What is Aetna?
Aetna is a leading healthcare benefits company in the United States, serving approximately 39 million people. It helps people make informed decisions about their healthcare and spending. Aetna’s health insurance plans and services encompass medical, pharmacy, dental, Medicare, Medicaid, behavioral health programs, and medical management services.
Aetna also offers a variety of insurance and employee benefits products, along with programs and services aimed at controlling rising medical costs while enhancing healthcare quality. These include healthcare management, workers' compensation administration, and health information technology services. With Zocdoc's help, you can easily find orthopedic surgeons who take Aetna insurance.
What are Aetna's pros and cons?
Aetna provides significant advantages, including competitive premiums. However, it also has drawbacks. Despite these challenges, Aetna’s affordability, quality, and additional perks make it a noteworthy option in the health insurance market.
Pros:
- Aetna offers some of the most affordable average premiums for Affordable Care Act (ACA) plans among significant health insurance providers.
- It receives slightly above-average quality ratings from the National Committee for Quality Assurance (NCQA).
- Since Aetna is part of CVS Health, members enjoy exclusive benefits such as a $25 allowance every three months for CVS Health shopping and a 20% discount on CVS Health brand products.
Con:
- Aetna's silver plan deductibles are generally higher than the industry average.
What are Aetna’s various Medicare Advantage plans?
Aetna Medicare Advantage plans include benefits and services that focus on overall health. The company is dedicated to delivering the coverage, resources, and care that members require. The Evidence of Coverage comprehensively describes plan benefits, including any exclusions, limitations, and coverage conditions. Please note that plan features and availability may vary by service area.
- Medicare Advantage HMO plans: A Health Maintenance Organization (HMO) plan offers affordable insurance with lower deductibles and premiums. Aetna's Medicare Advantage HMO plans require members to opt for a primary care provider to coordinate their care within a network of doctors and hospitals. This plan offers Medicare coverage that ensures patients receive the right care at the right time.
- Medicare Advantage HMO-POS plans: A Point of Service (POS) plan generally covers out-of-network doctors for a higher premium. Aetna's Medicare Advantage HMO-POS plans combine the benefits of network care with added flexibility. Members can select a doctor from a group of participating providers for their medical care. These plans allow members to visit licensed dental providers in and out of the network for routine dental care, although out-of-network visits may incur higher costs. This coordinated approach to Medicare coverage provides members with more options.
- Medicare Advantage PPO plans: A Preferred Provider Organization (PPO) plan enables visits to specialists and out-of-network doctors without referrals. Aetna’s Medicare Advantage PPO plans extend this flexibility by permitting visits to any Medicare-approved providers, both in and out of the network, provided they accept Aetna® plan terms. However, out-of-network visits may incur higher costs.
- Medicare Advantage Dual Special Needs plans (D-SNP): Aetna's Dual-Eligible Special Needs plan (D-SNP) is a type of Medicare Advantage plan designed to offer additional support for individuals who possess both Medicare and Medicaid.
What are association health plans (AHPs), and who can use them?
An Association Health Plan (AHP), a group membership-sponsored health plan, allows individuals to join based on profession, affiliation, or shared business interests to access group rates on health insurance. AHPs benefit those without employer-sponsored insurance, such as freelancers, self-employed individuals, or members of professional groups like the Writers Guild of America or the Freelancers Union.
In 2018, new regulations expanded AHP availability, making participating easier for people linked by geography or business interest. However, these plans are not required to cover the 10 basic health benefits mandated by the Affordable Care Act (ACA), potentially offering limited coverage at higher costs than ACA plans.
What does “allowable charge” mean in your health plan?
The maximum amount your insurance company will pay for a particular medical service or procedure is the allowable charge. If the total charge from the provider is higher than the allowable charge set by your insurer, you’ll be responsible for paying the difference.
Example: If an acupuncturist charges $95 for a session, but your insurer’s allowable charge is only $45, you must pay the remaining $50 out of pocket.
How do accountable care organizations work?
