Is Aetna HMO a good insurance?
Asked by: Erna Vandervort | Last update: December 23, 2025Score: 4.6/5 (64 votes)
What is better, Aetna HMO or PPO?
A Preferred Provider Organization (PPO) has higher premiums than an HMO or POS. But this plan lets you see specialists and out-of-network doctors without a referral. Copays and coinsurance for in-network doctors are low.
Which is a disadvantage of a HMO insurance plan?
Cons Explained
No specialist visits without a referral: You'll need referrals for any specialists if you want your HMO to pay for those visits. If you need to visit a rheumatologist or a dermatologist, for example, your PCP must make a referral before you can see one for the plan to pay for your visit.
Is Aetna considered good insurance?
Aetna is rated A (excellent) by AM Best, and has high ratings from several other financial ratings services. AM Best is a credit rating firm that assesses the creditworthiness of and/or reports on over 16,000 insurance companies worldwide.
What is an Aetna HMO plan?
The HMO plan is ideal for employers in urban locations who want to offer simple, convenient care with fixed, predictable costs. Members must choose a PCP* to guide their treatment and coordinate all specialist care — which all takes place in a quality network to keep costs in check.
What’s the difference between an HMO, a POS, and a PPO? | Health care answers in 60 seconds
Do doctors prefer HMO or PPO?
HMO plans might involve more bureaucracy and can limit doctors' ability to practice medicine as they see fit due to stricter guidelines on treatment protocols. So just as with patients, providers who prefer a greater degree of flexibility tend to prefer PPO plans.
Does Aetna deny a lot of claims?
In the same year, Medicare denied 6.85% of its claims. One year later, AMA reported that all the surveyed insurers were denying fewer claims: Aetna's denial rate was down to 1.81%, Anthem BCBS reduced its rate to 4.34%, and private insurers overall were down to 2.79%, while Medicare denied only 4% of claims.
Why is Aetna so expensive?
Factors influencing Aetna insurance monthly costs
Plans with broader coverage and extensive benefits, such as lower deductibles, co-pays, and comprehensive services like dental and vision care, often come with higher monthly costs.
What is the best healthcare insurance?
Investopedia's analysis ranks Kaiser Permanente as the best health insurance company for 2025 because of its blend of affordability and low customer complaints. UnitedHealthcare and Aetna also earned top marks. We evaluated nine insurers using dozens of criteria, such as customer satisfaction, plan types, and costs.
Why do people not like HMO plans?
Cons of HMO Plans
Referrals Needed for Specialists: To see a specialist, you must first get a referral from your primary care doctor, which can delay care. Less Flexibility: If you often need care outside your network or prefer more choice in doctors, an HMO may feel restrictive compared to a PPO plan.
What is not covered by HMO?
With HMOs, out-of-network coverage will usually be limited to emergencies; non-emergency services are not usually covered at all.
Who benefits from HMO insurance?
HMOs are an affordable option for people who don't usually need anything more than basic medical care like annual checkups or immunizations. However, even though costs are generally lower with an HMO, they don't cover any out-of-network care, except in a true emergency.
Does Aetna HMO cover mammograms?
Your EyeMed vision plan remains the same for 2023. How are mammograms covered? Aetna covers routine mammograms as well as diagnostic mammograms, including 3D mammograms. Routine mammograms are covered at 100% and diagnostic mammograms would fall under the diagnostic X-ray benefit.
What are three disadvantages of HMO?
- If you need specialized care, you will need a referral from your primary care physician to an in-network provider.
- Must see in-network providers for care-less flexibility than a PPO plan.
How does Aetna health insurance rank?
By membership and revenue, Aetna is ranked third in the country for health insurance. Aetna has over 22 million members and receives annual revenues of over $60 billion.
Why is Aetna struggling?
Aetna majorly miscalculated utilization trends in pricing Medicare Advantage plans for this year, causing hundreds of thousands of seniors to flock to its generous coverage and saddling the insurer with an unexpectedly steep price tag for their care.
Does Aetna have copays?
The plan requires only copays for medical services and prescription drugs up to the plan member's out-of-pocket maximum, with no deductibles or coinsurance costs.
Is Aetna insurance good in all states?
Aetna offers group health insurance plans in all 50 states and in terms of membership is the third largest health insurer in the United States behind United Healthcare and Anthem Blue Cross. In California, Aetna ranks sixth in number of members among health insurance companies.
Does Aetna cover surgery?
If you successfully meet the requirements, then your insurance provider will cover the costs of the surgery or treatment plan recommended by your doctor. Elective or cosmetic plastic surgery procedures are typically not covered by Aetna insurance policies.
Which health insurance denies the most claims?
According to the analysis, AvMed and UnitedHealthcare tied for the highest denial rate, with both companies denying about a third of in-network claims for plans sold on the Marketplace in 2023, respectively.
What is the class action lawsuit against Aetna?
The lawsuit seeks a declaratory judgment, injunctive relief to end Aetna's exclusionary policy, and compensatory damages for all policyholders who have had to pay out of pocket for gender-affirming facial surgery because of Aetna's discriminatory exclusion.
Is Aetna a good plan?
People choose Aetna for its vast network of providers, competitive rates and long history in the insurance industry. It also offers benefits like access to 24/7 virtual care at no or low costs, depending on your plan, and mental health coverage. Aetna is regarded as a good health insurance provider overall.
Is $200 a month good for health insurance?
Health insurance that costs $200 per month is a good deal in California. Silver plans typically cost $513 per month for a 21-year-old or $656 per month for a 40-year-old. The best way to get cheap rates is to use health insurance subsidies, which lower the cost of an insurance plan based on your income.
What is the difference between a PPO and a HMO?
HMOs (health maintenance organizations) are typically cheaper than PPOs, but they tend to have smaller networks. You need to see your primary care physician before getting a referral to a specialist. PPOs (preferred provider organizations) are usually more expensive.