Aetna was founded nearly 165 years ago (early 1800s) and was one of the first publicly held insurance companies to enter the health insurance field. The company is now led by chairman and CEO Mark Bertolini and currently covers over 22 million medical members.
At the end of Q4 2017, it was announced that CVS would purchase Aetna for an estimated $69 billion, making it one of the biggest healthcare acquisitions in U.S. history. Aetna was planning on moving its headquarters to New York City prior to the aquisition, but CVS announced the company’s headquarters will now remain in Hartford, Connecticut.
Services Currently Offered by Aetna
Medical, pharmacy and dental plans
Behavioral health programs
Student & International Health
No short-term or stand-alone travelers coverage are available through Aetna. In addition to health insurance, Aetna offers: group, life, disability, and long-term care insurance, and employee benefits.
Aetna is best categorized as a managed health care company that delivers traditional and consumer directed health insurance plans (and other related services). Aetna coverage policies are primarily offered through employer-paid (fully or partly) insurance and benefit programs, and also through Medicare. Aetna is also becoming one of the leaders in value-based care.
Member Statistics for Aetna Health Insurance
Approximately 22.2 million medical members
Approximately 13.4 million dental members
Approximately 13.1 million pharmacy benefit management services members
Its is estimated that 38.8 million people rely on Aetna to help them make decisions about their health care and their health care spending
Health Providers and Facility Networks
About 1.2 million health care professionals
More than 690,000 primary care doctors and specialists
Over 5,700 hospitals
Approximately 13.8 million pharmacy benefit management services affiliates
Subsidiaries include: ActiveHealth Management, Inc., Aetna Student Health Agency Inc., Cofinity, Inc., Medicity, Inc., Meritain Health, Inc.
Find a pharmacy tool: click here
Coverage by State
Aetna offers the most comprehensive healthcare coverage for the following states: Arkansas, California, Colorado, Connecticut, Illinois, Maine, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont, Texas
A broad range of small business health plan offerings are also available in every state: click here
Medicare and Medicaid plans vary by state and can be found using this helpful tool: click here
Plans and Prices
Aetna healthcare plans are broken down by six different benefits levels. Policies are written after your lifestyle and health are evaluated to get a better take on they type of health insurance you need, and this ultimately determines the total healthcare cost Aetna will pay, compared with the out-of-pocket expenses that you will pay as a policyholder.
It’s important to think about your current health status and lifestyle when deciding on an Aetna plan. For example, if you are healthy, active, and typically only visit the doctor for an annual check-up, you may qualify for a nationwide PPO policy that offers full coverage at a relatively low monthly premium.
Estimated Premium Rates
35 Years of Age: $190 – $310 monthly National Average is $300/mo
45 Years of Age: $220 – $370 monthly National Average is $350/mo
55 Years of Age: $400 – $570 monthly National Average is $550/mo
Aetna Benefits Levels
Benefits category 1
Patients must select and use a participating primary care provider (PCP) and receive PCP-referred care through participating providers. Services received outside of Aetna’s participating provider network are not covered, except emergency/out-of-area urgent care or out-of-area renal dialysis, unless approved by the health maintenance organization (HMO) in advance of receiving services.
Aetna MedicareSM Plan (HMO)
Aetna Medicare Prime Plan (HMO)
Benefits category 2
Patients receive the highest benefits level by selecting and using a participating PCP and receiving PCP-referred care through participating providers. Patients receiving covered services from a nonparticipating provider are subject to out-of-network deductibles, coinsurance and potential balance billing.
Benefits category 3
Patients are encouraged to select and use a participating PCP. Services received outside of Aetna’s participating provider network are not covered, except emergency/out-of-area urgent care or out-of-area renal dialysis, unless approved by Aetna in advance of receiving services.
Aetna Medicare Plan (HMO) Open Access
Aetna Health Network Only
Aetna Open Access® Elect Choice
Aetna Open Access HMO
Open Access Aetna Select
Benefits category 4
Patients are encouraged to select and use a participating PCP. Patients receiving covered services from a nonparticipating provider are subject to out-of-network deductibles, coinsurance and potential balance billing.
Aetna Choice® POS
Aetna Choice POS II
Aetna Health Network Option
Aetna Open Access Managed Choice
Aetna Medicare Prime Plan (PPO)
Benefits category 5
Patients receiving covered services from a nonparticipating provider are subject to out-of-network deductibles, coinsurance and potential balance billing.
Aetna Limited Benefits Insurance Plan (PPO)
Open Choice® PPO
Benefits category 6
Patients have access to all licensed providers for covered benefits. Patients are responsible for all applicable deductibles, coinsurance and potential balance billing.
Aetna Voluntary Group Medical Plan (indemnity plan)
AETNA HEALTH INSURANCE
Top Ten Reviews:8.75/ 10
ADVANTAGES /Aetna has some of the least expensive premiums available in the private market and is aiming to keep cutting costs with its focus on value-based care. It’s pharmacy network is also one of the most extensive in the country, and that will only continue to grow as CVS integrates its own resources within Aetna’s current infrastructure.
DISADVANTAGES /Short-term policies to cover gaps in insurance caused by changes in employment or other issues are not offered by Aetna. The layout of Aetna’s benefits levels is also more complicated than most carrier offerings.
CONSUMER TAKEAWAYS / With strong consumer reviews and an 8.75 / 10 overall rating from Top Ten Reviews. Aetna is a longstanding health insurance company that provides a multitude of different plans, both privately and through the health exchange. Dental and vision plans, student insurance and international insurance are also available, and Aetna provides supplemental insurances to augment any current plans.
A case study by Top 10 Reviews also found that Aetna plans are about $600/year cheaper on average even though individual results will vary. Aetna is not for you if you are between jobs, if are a recent college graduate, or if you waiting to be enrolled in your company’s insurance.
Aetna is a carrier to watch as value-based care, corporate restructuring, and technical efficiencies leave it poised for significant innovation and growth in the health insurance market for years to come. Aetna prides itself in having a ‘a range of insurance and employee benefits products, programs and services that help control rising costs while striving to improve the quality of health care, and tools and information to help people make better-informed decisions about their health care and financial well-being.’