Aetna – HMO Plans
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- Provider Finder
- 2024 Aetna Illinois Plan Grid
- 2024 Formulary
- 2024 Aetna HMO hospital list
Our Rating: 
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 PPO – Gold plans will have the highest premiums, but the lowest out-of-pocket costs as well as the lowest deductibles.
⬤ Silver PPO – Silver plans will have moderate premiums, moderate out-of-pocket-costs, and will have deductibles that are lower than Bronze plan options.
⬤ Bronze PPO – Bronze 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
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 HMO Plans
| 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 |
| Primary Care/Specialist | $55 / $125 | $15 / $100 | $50 / $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/ $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 |
Aetna SILVER HMO Plans
| Plan Info | Silver 5 | Silver 6 | Silver 7 | Silver S |
|---|---|---|---|---|
| Benefits Summary | Benefits Summary | Benefits Summary | Benefits 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 Care | 50% coinsurance | 50% coinsurance | 50% coinsurance | 40% coinsurance |
| Urgent Care | $50 copay | $50 copay | $50 copay | $60 copay |
| Inpatient hospital stay | 50% coinsurance | 50% coinsurance | 50% 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/ $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 Drugs | 40% 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 |
Aetna GOLD HMO 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 |
| Primary Care/Specialist | $15 / $35 | $30 / $60 |
| Emergency Room Care | 50% coinsurance | 25% coinsurance |
| Urgent Care | $25 copay | $45 copay |
| Inpatient hospital stay | 50% 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 |
