Aetna – HMO Plans


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Aetna CVS HMO

What is an HMO? HMO stands for Health Maintenance Organization. HMOs have their own network of doctors, hospitals and other healthcare providers who have agreed to accept payment at a certain level for any services they provide. This allows the HMO to keep costs in check for its members. There are several factors to take into account when choosing whether an HMO plan is the right option for you and your family. If you are someone who doesn’t need a lot of specialist care or don’t mind having your care coordinated through a PCP, you can save money with an HMO plan.

Aetna offers 3 metal tiers of HMO Options:

Gold HMO Gold plans will have the highest premiums, but the lowest out-of-pocket costs as well as the lowest deductibles.

Silver HMO Silver plans will have moderate premiums, moderate out-of-pocket-costs, and will have deductibles that are lower than Bronze plan options.

Bronze HMOBronze plans will have the lowest premiums, but the highest out-of-pocket costs as well as the highest deductibles

Aetna CVS Health Plans – 2024 Illinois HMO Hospital Network

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

  • Edward Hospital
  • Elmhurst Memorial Hospital
  • Holy Cross Hospital
  • Humboldt Park Health
  • Insight Chicago, Inc.
  • Jackson Park Hospital Foundation
  • John H. Stroger Hospital of Cook County
  • LaRabida Children’s Hospital
  • Loretto Hospital
  • Louis A. Weiss Memorial Hospital
  • Mercy Harvard Hospital, Inc.
  • Methodist Hospital of Chicago
  • Mount Sinai Hospital Medical Center
  • Northshore University Health System – Evanston Hospital
  • NorthShore University HealthSystem – Glenbrook Hospital
  • NorthShore University HealthSystem – Highland Park
  • NorthShore University Health System – Skokie Hospital
  • Northwest Community Hospital
  • OSF Little Company of Mary Medical Center
  • Provident Hospital of Cook County
  • Roseland Community Hospital
  • Shriners Hospital for Children-Chicago IL
  • South Shore Hospital

Aetna BRONZE HMO Plans

Plan InfoBronze 1Bronze 4 Bronze S
Benefits SummaryBenefits SummaryBenefits 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
Primary Care/Specialist$55 / $125$15 / $100$50 / $100
Emergency Room Care50% coinsurance$2,200 copay/visit50% coinsurance
Urgent Care$60 copay$50 copay/visit$75 copay
Inpatient hospital stay50% coinsurance$2,500 copay/day, days 1-350% coinsurance
Lab services / Xray50% coinsuranceLab: $50 copay / visit
X-ray: $75 copay / visit
50% coinsurance
Prescription Drugs
Preferred genericTier 1A: $5 copay/ $12.50 copay
Tier 1: $40 copay/ $100 copay deductible does not apply
Tier 1A: $5 copay/ $12.50 copay/
Tier 1: $40 copay/ $100 copay
$25 copay/ $62.50 copay deductible does not apply (preferred and non preferred)
Preferred Brand Drugs$70 copay/$175 copay
deductible does not apply
40% coinsurance for up to a 90 day supply$50 copay / $125 copay
Non-preferred generic/brand drugs$95 copay / $237.50 copay
deductible does not apply
45% coinsurance for up to a 90 day supply$100 copay/ $250 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 HMO Plans

Plan InfoSilver 5Silver 6 Silver 7Silver S
Benefits SummaryBenefits SummaryBenefits SummaryBenefits Summary
Deductible – Individual/Family$8,395 / $16,790$7,795 / $15,590$7,795 / $15,590 $5,900 / $11,800
Out of Pocket Max – Individual/Family$8,885 / $17,770$8,445 / $16,890 $8,845 / $17,690$9,100 / $18,200
Primary Care/Specialist$50 / $80$35 / $80$30 / $60$40 / $80
Emergency Room Care50% coinsurance50% coinsurance50% coinsurance40% coinsurance
Urgent Care$50 copay$50 copay$50 copay$60 copay
Inpatient hospital stay50% coinsurance50% coinsurance50% coinsurance40% coinsurance
Lab services / XrayLab: $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 genericTier 1A: $5 copay/ $12.50 copay
Tier 1: $25 copay/ $62.50 copay
ded does not apply
Tier 1A: $5 copay / $12.50 copay
Tier 1: $25 copay / $62.50 copay
ded does not apply
Tier 1A: $5 copay / $12.50 copay
Tier 1: $25 copay / $62.50 copay
ded does not apply
$20 copay / $50 copay
ded does not apply
Preferred Brand Drugs40% coinsurance ded does not apply$60 copay / $150 copay
ded does not apply
$60 copay / $150 copay
ded does not apply
$40 copay / $100 copay
ded does not apply
Non-preferred generic/brand drugs$125 copay / $312.50 copay
ded does not apply
$125 copay /
$312.50 copay
ded does not apply
$125 copay / $312.50 copay
ded does not apply
$80 copay/ $200 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 HMO Plans

Plan InfoGold 3 Gold S
Benefits SummaryBenefits 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
Primary Care/Specialist$15 / $35$30 / $60
Emergency Room Care50% coinsurance25% coinsurance
Urgent Care$25 copay$45 copay
Inpatient hospital stay50% coinsurance25% coinsurance
Lab services / XrayLab: $20 copay
X-ray: $35 copay
25% coinsurance
Prescription Drugs
Preferred genericTier 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