Aetna and its coverages
Aetna is a diversified healthcare benefits company and a subsidiary of CVS Health. Founded in Hartford, Connecticut, in 1853, Aetna caters to an estimated 39 million people in health care decisions and spending. Their customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups, and expatriates. Aetna's health insurance plans and services include:
- Medicare plans
- Medicaid services
- Medical, pharmacy, and dental plans
- Behavioral health programs
- Medical management
As of 2023, Aetna's Medicare Advantage plans had approximately 3.3 million registered members, accounting for roughly 11% of the Medicare Advantage market.
What is coinsurance and deductible?
Coinsurance is the percentage of a healthcare expense you pay after surpassing your deductible. Once you meet your deductible, you will split the costs with your health insurance provider through coinsurance till you reach your out-of-pocket limit.
Consider it as dividing the bill, but you usually pay considerably less than the health insurer. Your health plan's coinsurance may be 20%. In such instances, after you reach your deductible, you pay that percentage of the cost, while your health insurance provider pays the remaining 80%.
A deductible is the amount a covered individual must pay out of pocket each year for eligible healthcare services before the insurance plan pays for them. The size of the deductible varies by health insurance plan. Generally, the larger the monthly premium, the lower the deductible.
Refer to our guide for other insurance terminology, such as Medicaid, grace period, deductibles, etc.
What is a Medicare plan?
Medicare is a government health insurance program for adults 65 and older and some people under 65 with specific disabilities or diseases. Medicare is managed by the Centers for Medicare and Medicaid Services, a federal agency. Since it is a federal program, Medicare has established cost and coverage guidelines. This means that a person's Medicare coverage will remain the same regardless of where they live.
Medicare-related bills are reimbursed through two trust funds managed by the United States Treasury. The trust funds get their funding through various sources, including payroll taxes and cash authorized by Congress. People on Medicare bear some of the costs through monthly medical and pharmacy coverage fees, deductibles, and coinsurance.
What is prescription coverage, and how do I check if Aetna covers my medication?
Prescription coverage refers to health insurance or a plan that covers prescription medications and drugs. Many health insurance plans offer a prescription drug benefit, though benefits may vary depending on the plan. Typically, your plan covers the majority of the cost of doctor-prescribed drugs. It is crucial to understand your insurance plan's coverage for specific prescriptions. Health insurance firms are required to provide information about covered medications and out-of-pocket costs.
Check your member website to see if a medicine is covered by your plan. To check coverage information, look for the drug's name. If you know your pharmacy plan's name, you can look up your formulary (drug list) online. Once you select your plan year and type, you will be directed to Aetna's "Find a covered drug" tool. You can also view the Aetna drug guide in PDF format.
What is primary care, and what services does a primary care doctor offer?
Primary care is meant to be your primary source of healthcare, and you and your provider will collaborate continuously.
Primary care aims to help with the following:
- Improve your access to healthcare
- Lower your healthcare costs,
- Improve your health outcomes
Your primary care practitioner can provide a wide range of diagnostic services, treatments, and procedures. Here are a few of the services they typically provide:
- Cancer screenings
- Cardiovascular health screenings
- Diabetes Screenings
- Medication prescriptions
- Immunizations
- Minor surgical operations, including suturing wounds and providing birth control services.
- Ultrasounds
- Casting, splinting, and bracing for wound treatment.
- Health Counseling
How do I find the top-rated Aetna primary care doctors near me in Denver?
In the United States, one suitable way to look for a primary care doctor is with your health insurance company. Many plans keep a list of primary care providers in the area. It can be helpful to find skilled in-network primary care doctors near you to ensure affordable healthcare.
To make this process easier, visit the Zocdoc website and find the best primary care doctor in Denver who accepts Aetna. Select the condition or specialty, location, and insurance plan, and you will get a list of doctors based on your 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 select the right Aetna primary care doctor near you.
You can also check out Zocdoc's guides on health insurance for college students and freelancers.
What is the network size of Aetna? How many people are insured in Colorado?
Aetna maintains a network of 1 million health insurance providers across the United States who provide health care services to its customers.
According to the Colorado Health Institute, in 2023, around one out of every twenty Coloradans did not have health insurance. Although the uninsured rate fell to 4.6% after lingering above 6.5% for nearly a decade, it still accounted for 265,000 people without health insurance. 86.9% said the high cost of Coverage was the primary reason for being uninsured, while 25.7% said they did not know how to get health insurance.
Of the insured, roughly 49.4% were employer-insured, about 30.1% had Medicaid/CHP+, nearly 10.5% had Medicare, and approximately 5.4% had individual or other health insurance.
Sources
Investopedia[1]
Investopedia[2]
Aetna[1]
Aetna[2]
Forbes[1]
Forbes[2]
Forbes[3]
Healthline
Colorado Health Institute
HealthCare.gov
nh.gov
