Aetna Medical
From your annual checkup to unexpected health needs, our Aetna medical plans help you get the care you need while managing your out-of-pocket costs. You can choose between two Aetna medical plans, each offering access to the Aetna Premier Care Network Plus (APCN+).
Parts of Your Medical Plan
- Annual deductible: The amount you pay each year for eligible in-network or out-of-network charges before the plan begins to pay. If you enroll in family coverage, your deductible may be aggregate or embedded depending on the plan you choose.
- Out-of-pocket maximum: The most you will pay each year for eligible network services and/or prescriptions. After you reach your out-of-pocket maximum, the plan picks up the full cost of covered medical care for the remainder of the year.
- Copays: A copay is a fixed amount you pay for a health care service. Copays do not count toward your deductible but do count toward your annual out-of-pocket maximum.
- Coinsurance: Once you’ve met your deductible, you and the plan share the cost of care, which is called coinsurance. For example, you pay 20% for services and the plan will pay 80% of the cost until you have reached your out-of-pocket maximum.
Aetna APCN+ Network
The APCN+ Multi-Tier network groups doctors and facilities into three tiers to give you more choice in how you receive care. Your costs can vary by tier, including your deductible, copays, coinsurance, and out-of-pocket maximum. Tier 1 providers offer the highest level of savings, while you may pay more if you see Tier 2 or Tier 3 providers.
- Tier 1 – Maximum Savings: In-network providers with the lowest member costs.
- Tier 2 – Standard Savings: In-network providers with higher member costs than Tier 1.
- Tier 3 – Minimal Savings: Out-of-network providers with the highest member costs.
Click here to check your provider’s tier before receiving care.
Choose the Plan That Fits Your Needs
You can choose between two Aetna medical plans: the Aetna Core APCN+ plan and the Aetna High Deductible APCN+ plan. Both plans give you access to the Aetna Premier Care Network Plus (APCN+) and cover preventive care at 100% when you use in-network providers.
Aetna Core APCN+ Plan
The Aetna Core APCN+ plan offers copays for certain services, such as primary care and specialist visits, to help offset the cost of care before you meet your deductible. For other services, you pay the full cost until you meet your deductible, then you pay coinsurance until you reach your out-of-pocket maximum.
If you enroll in family coverage, the Aetna Core APCN+ plan has an embedded deductible, meaning each family member has their own individual deductible to meet. Once a family member meets their deductible, the plan begins paying for that person.
Aetna Core APCN+ Plan Overview
| Tier 1: In-Network Maximum Savings | Tier 2: In-Network Standard Savings | Tier 3: Out-of-Network Minimal Savings | |
| Plan Features | |||
| Annual Deductible – Individual / Family (Embedded) | $1,500 | $3,000 | $3,500 | $7,000 | $7,000 | $14,000 |
| Annual Out-of-Pocket Maximum – Individual / Family (Embedded) | $4,000 | $8,000 | $7,000 | $14,000 | $14,000 | $28,000 |
| Your Costs for Care | |||
| Coinsurance | 20%* | 40%* | 50%* |
| Preventive Care | No cost | No cost | 50%* |
| Primary Care Physician (PCP) – Office Visit & Telemedicine | $25 | $30 | 50%* |
| Specialist – Office Visit & Telemedicine | $40 | $50 | 50%* |
| Urgent Care | $50 | $50 | 50%* |
| Emergency Room | $150 + 20%** | $150 + 20%** | $150 + 20%** |
| Inpatient Hospital | $250 + 20%* | $250 + 40%* | $500 + 50%* |
| Outpatient Hospital | 20%* | 40%* | 50%* |
| Mental Health | $40 | $50 | 50%* |
| Outpatient Surgery | 20%* | 40%* | 50%* |
| Lab and X-ray (Outpatient) | 20%* | 40%* | 50%* |
* After deductible
** Tier 1 deductible and out-of-pocket maximum will apply
Aetna High Deductible APCN+ Plan
The Aetna High Deductible APCN+ plan is a High Deductible Health Plan (HDHP), which means you pay the full cost of most covered care until you meet your deductible. After that, you pay coinsurance until you reach your out-of-pocket maximum. The plan generally has lower premiums and allows you to contribute to a Health Savings Account (HSA) to help pay for eligible health care expenses.
If you enroll in family coverage, the plan has an aggregate deductible, meaning the full family deductible must be met before the plan begins paying a portion of covered care for anyone. Expenses from any family member count toward the family deductible. Once it’s met, the plan pays a portion of covered care for all family members, and you pay coinsurance until you reach the out-of-pocket maximum.
Aetna High Deductible APCN+ Plan Overview
| Tier 1: In-Network Maximum Savings | Tier 2: In-Network Standard Savings | Tier 3: Out-of-Network Minimal Savings | |
| Plan Features | |||
| Annual HSA Employee Contribution Maximum | Individual: $4,500 | Family: $9,000 | ||
| Annual Deductible – Individual / Family (Aggregate) | $2,500 | $4,000 | $6,000 | $12,000 | $12,000 | $24,000 |
| Annual Out-of-Pocket Maximum – Individual / Family (Embedded) | $6,000 | $12,000 | $8,500 | $17,000 | $20,000 | $40,000 |
| Your Costs for Care | |||
| Coinsurance | 20%* | 40%* | 50%* |
| Preventive Care | No cost | No cost | 50%* |
| Primary Care Physician (PCP) – Office Visit & Telemedicine | 20%* | 40%* | 50%* |
| Specialist – Office Visit & Telemedicine | 20%* | 40%* | 50%* |
| Urgent Care | 20%* | 40%* | 50%* |
| Emergency Room | 20%** | 20%** | 20%** |
| Inpatient Hospital | 20%* | 40%* | 50%* |
| Outpatient Hospital | 20%* | 40%* | 50%* |
| Mental Health | 20%* | 40%* | 50%* |
| Outpatient Surgery | 20%* | 40%* | 50%* |
| Lab and X-ray (Outpatient) | 20%* | 40%* | 50%* |
* After deductible
** Tier 1 deductible and out-of-pocket maximum will apply
Aetna Resources
Register Online
Create your account at Aetna.com to find a doctor, view lab results, manage your Explanation of Benefits (EOBs), access tips for healthy living, and more. You’ll need your carrier-assigned ID number to register.
Download the Aetna Mobile App
Manage your health care on the go with the Aetna mobile app, available through the Apple App Store and Google Play. You’ll need your carrier-assigned ID number to register and use the app.
Find an In-Network Provider
Use Aetna’s Find-A-Doctor tool to search for doctors and facilities in the APCN+ network and check their tier before receiving care.
Questions?
Have questions about your plan, coverage, providers, or billing? Call Aetna Concierge Services at 1-800-922-5863, Monday through Friday from 8 a.m. to 6 p.m. ET, for help understanding your benefits and navigating your medical plan.
Also see: LGBTQIA+ Benefits
Aetna Contacts
Aetna Concierge Services
1-800-922-5863
Call Aetna Concierge Services (M–F, 8 a.m.–6 p.m. ET)