Aetna POS Value Plan Enrollment and Comparison Guide

The Aetna POS Value Plan is a popular choice for individuals and families who want affordable health insurance coverage. This plan is designed to help you save money on out-of-pocket expenses.

The Aetna POS Value Plan has a maximum out-of-pocket limit of $7,000 for individuals and $14,000 for families. This means that once you reach this limit, you won't have to pay any more out-of-pocket expenses for the rest of the year.

To enroll in the Aetna POS Value Plan, you can visit the Aetna website or contact a licensed insurance agent. You can also enroll during the annual open enrollment period or during a special enrollment period if you experience a qualifying life event.

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The Aetna POS Value Plan allows you to receive care from either in-network or out-of-network providers.

You'll need to meet a calendar-year deductible before eligible expenses are considered for reimbursement. The deductible is the amount you pay in a year before insurance kicks in.

The effective deductibles for 2025 are: $1,650 individual or $3,300 family for in-network services, and $3,300 individual or $6,600 family for out-of-network services.

For in-network services, you'll pay 20% of the contracted rate after meeting the deductible. For out-of-network services, you'll pay 40% of the Usual and Customary Rate (UCR) plus any billed amount exceeding the UCR.

You must submit an Aetna claim form to receive reimbursement for out-of-network services, and the request must be received by Aetna within 12 months of the date of service.

Here's a breakdown of the deductibles for 2025:

The Aetna POS Value Plan offers flexibility when it comes to visiting doctors, both in and out of network. You can see any licensed provider, regardless of their network status.

You'll pay 50% of the plan's allowance for out-of-network care, plus any difference between the allowance and the billed amount, after meeting your deductible. The annual out-of-network deductible is $1,400 for Self Only and $2,800 for Self Plus One or Self and Family.

To find a provider, use Aetna's provider search tool. This will give you access to information about their network, as well as individual physicians' credentials, such as their board certification status and languages spoken.

Dental coverage is not included in the Value plan.

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The Aetna POS Value Plan has various costs and coverage options. The plan has an annual drug deductible of $450 (excludes Tiers 1 and 2) per year.

The monthly deductible for the plan is $590. This is a significant upfront cost, but it's worth noting that some services are not subject to the deductible.

You'll pay a copay for some services, such as office visits, which can range from $0 to $20. For example, a primary care doctor visit costs $0, while a specialty doctor visit costs $20.

Inpatient hospital care can be costly, with a daily rate of $300 for days 1-5 and $0 for days 6-90. This is a substantial cost, but it's worth noting that some services are not subject to the deductible.

Here's a breakdown of the out-of-pocket maximum costs:

The plan also has a catastrophic coverage limit of $2,000. This means that once you've reached this limit, you'll pay a higher percentage of your medical expenses.

In addition to these costs, you'll also pay a copay for urgent care, which is $50 for in-network care and $140 for worldwide urgent care. Emergency room visits cost $140, but if you're admitted to the hospital within 0 hours, your cost share may be waived.

The Aetna POS Value Plan offers a range of benefits and services to its members, including coverage for chiropractic services, with a copayment of $15 for in-network services.

You can also get diabetes supplies, training, and monitoring, with a 0% copayment for OneTouch/LifeScan diabetic supplies and 20% for other covered supplies.

In addition, the plan covers durable medical equipment, including continuous glucose monitors with a 0% copayment and all other Medicare-covered DME items with a 20% copayment.

Here's a breakdown of the costs for diagnostic tests, lab, and radiology services:

Dental care is an essential part of our overall health, and it's great to know that our plan covers a wide range of services.

Preventive dental services are covered at 100% for in-network providers, which means you won't have to pay a dime for oral exams, cleanings, fluoride treatments, x-rays, and other diagnostic services.

Comprehensive dental services, including restorative services, endodontic services, and oral and maxillofacial surgery, are also covered at 100% for in-network providers.

Out-of-network providers offer 50% coverage for preventive and comprehensive services.

You have a benefit amount of $1,250 every year for covered preventive and comprehensive dental services, whether you see an in-network or out-of-network provider. Medical necessity requirements vary by covered dental service.

Here's a breakdown of the covered dental services:

As for vision care, our Value plan covers routine eye refraction at 100%.

Health care services are an essential part of any insurance plan, and Aetna Medicare Value and Aetna Medicare Value Plus offer a range of benefits to help you stay healthy.

Chiropractic services are covered under both plans, with a copayment of $15 for Aetna Medicare Value and $20 for Aetna Medicare Value Plus.

Both plans also cover durable medical equipment, such as continuous glucose monitors, with 0% copayment.

Diagnostic tests, lab services, and radiology services are also covered, with some tests and services having a $0 copayment.

Lab services, including X-rays, are covered with a $0 copayment in-network.

Home health care is also covered under both plans, with a $0 copayment.

Mental health inpatient care is covered, but requires prior authorization and has a copayment of $300 per day for days 1 to 6 for Aetna Medicare Value and $370 per day for days 1 to 5 for Aetna Medicare Value Plus.

Mental health outpatient care is also covered, with a copayment of $25 for Aetna Medicare Value and $40 for Aetna Medicare Value Plus.

Outpatient services and surgery are covered, with some services having a $0 copayment in-network.

Skilled nursing facility care is covered, with a $0 copayment per day for days 1-20 in-network.

Here's a summary of the copayment amounts for some of the covered services:

The Aetna POS Value Plan offers a range of enrollment options, including individual and group plans.

You can enroll in the plan through the Aetna website or by contacting a licensed insurance agent.

The plan's out-of-pocket maximum is $7,000 for individuals and $14,000 for families, which means you won't pay more than this amount for covered medical expenses in a calendar year.

Enrollment procedures vary by agency, so it's essential to follow the specific instructions for your situation.

To enroll in the Federal Employees Health Benefits (FEHB) Program, you'll need to know the enrollment code for your chosen plan.

You can find the plans available in your area and the corresponding federal enrollment codes on the home page of the website.

Coverage for current members and annuitants begins on January 1, 2025, while coverage for active employees joining during Open Season becomes effective on the first day of the first pay period in January 2025.

Newly hired Federal Employees have 60 days to enroll in an FEHB plan, and their enrollment will become effective the beginning of the pay period after their enrollment is received.

You must live or work in the service area to enroll in the plan, and you can find the available plans on the home page.

If you're enrolled in the system, you can register on the member website and print an ID card, which you can use if you need medical or dental care.

Curious to learn more? Check out: Fehb Plans

Comparing Medicare Advantage Plans can be a daunting task, but let's break it down. There are over 180 Medicare Advantage plans available, offered by private insurance companies.

The cost of these plans varies greatly, with some having a $0 premium and others charging over $100 per month.

Medicare Advantage plans often have different networks of healthcare providers, which can affect the quality of care you receive. Some plans may have a narrower network, while others have a broader network.

In-network costs for Medicare Advantage plans can be significantly lower than out-of-network costs. For example, a plan may have a $10 copayment for in-network doctor visits, but $50 or more for out-of-network visits.

Preventive services, such as annual physicals and screenings, are often covered at 100% by Medicare Advantage plans. This can be a big cost savings for those who prioritize preventive care.

Some Medicare Advantage plans offer additional benefits, such as dental, vision, and hearing coverage, as well as fitness programs and transportation services. These benefits can be a great value, but may also increase the premium cost.

Curious to learn more? Check out: What's the Difference between Medigap and Medicare Advantage