Aetna Ohio health insurance coverage is available in most parts of the state and is very competitively priced. Group, individual, and family policies are among the most popular plans offered, along with Senior Medigap plans for applicants that have reached age 65. Also offered are specific plans for students and the self-employed. Policies can be easily customized, and flexible billing options are always available, including “direct bill at home.” As part of the CVS family, many additional benefits are available.
Individual Marketplace plans are now available for 2024, in the following counties: Adams, Ashland, Ashtabula, Brown, Butler, Clermont, Cuyahoga, Delaware, Fairfield, Franklin, Geauga, Hamilton, Henry, Lake, Licking, Lorain, Lucas, Medina, Pickaway, Portage, Summit, Union, and Wood. Several network providers include Fairfield Medical Center, Licking Memorial, Memorial Hospital Of Union, Mercy Health, Metro Health, Ohio Health, Summa Health, and University Hospitals.
About Aetna
CVS acquired Aetna four years ago, in of the largest corporate mergers ever. This giant carrier issued its first insurance policy in 1850. But, many Ohioans are truly happy they “met” Aetna, especially considering their large network of doctors and specialists. Their PPO coverage is recognized and respected by more than 21,000 doctors and hospitals, making it one of the most popular forms of medical coverage. More than 45 million persons are covered by health, pharmacy, and dental benefits, while employer-sponsored benefits continue to cover large and small companies.
In addition to individual and Senior coverage, other lines of business include dental, vision, disability, Group life, pharmacy, Medicaid services, and worker’s compensation administration. The network of providers is large for both young and older applicants. Currently, Aetna does not market subsidized Marketplace plans or “off-Exchange” contracts in the Buckeye State. It is possible, with new healthcare legislation, they may begin offering under-65 coverage in 2024 in selected counties.
Additional products offered in the state include: Indemnity, traditional choice, elect choice, and self-funded plans, and student medical plans that are medically-underwritten. Subsidiary companies include PayFlex, Meritain Health, Cofinity, and bswift.
Aetna Senior Medicare Coverage In Ohio (For Persons Age 65 And Older)
Medicare Supplement Plans
Medicare Supplement plans pay for many of the out-of-pocket expenses not covered by basic coverage. The standardized plans that are available are A, B, F, F (HD), G, and N. Options not offered by Aetna are generally available through many other companies, including Anthem Blue Cross, Humana, Medical Mutual, UnitedHealthcare, and many additional carriers.
Plan F is the most comprehensive and expensive option, since Part A and B deductibles, 100% Part B coinsurance, Part B excess, foreign travel emergency, and skilled nursing facility coinsurance are covered. Plan A is one of the least expensive options, since “Basic” benefits and the Part B coinsurance are the main features. Parts A and B deductibles are not covered. Plan F (HD) is the least expensive option, since a single deductible must be met before benefits are paid (100%).
Shown below are estimated monthly preferred rates for all available plans in selected areas.
Hamilton, Clermont, Clinton, Brown, Warren, Highland, Preble, Greene, Miami, Montgomery, Mercer, Clark, Fayette, Champaign, and Adams Counties Male Age 65
Plan A – $108
Plan B – $128
Plan F – $148
Plan G (HD) – $50
Plan G – $117
Plan N – $92
Hamilton, Clermont, Clinton, Brown, Warren, Highland, Preble, Greene, Miami, Montgomery, Mercer, Clark, Fayette, Champaign, and Adams Counties Female Age 65
Plan A – $94
Plan B – $111
Plan F – $128
Plan G (HD) – $43
Plan G – $102
Plan N – $80
Van Wert, Mercer, Allen, Auglaize, Hancock, Paulding, Putnam, Darke, Shelby, Athens, Meigs, Washington, Wyandot, Scioto, and Noble Counties Male Age 65
Plan A – $104
Plan B – $123
Plan F – $142
Plan G (HD) – $48
Plan G – $113
Plan N – $89
Van Wert, Mercer, Allen, Auglaize, Hancock, Paulding, Putnam, Darke, Shelby, Athens, Meigs, Washington, Wyandot, Scioto, and Noble Counties Female Age 65
Plan A – $90
Plan B – $107
Plan F – $123
Plan G (HD) – $41
Plan G – $98
Plan N – $77
Cuyahoga, Lake, Geauga, Ashtabula, Lorain, Medina, Wayne, Stark, Summit, Lorain, Portage, Columbiana, Mahoning, and Trumbull Counties Male Age 65
Plan A – $126
Plan B – $149
Plan F – $172
Plan G (HD) – $58
Plan G – $137
Plan N – $98
Cuyahoga, Lake, Geauga, Ashtabula, Lorain, Medina, Wayne, Stark, Summit, Lorain, Portage, Columbiana, Mahoning, and Trumbull Counties Female Age 65
Plan A – $109
Plan B – $129
Plan F – $149
Plan G (HD) – $50
Plan G – $119
Plan N – $85
Medicare Advantage Plans (Rates And Benefits Often Vary Depending On County)
Aetna Medicare Value Plan (PPO) – $0 monthly premium with $300 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $35, with ER copay of $95. Inpatient hospital copay is $325 per day for first four days, and $0 days 5-90. Lab services and outpatient x-ray copays are $0 and $0-$110. The ambulance copay is $250. Hearing exam copay is $45. Preferred pharmacy 30-day copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $20 (Tier 2), $141 (Tier 3), and $300 (Tier 4). 4.0 Summary Star Rating.
