About Aetna
Aetna is a healthcare services company that offers health insurance plan services. It is part of CVS Health, a health solutions company that aims to bring empathy and dedication to every aspect of individual health. They also assist in healthcare management, workers' compensation administration, and innovative health information technology solutions.
Nearly 39 million individuals trust Aetna to guide them in navigating their healthcare choices and expenditures. Its health insurance plans and services include medical, pharmacy, and dental coverage, medicare plans and services, behavioral health programs, and comprehensive medical management support.
History of Aetna
Aetna was founded in the 1800s. The company decided to keep the Aetna name because the original Aetna Life Insurance Company already had a good reputation. The name comes from Mt. Etna, an 11,000-foot volcano located on the eastern shores of Sicily. It was the most active volcano in Europe at that time.
In the 1910s, when the USA entered the state of World War I, Aetna utilized its financial strength to provide insurance to the government for bond contractors involved in construction. Later, in 1922, the company created its first-ever insurer-owned rehabilitation clinic for disabled workers in Syracuse, NY. Then, in the 1940s, it became the first insurer to advertise on television. Aetna drafted the first individual life insurance policies to safeguard America's original seven astronauts in 1963. It also became the first company to pay the first-ever Medicare claim in 1966. From 1997, Aetna started investing in affordable housing across the country. This resulted in about $1.4 billion of investments, supporting the building and renovation of more than 93,000 affordable homes.
Since 2003, Aetna has been a leader in addressing health disparities. It has committed over $3 million to improve healthcare access and delivery to its diverse populations. In the same year, Aetna also became the first national, full-service health insurer company to initiate a health savings account (HSA) option. In 2012, it was recognized as one of America's most community-minded companies and ranked fourth in "The Civic 50" survey.
In 2015, Karen S. Lynch became the first woman to serve as president in Aetna's history. In 2018, the company became part of CVS Health®, and Karen S. Lynch was chosen as the first woman to serve as president and CEO of CVS Health in 2021. Since then, Aetna has aimed to do the best for its people and every individual they serve.
Types of health insurance plans
Health insurance companies often use acronyms like HMO, POS, and EPO, which can be confusing. Here is a breakdown of the various types of health insurance plans and what they entail:
- Health Maintenance Organization (HMO): An HMO plan offers affordable insurance with lower deductibles and premiums. It features fixed copays for doctor visits and is a good option if you have a lower budget and do not have many health concerns. While signing up for an HMO plan, you can choose an Aetna primary care doctor near you. You'll need a referral from your doctor to see a specialist.
- Exclusive Provider Organization (EPO): The plan focuses on in-network coverage but typically offers broader coverage. Referrals from primary care doctors may or may not be necessary. The premiums are higher than those of HMOs but lower than those of PPOs.
- Preferred Provider Organization (PPO): PPO plans allow visits to specialists and out-of-network doctors without referrals. While premiums are higher, coinsurance and copays for in-network care are low, making them suitable for those needing extensive healthcare.
- Point of Service (POS): POS plans also require your doctor's referral to see a specialist. It provides out-of-network coverage benefits but slightly higher premiums than an HMO. This plan suits individuals who need frequent medical care for a condition, and their specialists may be outside the network.
- High Deductible Health Plans (HDHP) and Health Savings Accounts (HSA): HDHP offers low premiums but high upfront costs. Combined with HSA, they help cover deductibles and provide tax savings. Certain services like annual check-ups, vaccines, and screenings may be covered without meeting the deductible, making it attractive for those with chronic conditions on a budget.
Who is a primary care doctor, and when should you consult one?
A primary care physician (PCP) or a primary care doctor is a healthcare provider assisting individuals to manage their overall health. While typically doctors, PCPs can also include nurses and physician assistants. A doctor considers your lifestyle and history to promote overall health by:
- Guiding on healthy choices to prevent diseases, like quitting smoking, adopting nutritious diets, and managing stress.
- Ensuring your vaccinations are current to prevent illnesses such as the flu.
- Recommending screening tests like mammograms for early detection of issues like breast cancer.
- Addressing immediate health concerns like rashes or infections.
- Assisting in managing chronic problems such as diabetes, high blood pressure, or depression.
- Facilitating referrals to specialists like orthopedic surgeons or cardiologists when necessary.
