What is Aetna?
Aetna is an American health insurance company headquartered in Hartford, CT. Established in 1853, it has been around for nearly 170 years! In November 2018, it became a subsidiary of CVS Health, a leading health solutions company in the United States.
In line with their motto, 'healthier happens together,' Aetna is actively working towards health equity, ensuring everyone, irrespective of their race, income, religion, gender identity, and disability status, has an equal opportunity to access high-quality healthcare services and enjoy a good quality of life.
Aetna is committed to four primary goals, as discussed below:
- Healthy planet: Recognizing that the environment impacts people's health, Aetna and CVS Health focus on advancing climate action and sustainability strategies.
- Healthy community: One of Aetna's targets is making care accessible to all communities by reducing all types of discrimination.
- Healthy people: Aetna is helping more people become healthier and happier through equitable, affordable, and accessible healthcare experiences.
- Healthy business: Aetna ensures protection against healthcare fraud and abuse.
What health plan choices does Aetna offer?
Aetna prioritizes the needs of every type of patient, ensuring everyone finds health insurance solutions that benefit them. Explore some of their popular plan choices:
- Plans through work (for people with employers offering Aetna)
- Individual & family plans (for individuals and families below 65 years)
- Medicare plans (for older adults aged 65+)
- Medicaid plans (for individuals with low income, disabilities, severe health conditions, or other specific parameters)
- Dental plans (for individuals wanting to take proactive steps about their oral health)
- Student health plans (for students wishing quality coverage while they are in college or studying abroad)
Five insurance payment jargon you should know about
If you choose a health plan for yourself and your family, you will come across words such as premiums, deductibles, copays, and more. While it may seem challenging to understand the confusing jargon, you must take some time and effort to do it, as it will help you with budgeting. Read and take notes about the following most common health insurance terms:
- Premium: A specific monthly amount you need to pay to keep your health plan active
- Deductibles: Your total out-of-pocket expenses for medical care you receive before your insurance starts paying
- Co-payment: This is a fixed amount you need to pay for specific healthcare services
- Coinsurance: This is the percentage of costs you pay after paying your deductible
- Out-of-pocket maximum: This is the maximum amount you will need to pay in a year, including deductibles, copays, and coinsurance
What is an accountable care organization (ACO)?
An accountable care organization (ACO) is a network of healthcare providers. This includes doctors and hospitals that operate on a performance-based payment system. The healthier its Medicare-enrolled patients are, the more the ACO is compensated. These organizations follow a coordinated care model, ensuring providers collaborate to reduce redundant services, prevent medical errors, and lower costs. They share any savings generated among the providers as performance bonuses.
What is an allowable charge in health insurance?
An allowable charge is the highest amount an insurance company will give you/reimburse you for a specific medical expense. If the total cost of a procedure exceeds this amount, the patient may need to pay the difference.
Example: If an acupuncturist charges $95 per session, but the insurance company's allowable charge is $45, the patient has to pay the remaining $50.
What is an appeal in health insurance?
An appeal is a formal request for an insurer to reconsider a denial of coverage for a medical service or procedure. Insurance companies must provide a reason for denying coverage and inform policyholders of their right to challenge the decision. Patients can first request an internal review by the insurer. If the insurer maintains the denial, they may request a review from an independent third party.
What is an association health plan (AHP)?
An association health plan (AHP), a group membership-sponsored health plan, allows individuals to join based on their profession or affiliation to access group health insurance rates. AHPs offer discounted coverage for self-employed individuals, freelance workers, and those without employer-sponsored insurance. Organizations like the Writers Guild of America and the Freelancers Union provide health plans for their members.
In 2018, the Trump administration expanded AHP eligibility to individuals linked by geography or business interests, aiming to make it easier for small businesses to participate. However, AHPs are not required to cover all 10 essential health benefits that are mandated by the Affordable Care Act (ACA). As a result, small business employees may receive plans with fewer benefits and potentially higher costs than ACA-compliant options.
What is the role of a primary care doctor?
A primary care doctor fulfills the general healthcare needs of individuals across different ages and genders. They can diagnose and treat various common illnesses, manage multiple chronic diseases, and offer first aid for minor injuries. They also play a massive role in preventative care, encouraging patients to undergo annual physical exams, wellness screenings, and immunizations. Additionally, they help everyone make better lifestyle and diet choices to enjoy good health and well-being for a lifetime.
What happens during an appointment with them?
If you visit a primary care doctor-Aetna near you for the first time, here's what you can expect during the appointment:
- The provider's office staff will guide you through the initial paperwork and document submissions, including your photo ID and insurance card.
- Next, you will meet the primary care provider and cite your reasons for scheduling an appointment. At this point, you can detail your symptoms and concerns.
- The doctor will also check your medical records, including your health conditions, allergies, medications, injuries, surgeries, and diagnostic reports. They will also discuss your family history, lifestyle habits, and diet.
- The provider will perform a comprehensive physical exam and order diagnostic tests if necessary.
- Finally, they will explain the findings and prepare an individualized treatment plan for you, combining medications and health recommendations.
- The primary care doctor will give you enough time to address all your doubts and queries before you leave their office. They may also schedule a follow-up appointment if necessary.
How can you find a primary care doctor-Aetna near you in Los Angeles, CA?
Are you suffering from the flu? Did your child injure himself while playing? Are you due for an annual checkup? Do you want to change your lifestyle? Have you been feeling anxious and stressed lately? Then, you need to book a consultation with a primary care doctor! They can help you with tailored solutions for all your health needs.
If you are looking for a primary care doctor near you, Zocdoc can help! Go to the website and enter the required information, including the type of provider (primary care physician), location (Los Angeles, CA, or anywhere in the USA), and insurance carrier and plan (Aetna, UnitedHealthcare, Cigna, or more). When you click 'Find,' you will receive an extensive list of in-network providers. Our online patient support center can help you find primary care doctors who accept your insurance.
You can simplify your search results by applying different filters. For instance, you can mention your reasons for visiting, your preferred appointment date and time, and the distance you can travel. Furthermore, specify whether you prefer an in-person consultation or a video visit. Lastly, if you have any more requirements, such as seeing a provider of a particular gender or cultural background, you can select those options, too.
To maintain transparency between providers and patients, Zocdoc provides detailed information about each provider. You can review their education and training, hospital affiliations, board certifications, and awards. You can also read verified patient reviews to understand the provider's authenticity and credibility further.
You can also review our pages on how insurance works for freelancers and video visits. When you zero down on a primary care doctor-Aetna near you in Los Angeles, CA, feel free to book your first appointment via Zocdoc—it is easy, secure, and 100% free!
Statistics on Aetna coverage in the United States and California
An estimated 47,950 Aetna employees serve around 39 million people across America and the world. Aetna Better Health of California, a subsidiary of Aetna, has been offering Medicaid programs to more than 1.8 million people in the state for over 30 years. Some of the many population groups covered are children, adults, and people with disabilities and severe health conditions.
According to a KFF report, 6.4% of California's population was uninsured in 2023. The report also stated that people in California mainly opted for employer (47.0%) and Medicaid (26.8%) coverage.
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