Aetna – 2024 Illinois Individual Health Plans

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Aetna Coverage Counties

Adams, Bond, Brown, Calhoun, Cass, Christian, Clinton, Cook, DuPage, Greene, Jersey, Kane, Lake, Logan, Macon, Macoupin, Mason, McHenry, Menard, Montgomery, Morgan, Moultrie, Pike, Randolph, Sangamon, Schuyler, Scott, Shelby, Washington

Aetna CVS PPO Featured Plans

Our TOP recommended plans for Aetna PPO

Plan Info	Gold 3	Silver 7	Bronze S
	Benefits Summary	Benefits Summary	Benefits Summary
Deductible – Individual/Family	$795 / $1,590	$7,795 / $15,590	$7,500 / $15,000
Out of Pocket Max – Individual/Family	$9,195 / $18,390	$8,845 / $17,690	$9,400 / $18,800
Coinsurance	40%	40%	50%
Primary Care/Specialist	$15 / $35	$30 / $60	$50 / $100
Emergency Room Care	50% coinsurance	50% coinsurance	50% coinsurance
Urgent Care	$25 copay	$50 copay	$75 copay
Inpatient hospital stay	40% coinsurance	40% coinsurance	50% coinsurance
Lab services / Xray	Lab: $20 copay/visit X-ray: $35 copay/visit ded does not apply	Lab: $30 copay/visit X-ray: $50 copay ded does not apply	50% coinsurance
Prescription Drugs
Preferred generic	Tier 1A: $5 copay Tier 1: $10 copay ded does not apply	Tier 1A: $5 copay Tier 1: $25 copay ded does not apply	$25 copay deductible does not apply (preferred and non preferred)
Preferred Brand Drugs	$40 copay ded does not apply	$60 copay ded does not apply	$50 copay / $125 copay
Non-preferred generic/brand drugs	$70 copay/ prescription for up to a 30 day supply, $175 copay ded does not apply	$125 copay/ $312.50 copay/	$100 copay/ $250 copay
Preferred/non-preferred specialty drugs	$250 copay/ ded does not apply	$400 copay ded does not apply	$500 copay ded does not apply

DW = deductible waived || after ded = after deductible

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Aetna has more than 37 million members that include individuals, families, students, companies and retirees and has been named the most admired health insurance company by Fortune magazine.

The biggest advantage Aetna has over other insurance companies in Illinois is that their individual policies are issued without waivers or riders. Instead, Aetna offers various risk categories based on each applicant. This allows applicants to receive benefits for health conditions that other insurance companies normally exclude by charging an increased premium and ensures applicants with minimal health risk do not have to subsidize the cost of members with a higher health risk.

All essential health benefits are covered:

Ambulatory patient services
Emergency services
Hospitalization
Pregnancy, maternity and newborn care
Mental health and substance use disorder services, including behavioral health treatment
Prescription drugs
Rehabilitative and habilitative services
Laboratory services
Preventive and wellness services and chronic disease management
Pediatric services, including oral and vision care (Pediatric dental care only covered through Aetna on off-exchange plans.)

Aetna offers affordable care options. You decide which plan offers the copay, deductible, and coinsurance amounts that are right for you. And all Aetna’s plans offer these $0 benefits:

Preventive care, including routine screenings
Virtual Care*
MinuteClinic visits at CVS**

*Members may be required to pay a cost-share based on what medical services were received and the type of a provider a member visits. Please consult benefit documents for more details. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates.

**For a complete list of participating walk-in clinics, log in to Aetna.com and use our provider search tool. Includes select MinuteClinic services. Not allMinuteClinic services are covered. Please consult benefit documents to confirm which services are included. Members enrolled in qualified high-deductible health plans must meet their deductible before receiving covered non-preventative MinuteClinic services at no cost-share. However, such services are covered at negotiated contract rates. This benefit is not available in all states. Access to walk-in clinics varies by geography. Walk-in appointments are based on availability and not guaranteed. Online scheduling is recommended.

Aetna CVS Health Plans – 2024 Illinois PPO Hospital Network

Hospital Network Highlights – hospitals include, but are not limited to:

Chicago:

Northshore Hospital
Northwestern Hospital
Lurie’s Children’s HospitalJackson Park Hospital Foundation
Holy Cross Hospital
Humbolt Park Health
John H. Stroger Hospital of Cook County
La Rabida Children’s Hospital
Loretto Hospital
Louis Weiss Memorial Hospital
Mercy Harvard Hospital
Insight Chicago
Methodist Hospital of Chicago
Mount Sinai Hospital and Medical Center
Rush University Hospital
University of Chicago Hospital

Northshore University Health System:

Northshore University Health System – Chicago
Northshore University Health System – Glenbrook
Northshore University Health System – Highland Park
Northshore University Health System – Evanston
Northshore University Health System – Skokie
Edward Hospital
Elmhurst Memorial Hospital
Northwest Community Hospital
Swedish Covenant Hospital
- OSF Little Company of Mary Hospital
- Provident Hospital of Cook County
- Roseland Community Hospital
- Schwab Rehabilitation Hospital
- South Shore Hospital
- St. Anthony Hospital
- St. Bernard Hospital
- Swedish Covenant Hospital
- Thorek Hospital and Medical Center
- Vista Medical Center East
- Vista Medical Center West
University of Illinois at Chicago Medical Center

