What is Aetna?
Aetna is a well-known US-based healthcare insurance company. It is a subsidiary of CVS Health, with approximately 39 million healthcare insurance members. Aetna is committed to streamlining and improving the health insurance system for everyone. The company offers several insurance products and initiates programs and services to control rising costs while enhancing healthcare quality.
Aetna also provides tools and resources to empower individuals to make decisions suitable for their medical and financial conditions. Some of the health insurance plans and services comprise:
- Medical, pharmacy, and dental coverage
- Medicare plans
- Medicaid services
- Behavioral health programs
- Medical management
About Aetna preventive care coverage
Aetna's health benefits and insurance plans cover preventive care at no cost. It includes routine screenings, checkups, and counseling to prevent illness or disease. Services like regular checkups, gynecological exams, and well-child exams are included, with no out-of-pocket costs when in-network.
However, if these services are for diagnosing or treating an illness or injury, you may have copays, coinsurance, or deductibles. Aetna follows medical society recommendations for the frequency of these services. It can be helpful to discuss with an Aetna primary care doctor near you which services are right for your age, gender, and health.
Aetna's covered preventive services for adults typically include screenings for:
- Abdominal aortic aneurysm
- Alcohol misuse
- Blood pressure
- Cholesterol
- Colorectal cancer (adults above 50 years of age)
- Depression
Covered preventive services for women typically include screenings and counseling for:
- Cervical cancer for sexually active women
- Annual or biennial mammography for women over 40 years of age
- Chlamydia infection
- Anemia and diabetes screenings for pregnant women
- Genetic testing/ counseling for women at high risk of breast or ovarian cancer, irrespective of personal cancer history
After delivery, breastfeeding support and promotion are extended with up to six visits with a lactation consultant.
Some of the covered preventive services for children include screenings, assessments, and counseling for :
- Autism or behavioral problems
- Alcohol and drug abuse
- Congenital hypothyroidism
- Measurement of body mass index (BMI) as per height and weight
- Obesity
- Tuberculin testing for children at heightened risk of tuberculosis
- Iron supplements for children aged between 6 and 12 months at risk for anemia
- Oral health
What exclusions and limitations apply to Aetna's preventive care coverage?
The preventive care plan has limitations and exclusions regarding healthcare expenses. Members should check their plan documents to understand the services covered and their extent. Below is a list of services and supplies typically not covered. However, exceptions may exist based on the plan or additional riders.
- Any medical or hospital services that are not explicitly covered or are restricted as per your plan documents, including costs incurred before coverage starts or after it ends
- Cosmetic surgery
- Dental care
- Hearing aid
- Immunization for work or travel
- Sterilization reversal
Experimental and investigational procedures are generally excluded, except for medically necessary patient care costs for members participating in a cancer clinical trial. Therapy or rehabilitation services beyond what is outlined in the plan documents are also not covered.
Understanding common insurance terminologies
When selecting a healthcare plan, it is crucial to understand standard terms used in the health insurance industry. It will help you understand your responsibilities and find the best plan for your medical and financial needs. Here are simplified explanations of some insurance jargon:
- Deductibles: You must pay for covered medical services before your insurance coverage kicks in. Typically, deductibles are higher for plans with lower monthly premiums and vice versa.
- Coinsurance is a portion of the cost of covered healthcare services that you pay, usually after meeting your deductible. Your insurer covers the remaining amount. Coinsurance rates are generally lower for in-network providers than for out-of-network providers.
- Copayment: A copayment, or copay, is a set amount you pay for services like a doctor's visit or prescription refill, with your insurer covering the rest. Copays are typically lower for in-network providers than for out-of-network providers.
Refer to Zocdoc's health insurance guide to learn more about the insurance terms.
PPO, HMO, POS, EPO, and HDHP with HSA: Different health plan acronyms explained
Health insurance companies generally use acronyms like PPO, HMO, etc., which can be challenging to understand. Here, we explain the different types of health plans and their acronyms.
A Health Maintenance Organization (HMO) Plan is affordable health insurance. It may have coinsurance, but it generally has lower deductibles and premiums. HMO plans often have a fixed copay for doctor visits. It is a good health insurance choice if you are looking for budget-friendly options and don't have severe health issues.
HMO insurance plans require you to visit doctors in the HMO network for regular health checkups. Your provider is required to give you a referral to see a specialist. All health care services must go through your doctor in the HMO plan.