How much does a visit to a primary care doctor near you cost?
Many factors determine the cost of seeing a doctor, like health insurance coverage and the specific services included in the plan. Elements like the type of doctor (primary care or specialist), the location of care, and required treatments play a significant role. Whether one is a new or returning patient, all contribute to the overall expense. Without insurance, a doctor's visit can cost anywhere from $75 to $600, depending on the doctor's specialization and whether the doctor conducts additional procedures or lab tests.
An uninsured person's basic visit to a primary care doctor may cost between $150 and $300, with an average of $171 in major U.S. cities. A wellness exam may range from $75 to over $300, and additional lab work might cost $200 to $500 separately. A full physical exam with lab work can start at $199. However, a visit, including exams, immunizations, or extra tests, can go over $600 at some places without insurance.
If you seek affordable and accessible healthcare options, you may seek an Aetna-primary care doctor near you and health insurance products.
How can Aetna help you in lowering primary care costs?
Recently, individuals have found themselves shouldering a more significant share of their health costs, prompting a heightened interest in cost-saving strategies. One way to save money is to stay within Aetna's network of healthcare providers, including doctors, hospitals, and surgical centers. These in-network providers offer negotiated rates, contributing to potential savings for individuals.
If an individual chooses an out-of-network provider or hospital, they will have to pay the full cost themselves. The insurance plan might cover the expenses in emergency cases. Even if out-of-network coverage exists, fees are generally higher compared to using in-network services.
Some Aetna health plans cover out-of-network services, determining the allowed amount based on factors such as Medicare rates or a "reasonable" amount. Here is an illustration of the cost disparity between staying in the network and going out of the network for the same healthcare service.
Consider a $825 charge for a doctor's visit. The cost breakdown includes the negotiated rate with in-network providers, deductibles, and the percentage of coverage the plan provides.
- In-network cost: Within Aetna's network, the doctor's bill amounts to $825, and the contracted price is $500 for this particular visit, providing you with a $325 discount right from the start. Currently, your expenses are $0. For network care, the deductible stands at $50. After meeting the deductible, the plan covers 80% of the remaining amount, leaving you responsible for a 20% coinsurance, resulting in a total cost of $140.
- Out-of-network cost: The doctor's bill is $825, while the "allowed" amount for such visits is $400. The patient must pay the remaining $425, known as balance billing. The deductible for out-of-network care is $100. After meeting the deductible, the plan covers 60% of the remaining allowed amount, leaving the patient responsible for a 40% coinsurance. Consequently, the total cost sums up to $645.
How do you find an Aetna-primary care doctor near you in Chicago, IL?
When finding an Aetna primary care doctor in Chicago, IL, Zocdoc offers a seamless and user-friendly solution to simplify your search. By leveraging Zocdoc's services, you can navigate through a carefully curated selection of primary care doctors in Chicago, IL.
Tailor your search by specifying your location, preferred specialties, and insurance coverage, and watch as Zocdoc generates a comprehensive list of Aetna primary care doctors nearby. Explore detailed profiles encompassing their practice locations, services, educational backgrounds, and insightful patient reviews. You can also check whether a doctor offers in-person or virtual consultations. Know how insurance works for a video visit here.
Remember, while adding your insurance information to your Zocdoc account makes it easier to find in-network providers, many offices still require you to bring your insurance card to your appointment. For any insurance-related queries, visit Zocdoc's patient help center.
Zocdoc can be your trusted partner in finding an Aetna-primary care doctor near you that meets your healthcare needs.
Statistics related to healthcare and insurance in Chicago, IL
A 2020 report from the Society of Actuaries highlighted that the cost of specific primary care services posed a hurdle for patients, making them less affordable. Furthermore, the escalating demand for these services has taken a toll on providers, with many managing a workload exceeding 2,500 patients each, contributing to burnout.
Data from Statista for the year 2021 underscores the healthcare landscape in Illinois. Notably, over six percent of the state's population was uninsured, revealing a significant coverage gap. According to the Illinois Department of Healthcare and Family Services, nearly 3.9 million residents of Illinois are enrolled in Medicaid, including pregnant women, children, low-income adults, and people with disabilities.
Sources
Aetna[1]
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Cleveland Clinic
Society of Actuaries
Statista
Illinois Department of Healthcare and Family Services
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