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What Aetna Health Insurance Covers

Health insurance companies use a lot of acronyms (HMO, PPO) and specialized terms such as “deductible” and “copay.” You may be wondering if you are the only one who’s confused: “Was I out sick the day that everyone else learned what this stuff means?”

This study guide will teach you all you need to know to pick a health insurance plan. We will describe the different types of plans and explain how your health history and budget might impact your insurance needs. Soon, you will understand all your options and feel more confident about making the correct decision.

HMO: A Budget-Friendly Plan

A Health Maintenance Organization (HMO) plan is one of the affordable types of health insurance. It has low premiums and deductibles and fixed copays for physician visits. HMOs, necessitate you to choose doctors within their network. When you enroll for the plan, you will choose a primary care physician (PCP), whom you will see for regular checkups. Your PCP will need to give you a referral before you can see a specialist, such as a dermatologist (skin doctor). Since all your health services are funneled through your PCP, it’s vital to find one you trust. HMOs are a good option if you are on a tight budget and don’t have any medical issues.

POS: An Affordable Plan with Out-Of-Network Plan

As with an HMO, a Point of Service (POS) plan necessitates that you get a referral from your primary care physician (PCP) before seeing a specialist. But for slightly higher premiums than an HMO, this plan covers out-of-network doctors, though you will pay more than for in-network doctors. This is a significant difference if you are managing a condition, and one or more of your physicians are not in the network.

EPO: A Larger Network Makes Life Easier

An Exclusive Provider Organization (EPO) is a lesser-known plan kind. Like HMOs, EPOs cover only in-network care, but networks are typically larger than for HMOs. They may or may not need referrals from a primary care physician. Premiums are higher than the Health Maintenance Organization but lower than PPOs

HDHP with HSA: Offset Out-Of-Pocket Expenses with a Health Savings Account

A High Deductible Health Plan (HDHP) has low premiums but higher immediate out-of-pocket expenses. Employers usually pair HDHPs with a Health Savings Account (HSA) funded to cover some or all of your deductible. You can also deposit pre-tax dollars in your account to cover medical costs, saving you about 30%. And remember, depending on your age, services like mammograms, colonoscopies, annual well visits, and vaccinations may be covered free of charge, even if you have not met your deductible.

An HDHP might be an HMO, POS, PPO, or EPO. Individuals who are managing a health condition but cannot afford higher monthly premiums may find that an HDHP saves them money in the long run.

References and Resources

• Exclusive Provider Organization Health Insurance
• Point of Service Plans