Aetna Insurance: Unpredictable Appointment Changes

There are many reasons why your Aetna Insurance appointment may change. If you have health benefits through your employer, you can change them during open enrollment, which is typically in the fall. You can also change your health benefits when you get a divorce, give birth or adopt a child, or lose your health coverage due to a change in your spouse or domestic partner's job situation. Losing your job or changing jobs may also result in a change of insurance plan. Additionally, if your physician leaves the Aetna network, you will be asked to select another primary care provider.

Losing your job

COBRA Continuation Coverage:

COBRA (Consolidated Omnibus Budget Reconciliation Act) allows you to temporarily keep your employer-sponsored health insurance plan. You usually have 60 days to decide whether to sign up for COBRA coverage after losing your job. This coverage typically lasts for up to 18 months, and you will be responsible for paying the full premium yourself, which can be expensive.

• Health Insurance Marketplace:
• Spouse's Insurance:

If you are married or in a domestic partnership, you may be able to enroll in your partner's health insurance plan. Losing your health coverage is generally considered a qualifying event, allowing you to join your spouse's plan outside of the annual enrollment period. Contact your spouse's employer or benefits administrator for more information.

Short-Term Health Insurance:

Short-term health insurance, also known as temporary health insurance, can help bridge the gap between jobs. It is typically more affordable than COBRA or Marketplace plans, but the coverage may be limited, and some preventative care services or prescriptions may not be covered. Short-term plans are meant to protect you when you are between insurance plans.

Medicaid:

Medicaid offers free or low-cost health coverage for individuals and families with limited income. Eligibility and coverage vary by state, but in most states, individuals with income below a certain threshold are eligible for Medicaid. You can apply for Medicaid at any time and don't have to wait for a special enrollment period.

It's important to act quickly when exploring these options, as there are often time limits for enrolling in new health insurance after losing job-based coverage. Additionally, maintaining continuous health insurance coverage can help prevent gaps in coverage and ensure access to vital healthcare services.

Divorce or legal separation

Impact on Health Insurance:

Timeline for Changes:

Aetna allows you to make updates to your benefits coverage within 30 to 60 days of your divorce or legal separation. It's important to notify your current or future health plan sponsor of the qualifying event as soon as possible to initiate the necessary changes.

Adding or Removing Coverage:

Depending on your situation, you may need to add or remove your former spouse from your health insurance plan. Contact your employer or plan administrator to make these changes, as they can guide you through the process and ensure that you have the appropriate coverage for your new circumstances.

Exploring Coverage Options:

If you previously had health insurance through your spouse's employer, you may need to explore alternative coverage options. You can consider purchasing an individual insurance plan, joining a government program like Medicaid, or, if applicable, staying on your parent's health plan. Each option has its own requirements and limitations, so be sure to review them carefully.

Understanding Your Benefits:

It's important to have a clear understanding of your current benefits and coverage. You can access a summary of your benefits and coverage (SBC) through your member website or by contacting your employer's benefits office. This information will help you make informed decisions about any changes to your plan.

Primary Care Physician (PCP):

If you need to change your PCP due to your divorce or legal separation, you can do so through your secure member account or by calling the toll-free Member Services number on your Aetna ID card. They can help you choose a new PCP that meets your needs.

Remember, it's crucial to stay proactive and make the necessary changes to your health insurance plan during this transition. By understanding your options and taking timely action, you can ensure that you have the coverage you need to support your health and well-being during this challenging time.

Giving birth or adopting a child

If you are planning to give birth or adopt a child, you can change your health insurance coverage. Your child will be covered for 31 days from their date of birth. To continue coverage after this time, you will need to enrol your child within 31 days and pay the plan premium.

If you have an Aetna plan through your employer, you will need to let them know about the change. If you have a plan that you purchased directly from Aetna, you can log in to send your updated information through the "Contact Us" feature or call Member Services. If you have an exchange plan, you will need to contact the plan directly.

A "qualifying life event" is a circumstance that allows you to add or remove people from your plan or change the plan itself. Giving birth or adopting a child is considered a qualifying life event.

Special enrolment period

A qualifying life event triggers a "special enrolment period" that typically lasts 30 to 60 days, during which you can select a new plan or add a new dependent to your plan.

Maternity program

Aetna offers a maternity program that provides educational materials, a pregnancy survey, a preterm labour program, and access to specially trained nurses for high-risk mothers-to-be.

Losing your health coverage

• Check if you're eligible for COBRA coverage: If you lose your job-based health insurance, you may be eligible to continue your group health plan coverage temporarily through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA). Contact your employer to find out if they are subject to federal COBRA and to understand your options.
• Explore alternative insurance plans: Losing your job-based health insurance may qualify as a "qualifying life event," which allows you to change your health insurance plan outside of the usual enrollment season. You can explore alternative insurance plans, such as Medicaid, the Health Insurance Marketplace, or a family member's plan.
• Understand your rights: The Health Insurance Portability and Accountability Act of 1996 (HIPAA) makes it easier for people to change jobs without losing health coverage. This may be relevant if you are transitioning between jobs and want to maintain continuous coverage.
• Consider purchasing an insurance plan: If none of the above options are feasible, you may need to purchase an insurance plan on your own. This may be a good time to compare different plans and choose one that best suits your needs.

Remember, it's important to act quickly, as there are often time limits for selecting a new plan or adding a new dependent to your plan after a qualifying life event. By being proactive and exploring your options, you can help ensure that you maintain access to the healthcare services you need.

Moving home

Update your address

It is important to update your address with your health insurance provider as soon as possible. If you have an Aetna plan through your employer, let your employer know your new address, and they will send the update to Aetna. If you purchased your plan directly from Aetna, you can log in to send your updated address through the "Contact Us" feature or call Member Services at the number on your ID card.

Understand your options

If you have health benefits through your employer, you can usually change them during "open enrollment," which typically occurs in the fall. Outside of open enrollment, a move is generally considered a "qualifying life event," giving you access to a special enrollment period to change your plan. This special enrollment period is usually 30 to 60 days from the date of your move.

Choose a new plan

When choosing a new plan, consider your specific needs and those of your family members. Ask yourself what you liked and didn't like about your previous coverage. Think about whether it is important to have a hospital or specialist in your network nearby, or if you are willing to drive farther. Review the costs associated with each plan, including the premium, deductible, copay, and coinsurance. If your premium becomes unaffordable, check if you qualify for subsidies for an ACA marketplace plan.

Apply for coverage

Gather the necessary paperwork, including Social Security numbers, immigration documents, employer and income information, and federal tax returns for all household members. Then, submit your application through your state's health insurance marketplace or HealthCare.gov, depending on your state. You may be asked to submit verification of your move, such as a change of address confirmation, a driver's license or ID card with your new address, or a bill or bank statement with your new address.

Understand network changes

Be prepared for the fact that your provider network will likely change with your new plan, especially if you are moving to a different state. Even if you stay with the same insurance carrier, you will likely need to re-enroll in a new plan specific to your new state.

Frequently asked questions