Aetna, Pennsylvania
POS OA HSA 5000

Vimo Editorial: Health Plan Profile

Aetna ’s Point of Service Open Access 5000 plan, compatible with Health Savings Accounts (HSAs), has low premiums but high out-of-pocket expenses. It’s definitely designed for use with an HSA, with most benefits coming into effect only after you’ve burned through your deductible. There is, however, a $25 copay for preventive health not covered by deductible.  There’s no pharmaceutical drug benefit, something that’s standard for an HSA plan.

Aetna ’s Open Access plans offer members the freedom to go directly to any doctor, hospital or health care professional — including specialists — for covered services. If a member chooses a health care professional from Aetna ’s extensive network of participating physicians and hospitals, out-of-pocket costs will be lower (generally 20 percent of the cost, rather than 50 percent).

The POS OA HSA 5000 is one of the simplest plans on the market, because the deductible matches the out-of-pocket maximum. Once you’ve burned through your deductible, you pay 0% for office visits, specialist visits, hospital admission, outpatient surgery and emergency room services.

PROS: HSA compatibility, simplicity, and low, low premiums.

CONS: Some of the same issues that are part of any high-deductible health plan, like lack of maternity coverage and lack of drug coverage.

BEST FOR: Someone looking for a simple high-deductible health plan for use with an HSA.