A Point of Service (POS) plan has certain out-of-network coverage benefits. Like an HMO plan, under the POS plan, you must get a referral from your doctor to see a specialist. It has higher premiums than HMO plans and also covers out-of-network doctors. You can consider a POS plan if you have a chronic condition and one or more of your specialist doctors are outside the insurance carrier's network.
An Exclusive Provider Organization (EPO) plan covers only network care but has a more extensive network than an HMO plan. You do not always require a physician's referral to see a specialist under this plan. The premiums are generally higher than the HMO plans.
A Preferred Provider Organization (PPO) plan allows you to see specialists and out-of-network doctors without requiring a referral. The premiums are higher than HMO plans, but the coinsurance and copays for in-network doctors are low. A PPO plan is ideal if you require more health care in the future and can pay a higher premium.
A High Deductible Health Plan or HDHP is a low premium plan with a high upfront cost. Most employers combine an HDHP with a Health Savings Account or HSA to help their employees cover a portion or all of the deductible. You can deposit a pre-tax amount into the account to cover the Medicaid expenses and ensure savings of up to 30%.
Depending on the age, the plan may cover you for services like annual well visits, vaccines, colonoscopies, and mammograms with no additional charges without you paying your deductible. People with chronic health conditions but a limited budget may benefit from an HDHP, as it may save money in the long term.
Who is a primary care doctor?
Primary care doctors are medical experts who diagnose and treat illnesses while promoting overall well-being. They are part of the primary care physician (PCP) group, encompassing other medical professionals such as nurses and physician assistants. Primary care doctors offer preventive care for common ailments like flu, colds, headaches, and high blood pressure. They manage chronic conditions like lupus and play a vital role in early disease detection, such as cancer, diabetes, and AIDS.
Primary care doctors perform various duties, including:
- Managing chronic illnesses
- Coordinating care with specialists
- Reviewing lab results
- Implementing lifestyle changes
- Renewing or adjusting medications
- Addressing mental health concerns
- Discussing new physical issues or worries
- Receiving recommendations for health screenings
Finding Aetna primary care doctors near you in Phoenix, AZ
If you are looking for a primary care doctor to treat a minor injury or a significant chronic condition, Zocdoc is a helpful resource. Enter your location, ailment, or doctor's specialty into the search box. Based on these criteria, Zocdoc generates a list of top experts in the area with detailed doctor profiles.
Each profile includes essential information about the doctors, such as their educational background, board certification, years of experience, areas of expertise, licensure, whether they treat children, and languages spoken.
If you want to find a provider who accepts your insurance, add your insurance information (your insurance provider and plan) on the Zocdoc search. It will help you see providers who accept your plan. You will see accurate results from in-network primary care doctors. Check out Zocdoc's patient help center for more information and solutions related to insurance.
Additionally, verified patient ratings and reviews assist you in making informed decisions. Once you find a doctor that meets your criteria, you can easily schedule an appointment based on the doctor's availability.
You can also check if they offer virtual consultations. Before you book an online appointment, verify how insurance coverage applies to video visits. Zocdoc makes finding an Aetna primary care doctor near you in Phoenix, AZ, hassle-free. Bookings on Zocdoc are simple, free, and 100% secure.
Statistics on primary care and health insurance coverage in Arizona and the US
According to America's Health Rankings, in 2022, approximately 10.3% of Arizona's population lacked private or public health insurance coverage. Around 8.4% of children under 19 years of age were uninsured. For women aged 19-44, the uninsured rate was around 14.3%, while for adults aged 55-64, it was almost 9.4%. Most of Arizona's population was insured through their employers, indicating a high reliance on employer-based health insurance.
According to data from the Arizona Department of Health Services, in 2021, there were about 9,751 primary care physicians in Arizona. The population-to-provider ratio stood at approximately 747:1. There has been notable progress in healthcare provision in Arizona, comparing statistics from 2019 to 2021. One potential factor contributing to this significant increase could be the rise in registrations, certifications, and licenses issued for primary care services during the COVID-19 pandemic.
According to Statista, the US's number of individuals with health insurance was over 300 million in 2021, about 92% of the population. The healthcare system in the country consists of a combination of public and private insurers, with private insurance being the primary form of coverage among the US population.
Sources
OSF Healthcare
WebMD
Aetna[1]
Aetna[2]
Aetna[3]
Statista[1]
Statista[2]
Arizona Department of Health Services
America’s Health Rankings[1]
America’s Health Rankings[2]
America’s Health Rankings[3]
America’s Health Rankings[4]