Aetna Medicare Value Plan (HMO) – $0 monthly premium with $300 deductible and maximum out-of-pocket expenses of $6,700. Office visit copays are $0 and $35, with ER copay of $95. Inpatient hospital copay is $325 per day for first four days, and $0 days 5-90. Lab services and outpatient x-ray copays are $0 and $0-$110. The ambulance copay is $250. Hearing exam copay is $45. Preferred pharmacy 30-day copays are $0 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 28% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $20 (Tier 2), $141 (Tier 3), and $300 (Tier 4). 4.0 Summary Star Rating.
Aetna Medicare Premier 1 (PPO) – $110 monthly premium with $0 deductible and maximum out-of-pocket expenses of $5,500. Office visit copays are $0 and $35, with ER copay of $110. Inpatient hospital copay is $220 per day for first six days, and $0 days 7-90. Lab services and outpatient x-ray copays are $0 and $20. The ambulance copay is $270. Hearing exam copay is $30. Dental copay is $0. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4). 4.0 Summary Star Rating.
Aetna Medicare Premier Plus 2 (Regional PPO) – $149 monthly premium with $250 deductible and maximum out-of-pocket expenses of $5,100. Office visit copays are $0 and $35, with ER copay of $110. Inpatient hospital copay is $350 per day for first five days, and $0 days 6-90. Lab services and outpatient x-ray copays are $0 and $0-$20. The ambulance copay is $150. Hearing exam copay is $35. Preventative dental copay is $0. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), 20% (Tier 3), 40% (Tier 4), and 49% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $0 (Tier 2), 20% (Tier 3), and 40% (Tier 4).
Aetna Medicare Premier (HMO) – $0 monthly premium with $0 deductible and maximum out-of-pocket expenses of $6,100. Office visit copays are $0 and $40, with ER copay of $90. Inpatient hospital copay is $385 per day for first five days, and $0 days 6-90. Lab services and outpatient x-ray copays are $0-$10 and $0-$100. The ambulance copay is $250. Hearing exam copay is $35. Preventative dental copay is $0. Preferred pharmacy 30-day copays are $2 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day mail-order copays are $5 (Tier 1), $10 (Tier 2), $141 (Tier 3), and $300 (Tier 4).
Aetna Medicare Premier 2 (PPO) – $124 monthly premium with $0 deductible and maximum out-of-pocket expenses of $4,800. Office visit copays are $5 and $40, with ER copay of $90. Inpatient hospital copay is $285 per day for first six days, and $0 days 7-90. Lab services and outpatient x-ray copays are $0-$10 and $5-$50. The ambulance copay is $280. Hearing exam copay is $40. Preventative dental copay is $0. Preferred pharmacy 30-day copays are $2 (Tier 1), $5 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day mail-order copays are $5 (Tier 1), $10 (Tier 2), $141 (Tier 3), and $300 (Tier 4).
Aetna Medicare Eagle (HMO) – Maximum out-of-pocket expenses of $7,550. Office visit copays are $0 and $45, with ER copay of $90. Inpatient hospital copay is $250 per day for first eight days, and $0 days 9-90. Lab and diagnostic copays are 0% and $10-$90. The ambulance copay is $250. Hearing, dental, and eyewear benefits are covered subject to policy limitations. Prescription coverage is not included.
Aetna Medicare OH Premier Plus 1 (Regional PPO) – $225 monthly premium with $0 deductible and maximum out-of-pocket expenses of $4,900. Office visit copays are $5 and $20, with ER copay of $90. Inpatient hospital copay is $200 per day for first five days, and $0 days 6-90. Lab services and outpatient x-ray copays are $0 and $15. The ambulance copay is $150. Hearing exam copay is $20. Preventative dental copay is $0. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 33% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4).
