Aetna BRONZE HMO Plans
| Plan Info | Bronze 1 Advanced: HMO + Rx Copay | Bronze 4 Advanced: HMO | Bronze S: HMO |
|---|---|---|---|
| Benefits Summary | Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $8,195/ $16,390 | $0 | $7,500 / $15,000 |
| Out of Pocket Max – Individual/Family | $9,195 / $18,390 | $9,195 / 18,390 | $9,200 / $18,400 |
| Primary Care/Specialist | $10 / $125 | No charge / $80 | $50 / $100 |
| Emergency Room Care | 50% coinsurance | $2,500 copay/visit | 50% coinsurance |
| Urgent Care | $60 copay | $50 copay/visit | $75 copay |
| Inpatient hospital stay | 50% coinsurance | $2,500 copay/day, days 1-3 | 50% coinsurance |
| Lab services / Xray | 50% coinsurance | Lab: $50 copay / visit X-ray: $85 copay / visit | 50% coinsurance |
| Prescription Drugs | |||
| Preferred generic | Copay/ prescription, deductible does not apply: $25 for up to a 30 day supply, $62.50 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $25 for up to a 30 day supply, $62.50 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $25 for up to a 30 day supply, $62.50 for up to a 90 day supply |
| Preferred Brand Drugs | Copay/ prescription, deductible does not apply: $125 for up to a 30 day supply, $312.50 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $195 for up to a 30 day supply, $487.50 for up to a 90 day supply | Copay/ prescription: $50 for up to a 30 day supply, $125 for up to a 90 day supply |
| Non-preferred generic/brand drugs | Copay/ prescription, deductible does not apply: $175 for up to a 30 day supply, $437.50 for up to a 90 day supply | Copay/ prescription: $275 for up to a 30 day supply, $687.50 for up to a 90 day supply, after specific deductible | Copay/ prescription: $100 for up to a 30 day supply, $250 for up to a 90 day supply |
| Preferred/non-preferred specialty drugs | Copay/prescription, deductible does not apply: $500 for up to a 30 day supply | 50% coinsurance for up to a 30 day supply, after specific deductible | Copay/ prescription: $500 for up to a 30 day supply |
Every ACA plan covers 10 essential benefits:
- Prescription drugs
- Pregnancy, maternity and newborn care
- Pediatric services, including oral and vision care
- Mental health and substance use disorder services
- Preventive and wellness services, and chronic disease management
- Laboratory services
- Emergency services
- Hospitalization
- Ambulatory services
- Rehabilitative and habilitative services and devices
Aetna CVS Health Plans – 2025 Illinois PPO Hospital Network
Hospital Network Highlights – Hospitals include, but are not limited to:
Chicagoland Area Hospitals:
- Chicago Holy Cross Hospital
- Chicago Humboldt Park Health
- Chicago Insight Chicago, Inc.
