Aetna has significantly reduces their PPO plan options
What is a PPO? PPO stands for Preferred Provider Organization. Just like an HMO, or health maintenance organization, a PPO plan offers a network of healthcare providers you can use for your medical care. These providers have agreed to provide care to the plan members at a certain rate. Unlike an HMO, a PPO offers you the freedom to receive care from any provider—in or out of your network. This means you can see any doctor or specialist, or use any hospital.
⬤ Gold PPO – Gold plans will have the highest premiums, but the lowest out-of-pocket costs as well as the lowest deductibles.
⬤ Silver PPO – Silver plans will have moderate premiums, moderate out-of-pocket-costs, and will have deductibles that are lower than Bronze plan options.
⬤ Bronze PPO – No longer available
See the table below for quick summary info for both available PPO plans
| Plan Info | Silver S PPO | Gold S PPO + Rx Copay |
|---|---|---|
| Benefits Summary | Benefits Summary | |
| Deductible – Individual/Family | $5,000/ $10,000 | $1,500/ $3,000 |
| Out of Pocket Max – Individual/Family | $8,000/ $16,000 | $7,800/ $15,600 |
| Coinsurance | 40% | 25% |
| Primary Care/Specialist | $40 / $80 | $30 / $60 |
| Emergency Room Care | 40% coinsurance | 25% coinsurance |
| Urgent Care | $60 copay | $45 copay |
| Inpatient hospital stay | 40% coinsurance | 25% coinsurance |
| If you have a test | Diagnostic / Imaging: 40% coinsurance | Diagnostic / Imaging: 25% coinsurance |
| Preferred generic | Copay/ prescription, deductible does not apply: $20 for up to a 30 day supply, $50 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $15 for up to a 30 day supply, $37.50 for up to a 90 day supply |
| Preferred Brand Drugs | Copay/ prescription, deductible does not apply: $40 for up to a 30 day supply, $100 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $30 for up to a 30 day supply, $75 for up to a 90 day supply |
| Non-preferred generic/brand drugs | Copay/ prescription: $80 for up to a 30 day supply, $200 for up to a 90 day supply | Copay/ prescription, deductible does not apply: $60 for up to a 30 day supply, $150 for up to a 90 day supply |
| Preferred/non-preferred specialty drugs | Copay/prescription: $350 for up to a 30 day supply | Copay/ prescription, deductible does not apply: $250 for up to a 30 day supply |
Aetna CVS Health Plans – 2024 Illinois PPO Hospital Network
Hospital Network Highlights – Hospitals include:
Chicago:
- Chicago Advocate Illinois Masonic Medical Center
- Chicago Advocate Trinity Hospital
- Chicago Ann & Robert H. Lurie Children’s Hospital of Chicago
- Chicago Community First Medical Center
- 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 Kindred Hospital – Chicago – Lakeshore
- Chicago Kindred Hospital Chicago (North Campus)
- 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 Northwestern Memorial Hospital
- Chicago Prentice Women’s Hospital
- Chicago Presence Resurrection Medical Center
- Chicago Presence Saints Mary and Elizabeth’s Medical Center
- Chicago Presence Saints Mary and Elizabeth’s Medical Center
- Chicago Presence St. Joseph Hospital Chicago
- Chicago Provident Hospital of Cook County
- Chicago Roseland Community Hospital
- Chicago Rush University Medical CenterK
- Chicago Shriners Hospital for Children-Chicago IL
- Chicago South Shore Hospital
- Chicago St. Anthony Hospital
- Chicago St. Bernard Hospital and Health Care Center
- Chicago Swedish Covenant Hospital
- Chicago The University of Chicago Comer Children’s Hospital
- Chicago Thorek Memorial Hospital
- Chicago University of Chicago Medical Center
- Chicago University of Illinois at Chicago Hospital
Chicagoland Area Hospitals:
- Arlington Heights Northwest Community Hospital
- Aurora Presence Mercy Medical Center
- Aurora Rush Copley Medical Center
- Barrington Advocate Good Shepherd Hospital
- Berwyn MacNeal Hospital
- Bolingbrook UChicago Medicine AdventHealth Bolingbrook
- DeKalb Kishwaukee Community Hospital
- Des Plaines Presence Holy Family Medical Center
- Downers Grove Advocate Good Samaritan Hospital
- Elgin Advocate Sherman Hospital
- Elgin Presence Saint Joseph Hospital – Elgin
- Elk Grove Village Alexian Brothers Medical Center
- Elmhurst Elmhurst Memorial Hospital
- Evanston Northshore University Health System – Evanston Hospital
- Evanston Presence Saint Francis Hospital
- Evergreen Park OSF Little Company of Mary Medical Center
- Geneva Delnor Community Hospital
- Glendale Heights UChicago Medicine AdventHealth GlenOaks
- Glenview NorthShore University HealthSystem Glenbrook Hospital
- Harvard Mercy Harvard Hospital, Inc.
- Harvey Ingalls Memorial Hospital
- Hazel Crest Advocate South Suburban Hospital
- Highland Park NorthShore University HealthSystem Highland Park
- Hinsdale UChicago Medicine AdventHealth Hinsdale
- Hoffman Estates Alexian Brothers Women and Children’s Hospital
- Hoffman Estates St. Alexius Medical Center
- Huntley Northwestern Medicine Huntley Hospital
- Joliet Presence Saint Joseph Medical Center
- Kankakee Ascension St. Mary’s Hospital
- Kankakee Riverside Medical Center
- La Grange UChicago Medicine AdventHealth La Grange
- Lake Forest Northwestern Lake Forest Hospital
- Libertyville Advocate Condell Medical Center
- Maywood Loyola University Medical Center
- McHenry Northwestern Medicine McHenry Hospital
- Melrose Park Gottlieb Memorial Hospital
- Naperville Edward Hospital
- New Lenox Silver Cross Hospital
- Northlake Kindred Hospital- Chicago (Northlake Campus)
- Oak Lawn Advocate Christ Medical Center
- Oak Park Rush Oak Park Hospital
- Oak Park West Suburban Medical Center
- Olympia Fields Franciscan Health Olympia Fields
- Palos Heights Palos Community Hospital
- Park Ridge Advocate Lutheran General Hospital
- Sandwich Valley West Community Hospital
- Skokie Lurie’s Children’s Center in Skokie
- Skokie NorthShore University Health System – Skokie Hospital
- Sycamore Kindred Hospital- Sycamore
- Waukegan Vista Medical Center East
- Winfield Central DuPage Hospital
- Woodstock Northwestern Medicine Woodstock Hospital
- Zion Cancer Treatment Centers of America, Chicago
All Aetna individual plans in Illinois allow you to go directly to any recognized health care provider, including specialists, for covered expenses. The following are standard benefits included in all Aetna individual plans:
- Unlimited office visits to your primary care physician and specialists
- No referrals required
- No waiting periods to access preventive health and routine physicals
- Lab work and x-rays included in routine physicals
- 100% annual routine GYN exam coverage – no waiting period, copay, or deductible
- 100% coverage on in-network childhood immunizations
- Prescription drug coverage