Aetna Major Medical Insurance
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Aetna Major Medical Insurance
Major medical insurance is designed to provide comprehensive health coverage for services like hospitalization, surgery, and prescription drugs. Aetna is one of the largest providers of major medical plans in the United States. In this article, we’ll take a close look at what Aetna’s major medical insurance covers, what it costs, and who it might be a good fit for.
An Overview of Major Medical Insurance?
Major medical insurance is a type of health plan that provides comprehensive coverage for a broad range of healthcare services. Unlike basic health plans that may only cover preventive care and limited office visits, major medical plans provide coverage for things like:
- Inpatient and outpatient hospital care
- Emergency room services
- Surgery
- Lab tests and X-rays
- Prescription drugs
- Physical therapy
- Home healthcare
- Mental health services
Major medical coverage kicks in after you’ve met your plan’s annual deductible. Most major medical plans have deductibles of at least $1,000 or more per individual. Once you’ve paid out that amount for covered care, your insurance starts chipping in on your costs.
One thing to note is that most major medical plans don’t cover every single healthcare service. They also have copays and coinsurance for certain services. But overall, they provide much more robust coverage than other types of health plans.
Aetna Major Medical Insurance Plans
Aetna Major Medical Insurance Plans
Aetna offers a range of different major medical insurance options including HMO, PPO, and POS plans. The plans fall into three main metal tiers:
Bronze Plans – These have lower monthly premiums but higher out-of-pocket costs when you receive care. Bronze deductibles are generally around $6,000 or more.
Silver Plans – The middle tier for premiums and out-of-pocket costs. Silver plan deductibles are usually between $3,000-$6,000.
Gold Plans – Higher monthly premiums but lower out-of-pocket costs when you get care. Deductibles for gold plans are typically under $3,000.
In addition to the metal tiers, Aetna offers different plan categories that determine your provider network and whether referrals are required to see specialists:
- HMO: Only covers in-network providers. Referrals are required for specialists.
- PPO: Covers in-network and out-of-network providers. No referrals are required. Out-of-network care costs more.
- POS: Combines features of HMO and PPO plans. Covers in-network and out-of-network providers but you pay less when using in-network providers.
The specific coverage details, costs, and provider networks vary a fair amount between each of Aetna’s major medical insurance offerings based on your location. It’s important to carefully review plan documents when considering an Aetna major medical policy.
What Does Aetna Major Medical Insurance Cover?
While coverage specifics will depend on your particular plan, Aetna major medical insurance provides comprehensive coverage for:
- Hospitalization – Such as surgery, overnight stays, maternity care, inpatient mental healthcare, and more.
- Preventive Care – Annual physicals, immunizations, cancer screenings, and certain health exams at no cost to you.
- Outpatient Care – Visits to your primary care doctor, specialists, lab work, x-rays, diagnostic testing, and outpatient surgery.
- Emergency Room Services – Emergency room visits are covered but the copay is usually higher unless you are admitted to the hospital.
- Prescription Drugs – Most plans cover the cost of generic and brand-name prescription medications.
- Pediatric Services – Covers child immunizations, well-child visits, pediatric specialist care, and more.
- Rehabilitative Services – Physical therapy, occupational therapy, speech therapy, and cardiac rehab are generally covered. Pre-approval may be required.
- Mental Health and Substance Abuse Treatment – Outpatient therapy, inpatient mental health, and substance abuse rehab are covered the same as other medical services.
- Aetna’s major medical plans offer robust coverage for comprehensive medical care. But there are some things that may not be covered or have limited coverage such as:
- Adult vision and dental care
- Long-term care
- Non-emergency care when traveling outside the U.S.
Be sure to review your plan documents for details on exclusions and limitations. Many plans allow you to add supplemental coverage like dental or vision for an additional cost.
How Much Does Aetna Major Medical Insurance Cost?
What you’ll pay for Aetna’s major medical insurance depends on several factors:
- – Location – Costs vary between states and even between zip codes. Plans are cheapest in areas with more competition and lower healthcare costs overall.
- Your Age – Premiums are higher for older individuals due to increased healthcare spending.
- Tobacco Use – In most states, current smokers may be charged up to 50% more for coverage due to higher expected costs.
- Individual vs. Family – Adding dependents like a spouse or children substantially increases total premiums.
- Deductible Amount – Plans with higher deductibles have lower monthly premiums. Those with lower deductibles cost more per month.
- Employer Group Plan – Many employers pay for a portion of health insurance premiums for their workers. Those rates are usually lower than buying coverage as an individual.
- According to a 2021 eHealthInsurance market report, the average monthly health insurance premium for an Aetna major medical plan was $536 for an individual and $1,437 for a family. Deductibles averaged around $4,500 for individuals and $8,700 for families.
Of course, costs vary significantly based on your particular situation and location. It’s a good idea to get rate quotes tailored to your circumstances.
Who is Aetna Major Medical Insurance Right For?
- Individuals who don’t get health insurance through an employer or a government program like Medicare or Medicaid.
- Early retirees needing comprehensive coverage before age 65 and Medicare eligibility.
- Employees whose employer gives a fixed allowance to purchase coverage individually.
- Families needing dependable coverage for things like maternity care, pediatrician visits, or surgery.
- Young adults are no longer eligible to remain on a parent’s health plan after age 26.
- Those with pre-existing conditions – all ACA-compliant plans must cover pre-existing conditions.
Major medical is often not the best value for:
- Healthy individuals who rarely need medical services. Catastrophic or short-term plans may be more affordable.
- Low-income households that qualify for subsidies and expanded Medicaid benefits under the Affordable Care Act.
For comprehensive health coverage, Aetna’s major medical plans are a solid choice with robust provider networks and coverage. But it’s critical to budget carefully for premiums, deductibles, and other out-of-pocket costs. Speaking with an insurance agent and comparing plans can help find the right Aetna policy to truly meet your health and budget needs.
Customer Comments about Aetna’s Major Medical Insurance:
- “Aetna has been providing major medical insurance for over 50 years. They have extensive experience and provide access to quality care.” – Karen Johnson, health insurance agent
- “I’ve been really happy with my Aetna major medical plan. It gives me peace of mind knowing I have solid coverage if anything major happens.” – Geoff Willis, Aetna member
- “Make sure you take the time to understand what is and isn’t covered under any major medical plan. Having comprehensive coverage is important but so is choosing a plan you can afford long-term.” – Dr. Anne Wallace, family physician
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Conclusion
Aetna’s major medical insurance plans are cost-effective and should be a top choice for anyone considering buying coverage. Aetna has a broad range of plans for individuals and organizations. To get your major medical insurance plan in about five minutes, enter your zip code and fill out an online application. Get the healthcare coverage you need today and save more.