- Chicago Jackson Park Hospital Foundation
- Chicago John H. Stroger Hospital of Cook County
- Chicago LaRabida Children’s Hospital
- Chicago Loretto Hospital
- Chicago Louis A. Weiss Memorial Hospital
- Chicago Methodist Hospital of Chicago
- Chicago Mount Sinai Hospital Medical Center
- Chicago Provident Hospital of Cook County
- Chicago Roseland Community Hospital
- Chicago Shriners Hospital for Children
- Chicago South Shore Hospital
- Chicago St. Anthony Hospital
- Chicago St. Bernard Hospital and Health Care Center
- Chicago Swedish Covenant Hospital
- Chicago Thorek Memorial Hospital
- Chicago University of Illinois at Chicago Hospital
Chicagoland Area Hospitals:
- Alton Alton Memorial Hospital
- Alton OSF Saint Anthony’s Health Center
- Anna Deaconess Illinois Union County Hospital, Inc
- Arlington Heights Northwest Community Hospital
- Benton Franklin Hospital 201 Bailey Lane
- Bloomington OSF St. Joseph Medical Center
- Breese St. Joseph’s Hospital – Breese
- Canton Graham Hospital
- Carbondale Memorial Hospital of Carbondale
- Carlinville Carlinville Area Hospital
- Carrollton Thomas H. Boyd Memorial Hospital
- Centralia SSM Health St. Mary’s Hospital – Centralia
- Chester Memorial Hospital
- Clinton Warner Hospital and Health Services
- Danville OSF Sacred Heart Medical Center
- Decatur Decatur Memorial Hospital
- Decatur St. Mary’s Hospital
- Du Quoin Marshall Browning Hospital
- Edwardsville St. Louis Children’s Hospital
- Eldorado Ferrell Hospital
- Elgin Presence Saint Joseph Hospital – Elgin
- Elmhurst Elmhurst Memorial Hospital
- Evanston Northshore University Health System – Evanston Hospital
- Evergreen Park OSF Little Company of Mary Medical Center
- Fairfield Fairfield Memorial Hospital
- Flora Clay County Hospital
- Galesburg OSF Saint Mary Medical Center
- Geneseo Hammond-Henry Hospital
- Gibson City Gibson Area Hospital & Health Services
- Glenview NorthShore University HealthSystem Glenbrook Hospital
- Greenville HSHS Holy Family Hospital, INC
- Harrisburg Harrisburg Medical Center
- Harvard Mercy Harvard Hospital, Inc.
- Havana Mason District Hospital
- Herrin Herrin Hospital
- Highland St. Joseph’s Hospital-Highland
- Highland Park NorthShore University HealthSystem
- Hillsboro Hillsboro Area Hospital
- Jacksonville Jacksonville Memorial Hospital
- Jerseyville Jersey Community Hospital
- Kewanee OSF Saint Luke Medical Center
- Lawrenceville Lawrence County Memorial Hospital
- Lincoln Abraham Lincoln Memorial Hospital
- Litchfield St. Francis Hospital
- Marion Heartland Regional Medical Center
- Mattoon Sarah Bush Lincoln Health Center
- Mc Leansboro Hamilton Memorial Hospital
- Mendota OSF Saint Paul Medical Center
- Metropolis Massac Memorial Hospital
- Monmouth OSF Holy Family Medical Center
- Monticello Kirby Medical Center
- Mt. Carmel Wabash General Hospital District
- Mt. Vernon Crossroads Community Hospital
- Mt. Vernon SSM Health Good Samaritan Hospital – Mt. Vernon
- Murphysboro St. Joseph Memorial Hospital
- Naperville Edward Hospital
- Nashville Washington County Hospital
- New Lenox Silver Cross Hospital
- O Fallon St. Elizabeth’s Hospital
- Oak Park West Suburban Medical Center
- Olney Richland Memorial Hospital
- Ottawa OSF Saint Elizabeth Medical Center
- Pana Pana Community Hospital
- Paris Paris Community Hospital
- Peoria OSF HealthCare Transitional Care Hospital
- Peoria OSF Saint Francis Medical Center
- Pinckneyville Pinckneyville Community Hospital
- Pittsfield Illini Community Hospital
- Pontiac OSF Saint James Medical Center
- Princeton OSF Saint Clare Medical Center
- Quincy Blessing Hospital
- Red Bud Red Bud Regional Hospital
- Robinson Crawford Memorial Hospital
- Salem Salem Township Hospital
- Shelbyville HSHS Good Shepherd Hospital
- Shiloh Siteman Cancer Center – IL
- Shiloh The Rehabilitation Institute of Southern Illinois, LLC
- Skokie NorthShore University Health System – Skokie Hospital
- Sparta Sparta Community Hospital
- Springfield Memorial Medical Center
- Springfield St. John’s Hospital
- Staunton Community Hospital of Staunton
- Taylorville Taylorville Memorial Hospital
- Urbana OSF Heart of Mary Medical Center
- Vandalia Sarah Bush Lincoln Fayette County Hospital
- Watseka Iroquois Memorial Hospital
- Waukegan Vista Medical Center East