Aetna CA Managed Choice Open Access 5000 with Dental – California Health Insurance Plan
A detailed comparison of the Aetna CA Managed Choice Open Access 5000 with Dental health insurance plan as offered in California is listed below for both Network and Non-Network coverage. This is a review of the coverage for this specific Aetna plan. However, GoHealthInsurance offers a large variety of health insurance options to fit your needs. If you wish, get a new Aetna health insurance quote for California now or view all of our Aetna health insurance quotes.
| Network | Non-Network | |
|---|---|---|
| Copay | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits) | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits) |
| OfficeVisit | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): $40 copay, deductible waived (Unlimited visits); Specialist Visit: $50 copay, deductible waived (Unlimited visits) | Non-Specialist Office Visit (General Physician, Family Practitioner, Pediatrician or Internist): 50% after deductible (Unlimited visits); Specialist Visit: 50% after deductible (Unlimited visits) |
| Deductible true | Individual: $5,000, Family: $10,000 | Individual: $10,000, Family: $20,000 |
| Coinsurance | 30% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied,Members responsibility) | 50% after deductible up to out-of-pocket max. ($0 once out-of-pocket max. is satisfied) |
| Coinsurance Limit | Individual: $5,000, Family: $10,000 | Individual: $2,500, Family: $5,000 |
| Out-of-Pocket Maximum | Hospital Admission: 30% after deductible; Outpatient Surgery: 30% after deductible; Urgent Care Facility: $75 copay deductible waived | Hospital Admission: 50% after deductible; Outpatient Surgery: 50% after deductible; Urgent Care Facility: 50% after deductible |
| Lifetime Maximum | Unlimited | Unlimited |
| Prescription Drugs | Pharmacy Deductible (per individual): $750 (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay, deductible waived; Preferred Brand (Oral Contraceptives Included): $35 copay after deductible; Non-Preferred Brand (Oral Contracepti | Pharmacy Deductible (per individual): $750 (Does not apply to generic); Generic (Oral Contraceptives Included): $15 copay plus 50%, deductible waived; Preferred Brand (Oral Contraceptives Included): $35 copay plus 50% after deductible; Non-Preferred Brand |
| Emergency Room | $350 copay (waived if admitted) | $350 copay (waived if admitted) |
| Adult Preventative Care | Annual Routine Gyn Exam (No waiting period, Annual Pap/Mammogram): $0 copay deductible waived; Preventive Health - Routine Physical (No waiting period): $0 copay deductible waived (Included lab work and X-rays) | Annual Routine Gyn Exam (No waiting period, Annual Pap/Mammogram): 50% after deductible; Preventive Health - Routine Physical (No waiting period): 50% after deductible (Included lab work and X-rays) |
| Child Preventative Care | $0 (Age and frequency limits apply); No charge for immunizations up to the age of 18 | 50% (Age and frequency limits apply); No charge for immunizations up to the age of 18 |
| Lab / X-Ray | 30% after deductible (Non-Preventive) | 50% after deductible (Non-Preventive) |
| Maternity | Treated the same as any other medical condition | Treated the same as any other medical condition |
| Physical Therapy | Physical/Occupational Therapy (24 visits per calendar year): 30% after deductible | Physical/Occupational Therapy (24 visits per calendar year): 50% after deductible |
| Home Health Care | 30% after deductible (instead of hospital, 30 visits per calendar year) | 50% after deductible (instead of hospital, 30 visits per calendar year) |
| Mental Health | Inpatient and Outpatient: coverage is only provided for severe mental or nervous disorders. Deductible and co-insurance/copay apply. | Inpatient and Outpatient: coverage is only provided for severe mental or nervous disorders. Deductible and co-insurance/copay apply. |
| Hospital Care | Hospital Admission: 30% after deductible; Outpatient Surgery: 30% after deductible; Urgent Care Facility: $75 copay deductible waived | Hospital Admission: 50% after deductible; Outpatient Surgery: 50% after deductible; Urgent Care Facility: 50% after deductible |
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