Aetna HMO – Gold Plan Options

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Gold HMO 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 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

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

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