About Aetna Better Health
Aetna, founded in Hartford, Connecticut, in 1853, is currently a subsidiary of CVS Health. The organization provides health insurance to nearly 39 million individuals, including Medicare plans, Medicaid programs, and other policies.
With 30+ years of experience, Aetna Better Health, the managed care plan by Aetna Medicaid, has assisted people with various healthcare needs. In the USA, their medical plans cover 12 states: Arizona, California, Florida, Maryland, Texas, Illinois, Kansas, Kentucky, Louisiana, Michigan, New Jersey, New York, Ohio, Oklahoma, Pennsylvania, Virginia, and West Virginia.
What is a network, and what are essential health benefits?
Before you decide on a healthcare plan, it helps to understand a few related terminologies.
A network is a list of doctors, other healthcare providers, and hospitals a plan contracts with to offer medical care to its members. In-network providers typically accommodate better coverage with lower coinsurance and copayments for healthcare services.
Essential health benefits refer to 10 categories of services that must come under the health insurance plans according to the Affordable Care Act. The following are the categories of benefits under an essential health benefits (EHB) package:
- Ambulatory patient services
- Hospitalization
- Lab services
- Emergency services
- Maternity and newborn care
- Prescription drugs
- Rehabilitative and habilitative services and devices
- Wellness and preventive services and chronic disease management
- Mental health and substance use disorder services
- Pediatric services, including oral and vision care
Understanding copays, deductibles, and coinsurance
Regarding health insurance, you're not just paying a monthly premium. Most plans include additional costs to share the financial responsibility. Here's how these work:
- Deductible: This is the amount you must pay out of pocket each year before your insurance starts covering costs. For example, if your deductible is $2,000, you must pay $2,000 for medical expenses like hospital visits or tests before your insurance kicks in.
- Copay: Even after you meet your deductible, you'll often pay a flat fee for specific services. For instance, you might pay $25 every time you visit your doctor or $10 for a prescription.
- Coinsurance: After meeting your deductible, you may share some of the costs with your insurer. Let's say your plan includes 20% coinsurance. If you have a $1,000 hospital bill, you'll pay $200, and your insurer covers the rest—until you hit your yearly out-of-pocket maximum.
Imagine you break your arm and visit the ER. If your deductible is $1,000 and you still need to pay something this year, you'll pay the full $1,000 for the ER visit. After that, your insurance covers a percentage. If your plan includes 20% coinsurance and costs $3,000, you'd pay $400 (20% of $2,000), and your insurer would handle the rest.
Plans with lower premiums usually mean higher out-of-pocket costs, such as deductibles, copays, and coinsurance. When choosing a plan, consider your healthcare needs. A lower premium might save you money monthly, but it could lead to larger expenses if you need extensive care.
You can refer to our guide to know more about other insurance lingo.
How much does healthcare insurance cost?
Monthly medical insurance premiums vary significantly across the nation. Though the Affordable Care Act ensures that these premiums are not decided by gender or pre-existing health conditions, various other factors can affect what you might have to pay for health insurance.
Here are ten key factors that impact the cost of health insurance premiums.
- State and federal laws: Legislation governs what health insurance must cover and how much companies can charge.
- Types of insurance: The amount you pay varies depending on whether you buy insurance on your own or via your employer's group plan.
- Income level: Low-wage workers typically pay more through their employers but may pay less via a federal or state exchange because of subsidies.
- Employer size: Large corporations typically offer lower insurance premiums.
- State of residence: Premium costs vary by state and county.
- Type of community: Premiums are often lower in urban areas than rural ones.
- County of residence: Some counties only provide one plan, but others have more competitors, which may result in lower pricing.
- Plan type: Preferred provider organizations (PPOs) and platinum plans offered by the federal Health Insurance Marketplace are often the most expensive.
- Age: Health insurance rates rise as policyholders age, with the older population paying rates almost three times more than younger people.
- Tobacco usage: Tobacco smokers face premiums that might be up to 50% higher.
Does Aetna Better Health cover transportation services under its plans?
Many Medicaid beneficiaries might not own a car, have neighbors or friends who can lend them one, or live in a location with few public transportation choices. Even though Medicaid provides outstanding health benefits, they have limited access to those advantages.
That is one of the reasons Aetna Better Health provides access to treatment by covering no-cost, curb-to-curb transportation for members who use a shared car, taxi, bus, or other public or private mode of transportation to go to a plan-covered medical visit. The program also provides mileage reimbursement, allowing individuals who own a vehicle to pay the petrol and maintenance costs associated with driving to and from appointments.
Who is a primary care doctor, and when should you visit one?
Primary care doctors or physicians (PCPs) provide general healthcare and address a wide range of health concerns. They are usually the first point of contact if you are experiencing a health problem. PCPs can help you with the following:
- Preventive care (preventing illness before it occurs)
- Treatment of common diseases
- Early diagnosis of illnesses or disorders (such as cancer)
- Management of chronic (long-term) conditions
- Referral to a medical expert
You can schedule an appointment with an Aetna primary care doctor near you if you have the flu, need vaccinations, are considering giving up smoking, need to manage diabetes, or want to lose weight. They are well-trained to handle various aspects of healthcare, but if your condition requires more specialized care, they may refer you to a specialist.
How do you find the best primary care doctors near you who accept Aetna?
When you or a family member is facing health-related issues, it can be challenging to find a skilled primary care doctor in the country who accepts your healthcare plan. Visit the Zocdoc website to find the best Aetna primary care doctors near you. Select the condition or specialty, location, and insurance plan, and you will get a list of doctors based on your preferred choices.
Every primary care doctor on Zocdoc has a detailed profile with information about their practice location, visit reasons, educational qualifications, gender, languages spoken, etc. You can also read patient reviews on Zocdoc to make an informed choice.
Conduct a tailored search to locate Aetna primary care doctors who accept your insurance and ensure accessibility. Upload a clear photo of your insurance card, allow Zocdoc to scan it, and receive your desired results. Finally, feed the information to the search bar and continue your search for in-network providers. Please go through Zocdoc's patient help center page for more insurance-related details.
You can also check out Zocdoc's guides on health insurance for college students and freelancers.
What is Aetna's annual revenue? How many people have health insurance?
According to Zippia, Aetna's peak revenue was nearly $60.6B in 2023. The company has almost 47,950 employees, and the revenue-per-employee ratio is approximately $1,263,816.
According to the United States Census Bureau, the number of people with health insurance increased in 2022 compared to 2021. In 2022, nearly 92.1 percent of individuals, approximately 304.0 million, had health insurance at some point in the year. This figure reflects an increase in the insured rate and the number of insured from 2021 (around 91.7 percent, or 300.9 million).
Sources
Aetna
Centers for Medicare & Medicaid Services
American Academy of Pediatrics
WebMD
Investopedia[1]
Aetna Better Health[1]
Zippia
United States Census Bureau
Aetna Better Health[2]
Investopedia[2]
