Get Pennsylvania Aetna HMO (Health Maintenance Organization) plans that provide some of the most comprehensive coverage available to Pa residents. As the leading trusted resource for single and family coverage in the Keystone State, we specialize in finding the policies that pay your claims at a price you can afford.
Aetna is one of the nation's largest providers and features an extensive Network of doctors, hospitals and facilities. Their rates are typically very competitive throughout most of the state. In some areas, Coventry plans are offered where Aetna is not available.
How An HMO Works
Individuals who join an Aetna or Coventry HMO are classified as its members. Your primary care physician (PCP) is selected from a large Network list. Your physician will coordinate and supervise all of your medical care and you can change your choice at any time. There are no claim forms when you visit a network provider and no waiting period for routine physical exams or most preventive services. Internal medicine and pediatric services will also be provided, if needed. It's essentially a "hassle-free" way to be treated.
NOTE: Treatment of prescriptions often changes (ie what is generic, what is non-generic etc...) and the Aetna Pharmacy Plan Drug List will help you stay updated regarding any changes. You can also contact us for an explanation.
Typically, you present your ID card and your physician or hospital will handle the paperwork. You then receive quality medical treatment at a reduced cost. This is because of the negotiation that is done on your behalf by the carrier. All Keystone State residents benefit by paying less, and the insurer and doctors are happy since they have more customers. If you travel outside of the area, depending on the policy, you can still be treated and receive the negotiated cost reduction.
Aetna utilizes the Leap Network in Pennsylvania. Generally, you can easily find a doctor, specialist, medical facility, treatment center, or hospital close to your work or home. Listed below are the seven offered provider networks and the counties of coverage:
Aetna Savings Plus - Bucks, Chester, Delaware, Montgomery, and Philadelphia.
Commonwealth Health - Columbia, Lackawanna, Luzerne, Wayne, and Wyoming.
Lehigh Valley Health Network - Lehigh and Northampton.
Penn Highlands Healthcare - Clearfield, Elk, and Jefferson.
Pinnacle Health - Cumberland, Dauphin, and Perry.
Uniontown Hospital - Fayette.
Aetna - Adams, Bradford, Cameron, Clinton, Franklin, Lycoming, McKean, Mercer, Monroe, Potter, Sullivan, Susquehanna, Tioga, Vernando, Warren, and York.
Impact Of The Affordable Care Act (Obamacare)
With the creation of the "Marketplace" concept of buying subsidized coverage, many companies (including Aetna) no longer offer plans in all parts of the state. Also, it is possible that availability of policies may be different, depending where you live. And of course, federal subsidies can potentially reduce your premiums, if your household income meets Federal Poverty Level guidelines. NOTE: The Pa Health Insurance Exchange offers single, family and small business coverage. You can view all available options directly through our website and enroll in 10 minutes.New 2017 plans are now available and eligible for financial assistance to help reduce premiums. We have listed below the current Pa Aetna HMO plans with a brief description. Dental and vision benefits are typically available as riders or stand-alone policies. These policies can be purchased "off-Exchange" and federal subsidies do not apply.
Aetna Pa HMO Plans
$15 Copay Savings Plus - $15 primary care physician copay. Specialist visits subject to the deductible ($5,000). $20 generic drug copay.
Deductible Only HSA Eligible - $6,300 deductible but can be used as an HSA. The investment account is optional.
$20 Copay - Similar to previous plan with $20 pcp copay and $15 generic drug copay. Deductible is also higher ($5,750).
Silver Tier (Eligible for cost-sharing)
$10 Copay - $3,750 deductible with $10 and $60 copays on office visits.
$5 Copay $2500 Savings Plus - $2,500 deductible with $5 and $50 copay on office visits. Popular with household with multiple children.
$10 Copay - $3,750 deductible with $10 and $75 office visit copays.
$5 Copay - $2,750 deductible with $5 and $75 copays on office visits. This plan is the most expensive HMO in the Silver tier.
$0 Copay Savings Plus - Low $1,250 deductible with $0 and $40 office visit copays. Both generic and brand drugs not subject to deductible.
$5 Copay - $1,400 deductible with $5 and $40 office visit copays. Brand drugs have a copay and deductible to meet.
Popular Non-HMO Plans
Bronze Deductible Only HSA Eligible OAMC POS - Identical to Deductible Only HMO option.
Bronze Deductible $20 Copay OAMC-POS - Identical to $20 Copay HMO option.
Silver $10 Copay OAMC-POS - Identical to second $10 Copay (Silver-tier).
We realize that it's sometimes not easy to fully understand all of the specifics of medical coverage. We'll be happy to take the time to review the coverages and determine if a policy is best for you. If it isn't, we'll consider hundreds of other options from the top companies and together, we'll compare your best choices. Remember that it's very important to review your existing policy before every annual Open Enrollment.
Pahealthinsurance.com will provide all the tools you need (along with personal service) to easily view benefits and apply for coverage. Call or email us any time for additional information on the Aetna HMO policy. Purchasing a policy is an easy process.