that amount won’t apply to your deductible and you won’t get network repricing. Horrible!

Labs and X-Rays aren’t covered either. Neither is physical therapy or durable medical equipment (like wheelchairs, crutches, etc.). Again, “not covered” means you’ll not only pay for them, but the cost won’t apply to your deductible with this Aetna coverage.

Preventative care under this Aetna coverage is handled well, giving you unlimited visits at $25 a pop – but who goes for preventative checks more than once or twice a year?

Finally, you’ll get your generic drugs at $15 each, but brand-name drugs are not covered. That’s the final nail in the coffin of this Aetna coverage.

The Verdict: I sat here for ten minutes trying to think of a reason why you should buy this Aetna coverage, and I didn’t come up with a single one. A resounding “NO.”

Aetna Coverage Option Eleven: Managed Choice Open Access and PPO Preventative & Hospital Care 3000

Somehow, worse than the 1250 Aetna coverage.

This Aetna coverage is probably the single most offensively awful thing I’ve ever come across. You’ve got a $3000 deductible, 20% coinsurance, and then another $2000 out of pocket. Then your Aetna coverage kicks in and pays 100% of your bills.

Again, office visits aren’t covered. Labs and X-Rays aren’t covered. Physical therapy isn’t covered. Durable medical equipment isn’t covered.

Under this Aetna coverage, you don’t even get the $15 generics – there is simply zero prescription drug coverage.

The Verdict: I wouldn’t wish this one on my worst enemy. This Aetna coverage option is the absolute, bottom-of-the-barrel worst health insurance plan offered by any major insurance company in Georgia. It is absolutely, positively unthinkable that there would ever be a situation in which this Aetna coverage option was the right choice for you.

Aetna Coverage Option Twelve: Managed Choice Open Access & PPO High Deductible 3000 (HSA Compatible)

The last two Aetna coverage options are very good and very simple. This Aetna coverage has a $3000 deductible – costs before it come out of pocket, costs after are paid 100% by Aetna. That’s it – doctor’s visits, hospitalizations, prescription drugs, everything. Once you’ve paid $3000, you’re done for the year and your Aetna coverage will pick up the rest. This is an extremely simple HSA style plan with very few moving parts and an integrated prescription deductible.

The Verdict: While this Aetna coverage option is great, it doesn’t offer any advantages over the Humana Autograph Total Rx series of plans. These two often run neck-and-neck as far as pricing goes, so comparison shop. However, as we’ll see in a moment, even if the Humana plan comes out to be $30 a month more expensive I’d probably recommend it over the comparable Aetna coverage.

Aetna Coverage Option Thirteen: Managed Choice Open Access & PPO High Deductible 5000 (HSA Compatible)

This plan is functionally identical to the previous plan – the only difference is that the deductible is $5000 instead of $3000. This, of course, makes the plan slightly more affordable while trading off some of the risk.

The Verdict: My feelings about this Aetna coverage are the same as they are about its $3000 sister. Compare closely against Humana to see which one works better for you.

Special Considerations

There are a couple of things to consider when you’re looking at an Aetna coverage option. Although the plans are some of the most affordable in the state, Aetna has a reputation for being somewhat difficult to deal with on the billing side. Aetna coverage comes with Aetna bureaucracy, which means increased headaches when it comes to getting bills paid and rates negotiated.

Aetna also has a nasty habit of raising their rates multiple times in the second year of coverage, turning a very affordable Aetna coverage plan into an overpriced bank-drainer. In contrast, Humana and Golden Rule will raise their rates once a year at most, and a company who has requested that we not name them will allow you to lock in your rate for up to three years on some plans.

There’s also no option to add maternity to your Aetna coverage, so if you’re planning a family then this isn’t the company for you.

On the positive side, Aetna’s dental coverage is widely regarded as some of the best in the business. It’s accepted across a large range of practitioners and geographic areas and is a very affordable form of dental coverage, too.

The final verdict on Aetna coverage in general: The plans are affordable (for the first year), but you’ve got to be very careful which one you pick. You could either get awesome Aetna coverage, or be stuck with one of the worst plans in the state – there’s very little middle ground when it comes to Aetna coverage. The company also has a slightly spotted reputation, but it’s still a first-tier carrier and that means it’s miles above no-names like Imerica and World.

In short, Aetna coverage is a good budget option, but probably shouldn’t ever be your first choice. Always compare these plans closely with offerings from Humana and Golden Rule before making your final decision.

Now that you’ve learned more about Aetna coverage than you probably ever wanted to know, it’s time to find out how much it costs! Head on over to our free Georgia insurance quote page to get your instant, personalized proposal now!

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