Jeffrey Wade
Aetna is a health insurance company that offers a range of plans to meet the needs of individuals and families, as well as employers and healthcare providers. They are part of the CVS Health family of companies and have been providing Medicaid services for over 30 years. Aetna offers health insurance plans that cover COVID-19-related services, including vaccines and lab tests, and provides members with the right to appeal coverage decisions. To get started with Aetna, you can visit their website or contact their member services for more information about their health plan options.
| Characteristics | Values |
|---|---|
| Plan type | Health insurance, dental, vision, and other plans for individuals and families, employers, health care providers, and insurance agents/brokers |
| Coverage | COVID-19 vaccines, COVID-19 lab tests and provider visits, and Medicaid benefits |
| Member benefits | Right to appeal coverage decisions, access to cost comparison tools, and worldwide telehealth services |
| Clinical policy | Clinical Policy Bulletins (CPBs) define Aetna's clinical policy, but medical necessity determinations are made on a case-by-case basis |
| Precertification | Refers to the utilization review process to determine if a requested service meets the company's clinical criteria for coverage |
| Customer support | Aetna Member Services available via phone and email for answering questions about coverage and member benefits |
| Enrollment period | Varies by state, e.g., California and New Jersey: enroll by January 31 for coverage on February 1; Virginia: enroll by January 22 for coverage on February 1 |
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What You'll Learn
How to get Aetna medical insurance for your family
If you're looking to get Aetna medical insurance for your family, there are a few options to consider. Firstly, you can explore the Affordable Care Act (ACA) Health Insurance Plans offered by Aetna CVS Health. These plans are available on the Health Insurance Marketplace, also known as the "exchange," and provide a range of benefits for individuals and families. The ACA Marketplace plans offer affordable health insurance with added value from the CVS brand, including access to their network of providers.
Another option is to look into Aetna's individual and family insurance plans, which include Medicare plans, employee insurance plans, and health insurance exchanges. These plans cater to the unique needs of families and offer various benefits, such as dental, vision, and other specialized plans.
Additionally, if you or your family members qualify for Medicaid, you can consider Aetna Better Health. This subsidiary of Aetna has been serving individuals who use Medicaid services for over 30 years and offers programs such as the Children's Health Insurance Program (CHIP), care for the aged, blind, and disabled, as well as long-term services.
To get started with any of these options, you can visit the Aetna website or the Health Insurance Marketplace to compare plans, estimate costs, and find the right coverage for your family's needs. You can also take advantage of their licensed agents who can guide you in choosing the most suitable plan. Remember to review the terms and conditions carefully before enrolling in any plan.
Lastly, it's important to note that Open Enrollment periods may apply, so ensure that you meet any necessary deadlines or have experienced a qualifying life event that allows you to change or shop for a new plan outside of the standard enrollment period.
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How to get Aetna medical insurance as an individual
Aetna is one of the leaders in health care, dental, pharmacy, group life, and disability insurance in the US. The company offers a broad range of insurance and employee benefits products, as well as resources for individuals and employers to help them make the right choices.
Aetna offers individual health insurance plans in 12 states. These are available on the Federal Marketplace and various state exchanges.
You can apply for an individual health plan in three ways:
- Directly with the insurer
- With an insurance broker or insurance navigator
- On Healthcare.gov or a state health insurance exchange
If you are enrolled in an individual health plan and your premium is not paid by the due date, you will get a one-month grace period. During this period, your claim may be pending. If the premium is not paid by the end of the grace period, your coverage will terminate.
Aetna's Clinical Policy Bulletins (CPBs) define the company's clinical policy, but medical necessity determinations in connection with coverage decisions are made on a case-by-case basis. If a member disagrees with a coverage determination, they have the right to appeal the decision and request an independent external review.
You can use Aetna's online tools to compare benefits, estimate costs, and find a plan that's right for you. You can also search for a provider or pharmacy, access health records, view claims, and find in-network doctors.
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How to get Aetna medical insurance through your employer
If you're looking to get Aetna medical insurance through your employer, there are a few things you need to do. Firstly, you should speak to your company's benefits department to understand the health benefits offered by your employer and how to access them. They will be able to provide you with information about the specific Aetna health plan available to you and guide you through the enrolment process.
