Aetna PPO – Gold Plan Options

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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 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 stay40% 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

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:


  • 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