Aetna Medicare Advantra Silver (PPO) – $0 monthly premium with $150 deductible and maximum out-of-pocket expenses of $5,900. Office visit copays are $5 and $40, with ER copay of $90. Inpatient hospital copay is $350 per day for first five days, and $0 days 6-90. Lab services and outpatient x-ray copays are $0-$15 and $5-$90. The ambulance copay is $350. Hearing exam copay is $30. Preventative dental copay is $0. Preferred pharmacy 30-day copays are $5 (Tier 1), $7 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 30% (Tier 5). 90-day mail-order copays are $15 (Tier 1), $21 (Tier 2), $141 (Tier 3), and $300 (Tier 4).
Aetna Medicare Assure (HMO D-SNP) – $0 monthly premium with $0 deductible. Office visit copays are $0 and 0% or 20%, with ER copay of 0% or 20%. Inpatient hospital copay is $0 or $1,408. Lab and diagnostic copays are $0 and 20%. Imaging copays are x-ray (0%-20%), and CT-scan and radiology (0%-20%). The ambulance copay is 0%-20%. Dental, hearing, and eyewear benefits vary. Preferred pharmacy 30-day copays are $0 (Tier 1), $0 (Tier 2), $47 (Tier 3), $100 (Tier 4), and 30% (Tier 5). 90-day mail-order copays are $0 (Tier1), $0 (Tier 2), $141 (Tier 3), and $300 (Tier 4).
Part D Prescription Drug Plans (PDP) Offered By SilverScipt, A CVS Company
SilverScript SmartRx – $7.30 per month premium. Annual prescription deductible is $0 for Tier 1. $445 deductible for Tiers 2, 3, 4, and 5. The initial coverage limit is $4,130, and the True Out-Of-Pocket Threshold Amount (TrOOP) is $6,550. 30-day copays are $19 (Tier 1), $20 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day copays are $0 (Tier 1), $57 (Tier 2), $138 (Tier 3), 49% (Tier 4), and NA (Tier 5). ID # S5601-189. 3,652 formulary drugs are available.
SilverScript Choice – $26.20 per month premium. Annual prescription deductible is $0 for Tiers 1 and 2. $445 deductible for Tiers 3, 4, and 5. The initial coverage limit is $4,130, and the True Out-Of-Pocket Threshold Amount (TrOOP) is $6,550. 30-day copays are $0 (Tier 1), $5 (Tier 2), $35 (Tier 3), 47% (Tier 4), and 25% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $15 (Tier 2), $105 (Tier 3), and 47% (Tier 4). ID # S5601-028. 3,091 formulary drugs are available.
SilverScript Plus – $74.50 per month premium. Annual prescription deductible is $0. The initial coverage limit is $4,130, and the True Out-Of-Pocket Threshold Amount (TrOOP) is $6,550. 30-day copays are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day mail-order copays are $0 (Tier 1), $0 (Tier 2), $120 (Tier 3), and 50% (Tier 4). ID # S5601-029. 3,150 formulary drugs are available.
Aetna Ohio Dental Plans
Aetna Dental Direct Preferred PPO – The policy deductible is $50 per person and $150 per family. The annual maximum benefit is $1,250. Preventive oral exams, cleanings, sealants, and full mouth series images are covered at 100% with no waiting period. Resin filling (one surface), uncomplicated extractions, and periodontal maintenance cleanings covered with 20% coinsurance (40% out-of-network) with a six month waiting period.
Major services have a 12-month waiting period (dentures, root canal therapy, crowns, and oral surgery). Major services are subject to 50% coinsurance. Orthodontics are not covered. Emergency dental care required to manage or relieve pain is covered 24/7. Network treatment will result in lower out-of-pocket costs.
Aetna Dental Direct Core PPO – The policy deductible is $50 per person and $150 per family. The annual maximum benefit is $1,250. Preventive oral exams, cleanings, sealants, and full mouth series images are coveted at 100% with no waiting period. Resin filling (one surface), uncomplicated extractions, and periodontal maintenance cleanings covered with 20% coinsurance (50% out-of-network) with six month waiting period.
Major services have a 12-month waiting period (orthodontics, dentures, root canal therapy, crowns, and oral surgery. Major services are subject to 50% coinsurance.
Vital Savings Dental Discount Card – Premiums start at $7.99 per month. Coverage is not considered insurance and should not be used as a substitute for a comprehensive plan. A 15%-50% discount can be utilized at more than 200,000 locations throughout the US. Discounted charges are negotiated for Aetna Vital Savings.
Examples of savings include $2,258 (braces), $53 (adult cleanings), $38 (child cleanings), $415 (dentures), $117 (extractions), $332 (root canals), $75 (x-rays), and $93 (fillings).