You can also find out more about your coverage and benefits by registering on the Aetna member website. Registration only takes a few minutes and requires your member number, which can be found on your member ID card. Once registered, you will be able to log in and access tools, resources, and support to help you understand and make the most of your health care plan.
Additionally, you can compare benefits, estimate costs, and find a plan that suits your needs on the Health Insurance Exchange/Marketplace. This is a useful option if you are new to Medicare or simply exploring your options.
It is important to note that the availability of employer-sponsored health insurance plans may vary depending on your state and the specific policies of your company. Therefore, it is always a good idea to consult with your employer's benefits department or Aetna directly to understand the specific options available to you.
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How to get Aetna medical insurance if you live outside the US
If you are a US citizen living abroad or a non-US citizen living outside the US, you can get Aetna medical insurance through your employer. Aetna offers global health plans for expatriates and business travellers. These plans provide support for physical, mental, and emotional health, as well as help with making informed healthcare decisions while abroad. They also offer multilingual nurse support for acute and chronic conditions, pre-trip and post-assignment planning, and emergency medical evacuation services.
Aetna also has an international health insurance plan called the Aetna Pioneer Plan, which provides comprehensive medical benefits and industry-leading customer service. However, as of January 2024, Aetna International is no longer offering individual global medical plans.
If you are a US citizen with a Medicare Advantage plan and you plan to travel outside the US, you can take advantage of the Travel Advantage feature, which allows you to remain in your plan for an extra six months on top of what CMS rules allow when you live outside your plan's service area. Before travelling outside the US, it is important to talk to your plan provider or insurance agent to understand the coverage and rules of your plan, as they may vary.
Additionally, if you are an employer or organisation looking for international medical insurance for your employees, Aetna offers group travel insurance plans. These plans provide coverage for medical expenses and other risks when travelling overseas for less than a year.
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How to get Aetna medical insurance if you're on Medicaid
If you're on Medicaid, you can get Aetna medical insurance through the following ways:
Aetna Better Health
Aetna Better Health is a part of Aetna and CVS Health and has been serving people who use Medicaid services for over 30 years. They offer programs like the Children's Health Insurance Program (CHIP), care for the aged, blind, and disabled, as well as long-term services and supports. You can check if you qualify for your state's Medicaid program and then choose a plan that suits your needs.
ACA Plans
If you've lost your Medicaid coverage, you can consider switching to an Affordable Care Act (ACA) plan. ACA plans are available on the Health Insurance Marketplace and provide affordable health insurance to individuals and families. These plans typically cost more than Medicaid, but financial assistance is available, and you may even qualify for a $0 or low-cost plan premium. You can visit the Health Insurance Marketplace to shop for ACA plans, check your eligibility, and see if you qualify for premium and plan savings.
State-Specific Options
In certain states, you may have specific options for Aetna health plans. For example, in California and New Jersey, you can enroll through January 31 for coverage starting on February 1. In Virginia, you can enroll through January 22 for coverage on February 1. Additionally, you can explore state-specific marketplaces, such as Nevada Health Link, Covered California, or Get Covered New Jersey, to find ACA plans and check your eligibility for savings.
Life Changes
If you've experienced a significant life change, such as losing your health plan, having a child, or getting married, you may qualify for special enrollment outside of the typical open enrollment period. This means you can sign up for an ACA plan and take advantage of any available savings or subsidies to make the plan more affordable.
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Frequently asked questions
Aetna offers health insurance, as well as dental, vision, and other plans to meet the needs of individuals and families. They also offer plans for employers, healthcare providers, and insurance agents/brokers.
You can visit the Health Insurance Marketplace to shop for individual and family plans, sign up, and see if you qualify for premium and plan savings.
The process for filing a claim with Aetna is not readily available. However, Aetna provides its members with the right to appeal a coverage decision and request an independent external review of coverage denials.
The contact number for Aetna Member Services is 1-855-339-9731 (TTY: 711). They are available Monday through Friday, from 7 AM to 5 PM CT.
You can change your plan during the annual Open Enrollment Period. Contact your employer to get started. If you've had a significant life event outside the Open Enrollment window, you may still be able to change your plan within 30 to 60 days.
