Aetna Individual Dental Plans – General Plan Descriptions



Aetna Dental is one of the nation’s leading providers of integrated and stand-alone dental products, serving more than 14 million dental members in the U.S. In Illinois, there are two PPO-style options for individuals to choose from – the Aetna Individual Advantage(SM) Dental PPO Plan and the Aetna Individual Advantage(SM) Dental PPO Plus Plan. Both plans will give members access to Aetna’s PPO network of participating dental practices, which includes more than 105,000 available dental practice locations throughout the country.

Dentists in the Aetna network are those who have chosen to provide services to Aetna dental policy holders at a discount rate; this rate applies to services that are covered as well as those that are not (such as braces or teeth whitening). Dentists that are not in Aetna’s network may charge more, which means that you will be required to pay more when you visit them (you will be responsible for charges that the dental plan didn’t cover or additional fees above what Aetna will pay).

Aetna Individual Advantage Dental Plans

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Aetna Individual Advantage Dental has two plans to meet your meets – the Aetna Individual AdvantageSM Dental PPO Plan and the Aetna Individual AdvantageSM Dental PPO Plus Plan. They both offer coverage for:

  • Preventive care services such as cleanings, x-rays and more
  • Basic care like fillings, simple extractions, root canals, basic restorative work and more
  • Major services such as bridges, crowns, dentures and more
Additional Features of both Aetna Individual Dental Plans include:
  • No underwriting required – plan is automatic issue
  • Members who access participating PPO dentists will receive discounts (equal to the PPO negotiated rate) for non-covered services such as tooth whitening and adult orthodontics
  • All Individual Advantage PPO Dental Plan members get access to Aetna’s Value Added Discount Programs. Members can save on: Vision, Natural Products and Services, Fitness, and discounts on Oral Health Care Supplies. In addition, discounts on vitamins, massage and acupuncture are also available
Difference Between Aetna PPO Plan and Aetna Advantage PPO Plus Plan

The difference between the two plans, Aetna Individual Advantage PPO Plan and the Aetna Individual Advantage PPO Plus Plan lies in the amount that each plan will pay for the covered services that the plan encompasses as illustrated in the table below. With the Plus Plan, Aetna will pay 100% of the cost of diagnostic and preventative services, while the Advantage PPO Plan will pay only 80%. For denture repairs, the plus plan will pay 80% while the regular plan will pay only 50%. When it comes to deductible (out of pocket) expenses, the Aetna PPO Plus Plan has a $50 deductible and the Advantage PPO Plan has a deductible of $100.

Aetna Individual Dental Plan Benefits

Dental Services Aetna PPO Plus Plan pays* Aetna PPO Plan pays*
Preventive (no waiting period, deductible waived)
Diagnostic and preventive 100% 80%
Basic (6 month waiting period)
Periodontal maintenance cleanings 80% 50%
Denture repair, rebase, and relining 80% 50%
Basic restorative (fillings) 80% 50%
Oral Surgery 50% 50%
Endodontics (root canals) 50% 50%
Major (18 month waiting period)
Periodontics (gum disease) 50% 50%
Crown and cast restorations 50% 50%
Prosthodontics (dentures) 50% 50%
Deductibles and Maximums (per member)
Deductible (calendar year) $50 $100
Maximum benefit (calendar year) $1200 $1000

2013 Illinois Plan Rates

Aetna prices these plans in two age groups – 49 and under and 50 or older.

Aetna PPO Plus Plan Rates (per month) Aetna PPO Plan Rates (per month)
Ages 49 and Under – Zip Codes 60001 – 60899
1 Person $37.99 $26.92
2 People $77.55 $54.96
Family $128.97 $91.73
Ages 49 and Under – Zip Codes 60901- 62999
1 Person $28.26 $23.86
2 People $57.30 $48.44
Family $95.95 $81.28
Ages 50 and Over – Zip Codes 60001 – 60899
1 Person $50.61 $36.23
2 People $96.15 $68.84
Family $144.84 $103.65
Ages 50 and Over – Zip Codes 60901 – 62999
1 Person $36.73 $31.45
2 People $69.79 $59.75
Family $106.60 $91.01