All Aetna individual plans in Illinois allow you to go directly to any recognized health care provider, including specialists, for covered expenses. The following are standard benefits included in all Aetna individual plans:

Unlimited office visits to your primary care physician and specialists
No referrals required
No waiting periods to access preventive health and routine physicals
Lab work and x-rays included in routine physicals
100% annual routine GYN exam coverage – no waiting period, copay, or deductible
100% coverage on in-network childhood immunizations
Prescription drug coverage

Aetna BRONZE PPO Plans

Our Rating:

Plan Info	Bronze 1	Bronze 4	Bronze S
	Benefits Summary	Benefits Summary	Benefits Summary
Deductible – Individual/Family	$8,995 / $17,990	$0	$7,500 / $15,000
Out of Pocket Max – Individual/Family	$9,395 / $18,790	$9,400 / $18,800	$9,400 / $18,800
Coinsurance	50%	50%	50%
Primary Care/Specialist	$55 / $125	$15 / $100	$55 / $100
Emergency Room Care	50% coinsurance	$2,200 copay/visit	50% coinsurance
Urgent Care	$60 copay	$50 copay/visit	$75 copay
Inpatient hospital stay	50% coinsurance	$2,500 copay/day, days 1-3	50% coinsurance
Lab services / Xray	50% coinsurance	Lab: $50 copay / visit X-ray: $75 copay / visit	50% coinsurance
Prescription Drugs
Preferred generic	Tier 1A: $5 copay Tier 1: $40 copay deductible does not apply	Tier 1A: $5 copay Tier 1: $40 copay	$25 copay deductible does not apply (preferred and non preferred)
Preferred Brand Drugs	$70 copay deductible does not apply	40% coinsurance for up to a 90 day supply	$50 copay
Non-preferred generic/brand drugs	$95 copay deductible does not apply	45% coinsurance for up to a 90 day supply	$100 copay
Preferred/non-preferred specialty drugs	$500 copay deductible does not apply	50% coinsurance for up to a 30 day supply	$500 copay

DW = deductible waived || after ded = after deductible

Aetna SILVER PPO Plans

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Plan Info	Silver 5	Silver 6	Silver 7	Silver S
	Benefits Summary	Benefits Summary	Benefits Summary	Benefits Summary
Deductible – Individual/Family	$8,200 / $16,400	$7,795 / $15,590	$7,795 / $15,590	$5,900 / $11,800
Out of Pocket Max – Individual/Family	$8,850 / $17,700	$8,445 / $16,890	$8,845 / $17,690	$9,100 / $18,200
Coinsurance	30%	35%	40%	40%
Primary Care/Specialist	$30 / $60	$35 / $80	$30 / $60	$40 / $80
Emergency Room Care	50% coinsurance	50% coinsurance	50% coinsurance	40% coinsurance
Urgent Care	$60 copay	$50 copay	$50 copay	$60 copay
Inpatient hospital stay	30% coinsurance	35% coinsurance	40% coinsurance	40% coinsurance
Lab services / Xray	Lab: $25 copay X-ray: $30 copay	Lab: $40 copay X-ray: $45 copay	Lab: $30 copay X-ray: $50 copay	40% coinsurance
Prescription Drugs
Preferred generic	Tier 1A: $5 copay Tier 1: $25 copay ded does not apply	Tier 1A: $5 copay Tier 1: $25 copay ded does not apply	Tier 1A: $5 copay Tier 1: $25 copay ded does not apply	$20 copay / $50 copay ded does not apply
Preferred Brand Drugs	$60 copay ded does not apply	$60 copay ded does not apply	$60 copay ded does not apply	$40 copay ded does not apply
Non-preferred generic/brand drugs	$125 copay ded does not apply	$125 copay ded does not apply	$125 copay ded does not apply	$80 copay
Preferred/non-preferred specialty drugs	$400 copay ded does not apply	$400 copay ded does not apply	$400 copay ded does not apply	$350 copay

DW = deductible waived || after ded = after deductible

Aetna GOLD PPO Plans

Our Rating:

Plan Info	Gold 3	Gold S
	Benefits Summary	Benefits Summary
Deductible – Individual/Family	$795 / $1,590	$1,500 / $3,000
Out of Pocket Max – Individual/Family	$9,195 / $18,390	$8,700 / $17,400
Coinsurance	40%	25%
Primary Care/Specialist	$15 / $35	$30 / $60
Emergency Room Care	50% coinsurance	25% coinsurance
Urgent Care	$25 copay	$45 copay
Inpatient hospital stay	40% coinsurance	25% coinsurance
Lab services / Xray	Lab: $20 copay X-ray: $35 copay	25% coinsurance
Prescription Drugs
Preferred generic	Tier 1A: $5 copay Tier 1: $10 copay ded does not apply	$15 copay ded does not apply
Preferred Brand Drugs	$40 copay ded does not apply	$30 copay ded does not apply
Non-preferred generic/brand drugs	$70 copay ded does not apply	$60 copay ded does not apply
Preferred/non-preferred specialty drugs	$250 copay ded does not apply	$250 copay ded does not apply

DW = deductible waived || after ded = after deductible