Aetna PPO – Gold Plan Options

Our Rating:

Gold PPO Options

Every ACA plan is assigned a metal tier: Platinum, Gold, Silver, or Bronze. All plans offer the same quality of care. The metal tier is based on how you and your plan split the costs. GOLD plans will have the highest premiums, but the lowest out-of-pocket costs as well as the lowest deductibles. Below you will find a comparison of Aetna’s Gold options.

Aetna GOLD PPO Plans

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 / $12.50 copay Tier 1: $10 copay/ $25 copay ded does not apply	$15 copay/ $37.50 copay ded does not apply
Preferred Brand Drugs	$40 copay / $100 copay ded does not apply	$30 copay / $75 copay ded does not apply
Non-preferred generic/brand drugs	$70 copay / $175 copay ded does not apply	$60 copay / $150 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

Every ACA plan covers 10 essential benefits:

Prescription drugs
Pregnancy, maternity and newborn care
Pediatric services, including oral and vision care
Mental health and substance use disorder services
Preventive and wellness services, and chronic disease management
Laboratory services
Emergency services
Hospitalization
Ambulatory services
Rehabilitative and habilitative services and devices

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 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