What does Aetna PPO mean?
Asked by: Ms. Icie Collins | Last update: December 18, 2025Score: 4.2/5 (33 votes)
What is the difference between Aetna PPO and HMO?
What is the main difference between the HMO-EPO plan and the PPO plan? The HMO-EPO plan only provides in-network coverage for services, except for urgent and emergent care which would be covered the same out-of-network as it would in-network. The PPO plan offers both in-network and out-of-network coverage.
Is Aetna PPO a good insurance?
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.
What is the Aetna PPO plan?
With the Aetna Open Choice ® PPO plan, members can visit any provider, in network or out, without a referral. But when they stay in network, we'll handle the claims and offer lower, contracted rates. So they save. And you can, too.
What does PPO mean when it comes to insurance?
Preferred Provider Organizations (PPOs)
A PPO has a network (or group) of preferred providers. You pay less if you go to these providers. Preferred providers are also called in-network providers. With a PPO, you can go to a doctor or hospital that is not on the preferred provider list.
Aetna Vs Blue Cross Medicare Plans What Would I Choose In 2024?
What is the downside to a PPO plan?
Cons of PPO Plans
Less Coordination: Without a primary care doctor managing your healthcare, there's less oversight, and it can be harder to keep track of your treatments and appointments.
Which is better, PPO or HMO?
Generally speaking, an HMO might make sense if lower costs are most important and if you don't mind using a PCP to manage your care. A PPO may be better if you already have a doctor or medical team that you want to keep but doesn't belong to your plan network.
Is Aetna the same as Blue Cross Blue Shield?
Aetna and Anthem are different health insurance companies. Aetna has broader availability, especially with Medicare Advantage plans. Aetna sells health insurance in 49 states plus Washington, D.C.. Anthem is a brand of the Blue Cross Blue Shield network. It only operates in 14 states.
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.
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.
Is Blue Cross Blue Shield a PPO?
Preferred Provider Organization (PPO)
However, BCBS still pays more to in-network providers than out-of-network providers. People who are part of a PPO do not need a physician's referral to consult with a specialist. PPOs also usually offer drug coverage. Learn about Medicare referrals.
Is the Aetna PPO plan good?
PPO: The plan with the most freedom
But this plan lets you see specialists and out-of-network doctors without a referral. Copays and coinsurance for in-network doctors are low. If you know you'll need more health care in the coming year and you can afford higher premiums, a PPO is a good choice.
Why do doctors prefer 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.
Is a mammogram covered by Aetna insurance?
Your Aetna plan covers one mammogram screening every 12 months.
Is Aetna good insurance for seniors?
Aetna is an established health insurance company with a long history of providing coverage and support to millions of seniors across the country. Their Medigap plans offer a variety of benefits and options to make sure that older adults have the quality care they need and deserve.
What insurance company owns Aetna?
Aetna® group of companies. Aetna is proud to be a part of the CVS Health® family of companies.
What is an Aetna copay?
Definitions: Out-of-pocket (OOP) max: The highest amount you could pay in a given year for services (excludes premium). Copay/coinsurance: The amount you pay per visit or prescription to treat an injury or illness. It typically counts toward your OOP max.
Does Aetna give money for groceries?
It's included in the Aetna D-SNP plan. Buying fresh, healthy foods can sometimes be pricey. That's why Aetna D-SNP provides this pre-paid debit card to many members. It can help you stock up on approved foods at the grocery store.
Does Aetna pay for surgery?
Aetna plans exclude coverage of cosmetic surgery and procedures that are not medically necessary, but generally provide coverage when the surgery or procedure is needed to improve the functioning of a body part or otherwise medically necessary even if the surgery or procedure also improves or changes the appearance of ...
What are the disadvantages of a PPO?
PPO plans often have higher monthly premiums and out-of-pocket costs than HMO plans. You may also need to pay a deductible before your benefits begin. If you see an out-of-network doctor, you'll typically have to pay the full cost of your visit and then file a claim to get money back from your PPO plan.
How do I tell what Aetna plan I have?
The best place to find details about your coverage and benefits is your Aetna member website. It takes only a few minutes to register. And you only need your member number, which is on your member ID card. You can still get benefits and coverage information by calling the number on your member ID card.
Why do people get PPO?
PPO plans give you more choices when picking health care providers than other types of insurance. In a PPO plan, you have a network of “preferred” providers. These include doctors and specialists who can offer care at the lowest out-of-pocket cost, compared to out-of-network providers.