An Accountable Care Organization (ACO) is a group of healthcare providers, including doctors and hospitals, whose payments depend on their performance. Specifically, they are rewarded based on how healthy their Medicare-enrolled patients are. ACOs follow a coordinated care model where healthcare providers work together as a team to reduce duplication of services, prevent medical errors, and ideally lower healthcare costs. When they save money while maintaining quality care, they share the savings among the group as bonuses.
How can you challenge a denied insurance claim?
An appeal is a request to your insurance provider to reconsider its decision to deny coverage for a medical service or procedure. Your insurer must explain why you deny coverage and inform you of your right to challenge their decision. You can start by filing an internal review with the insurance company. If they uphold the denial, you can escalate the appeal to a neutral third party for an external review.
Who is an orthopedic surgeon?
Aetna orthopedic surgeons near you, or orthopedists, specialize in diagnosing and treating musculoskeletal system issues, including bones, joints, ligaments, tendons, and muscles. While they can perform surgeries, they also employ non-surgical treatments and rehabilitation strategies to manage musculoskeletal conditions. Common procedures performed by orthopedists include surgeries on the ankle, knee, hip, spine, hand, and neck.
Patients typically seek orthopedic care for pain, stiffness, swelling, or injuries related to movement. Conditions like arthritis, bursitis, chronic pain, fractures, and sports injuries often necessitate a visit to an orthopedist. Orthopedic surgeons also treat long-term issues, including tumors and blood cancers affecting bones.
Becoming an orthopedic surgeon requires extensive education and training, including a bachelor’s degree, medical school, and a five-year residency in orthopedic surgery. Some orthopedic surgeons may also pursue an additional year of subspecialty training. After residency, they must practice for two years and clear a final exam to be certified by the American Board of Orthopedic Surgery.
How do you find Aetna orthopedic surgeons near you?
Do you want the best advice and treatment for joint or muscle problems? A qualified orthopedic surgeon can provide the best diagnosis and treatment. With Zocdoc, you can effortlessly find top Aetna orthopedic surgeons, anywhere in the U.S.
The process begins with a simple step: create a free account on Zocdoc. Choose the specialty or condition, location, and your insurance plan. A comprehensive list of orthopedic surgeons based on your search criteria will appear. If you cannot find your plan in the drop-down list, upload a photo of your insurance card, and Zocdoc will scan it to identify your likely plan. Rest assured, inputting your insurance details on the website is safe, as Zocdoc prioritizes your privacy and security, adhering to the industry's best practices to safeguard your information. You can read more about how Zocdoc handles data and privacy and check out Zocdoc's patient help center for answers to any insurance-related queries.
Each orthopedic surgeon on Zocdoc has a separate profile, which includes their brief introduction, education qualification, practice location, visit reasons, hospital affiliations, years of experience, and, most importantly, user-verified patient reviews. You can also schedule online appointments on Zocdoc before meeting your orthopedic surgeon in person, which can help you get to know them better. Look for a purple video icon on orthopedic surgeons' profiles or use the video appointment filter.
Booking appointments with an Aetna orthopedic surgeon near you is 100% secure, quick, and free with Zocdoc!
Statistics on health insurance in the U.S.
In 2022, the U.S. Census Bureau reported an increase in the number of adults with health insurance in the United States compared to the previous year. Approximately 304 million Americans, or about 92.1% of the population, had health insurance at some point during the year, up from around 300.9 million people, or nearly 91.7%, in 2021. Private health insurance was the most common type, covering almost 65.6% of insured adults, while around 36.1% had public health insurance.
Employment-based health insurance was the most prevalent, covering approximately 54.5% of Americans. Medicaid and Medicare followed, insuring around 18.8% and almost 18.7% of the population. The number of uninsured Americans dropped to almost 25.9 million, or nearly 7.9% 2022, down from about 27.2 million, or almost 8.3%, in 2021. Among uninsured nonelderly adults aged 18 to 64, the primary reason for lacking coverage was the high cost (≈69.6%), followed by eligibility concerns (≈26.2%) and a personal preference against being insured (≈23.5%).
Sources
Aetna[1]
Aetna[2]
Aetna[3]
Aetna[4]
Forbes[1]
Forbes[2]
WebMD
