Insurance Type | ACA (Obamacare) |
Plan Name | Aetna Gold $10 Copay OAEPO C/O |
Plan ID | hhs-17210NY0120016 |
Plan Year | 2021 |
Insurance Provider | Aetna |
Metal Level | Gold |
Plan Type | EPO |
Deductible | $0 |
Out-of-Pocket Maximum | $0 |
Plan Highlights |
Costs for Medical Care | |
---|---|
Primary Care Visit to Treat an Injury or Illness | $10 Copay |
Specialist Visit | $40 Copay |
Laboratory Outpatient and Professional Services | 20.00% Coinsurance after deductible |
X-rays and Diagnostic Imaging | 20.00% Coinsurance after deductible |
Diagnostic Imaging such as MRIs, CT, and PET scans | 20.00% Coinsurance after deductible |
Prescription drug coverage | |
---|---|
Generic Drugs | $5 Copay |
Preferred Brand Drugs | $35 Copay after deductible |
Non-Preferred Brand Drugs | $70 Copay after deductible |
Specialty Drugs | $70 Copay after deductible |
Access to doctors and hospitals | |
---|---|
Provider directory URL | http://www.aetna.com/dse/search?site_id=ivl |
Does this plan have access to a national provider network? | No |
Is a referral required to see a Specialist? | Not Covered |
Does this plan cover services outside plan service area? | No - Except for Emergencies |
Does this plan cover services outside the country? | Not Covered |
Hospital services | |
---|---|
Emergency Room Services | $250 Copay after deductible |
Inpatient Hospital Services (e.g., Hospital Stay) | 20.00% Coinsurance after deductible |
Inpatient Physician and Surgical Services | 20.00% Coinsurance after deductible |
Emergency Transportation or Ambulance Service | 20.00% Coinsurance after deductible |
Maternity | |
---|---|
Prenatal and Postnatal Care | 20.00% Coinsurance after deductible |
Delivery and all inpatient services for maternity care | 20.00% Coinsurance after deductible |
Mental Health | |
---|---|
Mental/Behavioral Health Outpatient Services | $10 Copay |
Mental/Behavioral Health Inpatient Services | 20.00% Coinsurance after deductible |
Substance use disorder outpatient services | $10 Copay |
Substance use disorder inpatient services | 20.00% Coinsurance after deductible |
Medical Management Programs | |
---|---|
Does this plan offer disease managment programs? | Diabetes, Heart Disease, Pregnancy, Weight Loss Programs |
Does this plan offer a wellness program? | Included |
Vision Coverage | |
---|---|
Routine Eye Exam for Children | Included |
Eye Glasses for Children | Included |
Routine Eye Exam for Adults | Not Covered |
Child Dental Coverage | |
---|---|
Child Dental Coverage - Routine Dental Care | Included |
Child Dental Coverage - Basic Dental Care | Included |
Child Dental Coverage - Orthodontia | Included |
Child Dental Coverage - Major Dental Care | Included |
Adult Dental Coverage | |
---|---|
Adult Dental Coverage - Routine Dental Care | Not Covered |
Adult Dental Coverage - Basic Dental Care | Not Covered |
Adult Dental Coverage - Orthodontia | Not Covered |
Adult Dental Coverage - Major Dental Care | Not Covered |
Exclusions and Limitations | |
---|---|
More Included Benefits | Other Practitioner Office Visit (Nurse, Physician Assistant) Preventive Care/Screening/Immunization Skilled Nursing Facility Bariatric Surgery Infertility Treatment Imaging (CT/PET Scans, MRIs) Outpatient Surgery Physician/Surgical Services Urgent Care Centers or Facilities Inpatient Physician and Surgical Services Habilitation Services Durable Medical Equipment Hospice Services Chiropractic Care Inpatient Rehabilitation Services Diabetes Care Management Inherited Metabolic Disorder - PKU Second Opinion Accidental Dental Allergy Testing Chemotherapy Diabetes Education Dialysis Infusion Therapy Laboratory Outpatient and Professional Services Nutritional Counseling Prosthetic Devices Radiation Reconstructive Surgery Transplant Treatment for Temporomandibular Joint Disorders Well Baby Visits and Care Autism Spectrum Disorders Breast Reconstructive Surgery Eating Disorder Treatment Post-Mastectomy Care Prescription Drugs Other Family Planning Services Outpatient Facility Fee (e.g., Ambulatory Surgery Center) |
More Limited Benefits | Hearing Aids Home Health Care Services Outpatient Rehabilitation Services Dental Check-Up for Children Abortion for Which Public Funding is Prohibited Rehabilitative Occupational and Rehabilitative Physical Therapy Rehabilitative Speech Therapy |
More Excluded Benefits | Acupuncture Cosmetic Surgery Private-Duty Nursing Weight Loss Programs Routine Foot Care Experimental or Investigational Services Long-Term/Custodial Nursing Home Care |
ObamaCare’s Gold Plan is a type of Metal Plan on the Health Insurance Marketplace. Gold Plans qualify for Tax Credits, have high premiums, and good cost sharing. Gold plans mean higher premiums, less Tax Credits, but much better cost sharing on average than Silver or Bronze.
The fundamental difference among the new Obamacare health plans is the percentage of covered medical costs paid by the health plan. The Gold Plan typically pays 80% of covered medical costs.
The monthly premium for a Gold Plan depends on the insurer from whom you purchase the plan, the number of people to be insured by the plan, your age, whether you smoke, and your geographic region. You can use HealthPocket’s comparison tool to compare Gold Plan premiums in your area.
The Open Enrollment period for the 2018 Affordable Care Act health plans begins November 1, 2017 and ends December 15, 2017. See our Open Enrollment article for more information.
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HealthPocket.com is a free information source. We receive our data from government, non-profit and private sources, and you should confirm key provisions of your coverage with your selected health plan. Our website is not a health insurance agency and not affiliated with and does not represent or endorse any health plan. While on our site, if you click on a plan or link, you may be directed to one of our partners who offers health insurance products. HealthPocket, Inc. is part of the Benefytt Technologies, Inc. family of companies.
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