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Major Carriers and High Deductible Health Plans

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Vimo Editorial: Health Plan Profile

Aetna ’s PPO 2500 plan offers excellent coverage for a high-deductible plan, even delivering benefits for non-specialist doctor visits beforeyou’ve spent more than your deductible. In other words, after your plan goes into effect, you can have a standard doctor visit for a small copay.

 

Granted, the deductible is high. At $2,500, it would take a serious medical emergency for you to burn through it. The plan also offers a pre-deductible $40 copay for an annual OB/GYN exam, and $15 copays for generic prescription drugs. In other words, if you don’t become seriously sick during the year, you still gain some benefits from the plan when you go on routine doctor visits.

 

BEST FOR: Someone looking for low monthly payments  who is willing to pay a high deductible, out-of-pocket maximum (OOPM), and office visit copays in return. The OOPM of the plan is $5,000 for individuals.

 

PROS: A big pro is Aetna itself. Aetna of Ohio received a rating of “Excellent Accreditation” for its commercial products from the National Committee for Quality Assurance (NCQA), a private, independent organization that rates health plans based on quality, access and service and wellness programs. The excellent rating is the highest distinction a health plan can receive, and is granted to plans that meet or exceed NCQA's standards for quality improvement and consumer protection.

 

CONS: A lack of maternity coverage may mean that the plan won’t appeal to many young women. The plan also isn’t compatible with Health Savings Accounts (HSAs).

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