Coverage can be purchased online, by mail or, by phone. A dental plus Rx card is also offered for approximately $9.99 per month. An initial enrollment fee of $15 must be paid at the time of application. An annual payment can be made ($75 for dental and $95 for dental and Rx). The family rates are $105 and $125.
Aetna Better Health Of Ohio
This managed care plan has a contract with Medicare and Ohio Medicaid. Physical, long term care, and behavioral benefits are provided for Buckeye State residents that have reached age 18. Coverage is offered in the following counties: Delaware, Franklin, Madison, Pickaway, Union, Butler, Clermont, Clinton, Hamilton, Warren, Fulton, Lucas, Ottawa, and Wood. Enrollment can be completed online or by calling the Ohio Medicaid Consumer Hotline.
Treatment must be provided inside the network unless emergency services are required, a federally approved health center or clinic is used, or pre-approval has been granted. Out-of-network charges may be more expensive and may not be covered.
Benefits provided with no out-of-pocket expenses include: Office visits, wellness and specialist visits, transportation to office visits (within 30 miles), lab tests, x-rays, screening tests, generic and brand name drugs, over-the-counter drugs, ER and ambulance services, Urgent Care visits, and hospital stays.
Additional benefits covered at 100% include rehab services, home medical equipment, eye exams, glasses, dental visits, hearing aids, hearing screenings, wheelchairs, nebulizers, and home health care services. Prior authorization may be required and coverage is subject to policy limits.
Small Business Plans
Network Only – HMO, Select, Open Access Select, Choice, Open Access Elect Choice, and Health Network Only.
Network Option Plans – Managed Choice, Open Choice, Open Choice PPO, Choice POS II, QPOS, and Open Access Managed Choice.
Indemnity Plans – Freedom of choice to visit any provider. Discounted rates and products.
Previous Year Pricing (Under Age 65)
Their rates are not always the lowest, when compared to other companies, but their PPO plans are usually a “good buy.” We expect to see Aetna continue to participate in the Ohio Exchange and Marketplace again by 2025, which will guarantee approval for all consumers that purchase a policy. You can apply directly through our website.
Although they have not offered individual medical plans as long as a few other companies, such as UnitedHealthOne, Medical Mutual or Anthem, a wide variety of quality policies are available, including comprehensive, catastrophic and HSA plans. Short-term coverage is not available although customers can cancel their policy at any time. Thus, if you only needed to purchase benefits for a few months, that would be acceptable. (Note: At this time, Aetna does not offer short-term plans).
Previously-Available Popular Marketplace Plans In Ohio
Bronze $20 Copay – The least expensive Bronze-tier policy that offers copays on office visits ($20) and generic prescriptions ($15). As a Point-Of-Service (POS) option, this plan combines HMO and PPO features, including substantial discounts if stay “in-network.”
Specialist visits are subject to a $50 copay and must meet the policy deductible of $5,750. Hospital visits have a $250 per stay charge plus applicable deductibles and copays.
Silver $10 Copay – Another POS plan that features a very low $10 copay on office visits but no deductible on specialist visits. Since the cost of a specialist can easily be more than $150, this is a major money-saver. The deductible of $3,750 is also very reasonable.
Cost-sharing applies (to all Silver-tier plans), so depending upon household income, deductible and out-of-pocket expenses can drastically reduce.
Gold $5 Copay – “Cadillac” of Ohio Marketplace policies. $5 and $40 copays on primary-care-physician and specialist visits. Add a low $1,400 deductible and you have a very attractive option if you’re willing to spend a few extra dollars. Maximum out-of-pocket maximum is $5,000.
Grandfathered plans (policies issued in April of 2010 or earlier) remain active for many households. Although benefits do not reflect new mandates and guidelines, unless they are terminated by the original carrier, you may keep the contract.
These options have become very popular in recent years. And although their rates are extremely competitive, it is still important to properly compare their policy to the other Ohio health companies. And that’s what we do best! Although we will consider all policies when researching your options, we feel it is most important to recommend the options that best fits your specific needs…regardless of which company that might be.
The quotes you view on our website are always free! When applying for coverage, we can help you every step of the way, including researching and comparing policies. You can also “apply direct” with the links we provide.
Aetna Savings Plans
Employers with 101-300 workers can utilize these specialized plans that provide lower premiums and include the most popular healthcare benefits. The larger provider networks allow for additional flexibility when choosing physicians and hospitals. Savings are frequently 10% or more compared to other available options. Increasing the deductible and copays on these types of plans is often not necessary.
Savings are maintained by encouraging members to visit an Urgent Care facility instead of the ER (when feasible), and encouraging the use of generic medications with lower copays and eliminating any applicable deductible. Plans are available in all Ohio counties.
