Both Aetna Open Access and Cigna HealthFlex provide comprehensive health insurance options with a range of plans to suit different needs. The best choice depends on individual healthcare requirements, budget, and preferred network of providers. It's essential to compare specific plan details carefully to determine the most suitable option.
| Attribute | Aetna Open Access | Cigna HealthFlex |
|---|---|---|
| Monthly Premium Cost | Not available | Not available |
| Deductible Amount (Individual/Family) | Many Aetna Open Access plans feature no deductible. Some plans may have a deductible. For instance, one plan has an individual deductible of $0 and a family deductible of $0. Another plan has an individual deductible of $2,000 and a family deductible of $4,000 In-Network. Aetna Open Access Managed Choice 2750 has a $2,750 individual and $5,500 family deductible. | Varies based on plan design. Some plans have a $0 deductible for in-network providers. Other plans have deductibles that apply before the plan pays for services, such as $2,000 individual / $4,000 family. Some plans may have separate deductibles for specific services like in-network outpatient hospital visits ($750) or hospital stays ($1,500 per admission). |
| Out-of-Pocket Maximum (Individual/Family) | Varies by plan. One example includes a medical out-of-pocket maximum of $1,500 for an individual and $3,000 for a family. Another example is $7,350 individual / $14,700 family. Another plan has a $7,500 individual and $15,000 family out-of-pocket maximum. | Varies by plan. Examples include $3,000 individual / $5,000 family, $4,000 individual / $8,000 family, $6,000 individual / $12,000 family, $750 individual / $1,500 family. These out-of-pocket maximums often combine medical, behavioral, and pharmacy costs. Once the out-of-pocket maximum is met, the plan pays 100% of covered healthcare costs for the rest of the plan year. |
| Copay for Primary Care Visit | Copays vary. One plan lists a $20 copay for a primary care visit. Another plan has a $30 copay. | Varies depending on the plan. Some plans have a $20 copay for primary care visits. Other plans may have 0% coinsurance. |
| Copay for Specialist Visit | Copays vary. One plan lists a $35 copay for a specialist visit. Another plan has a $60 copay. | Depends on the specific plan. A $30 or $40 copay is mentioned in some examples. Other plans may have 0% coinsurance. |
| Prescription Drug Coverage (Formulary Tiers) | Specifics vary by plan. One plan has a generic drug copay of $7 for a 30-day retail supply and $14 for mail order. Another plan has a $15 copay for generic drugs. Some plans have a three-tier formulary: generic, preferred brand, and non-preferred brand. | Prescription drug coverage varies significantly. Some plans have a copay, while others have coinsurance after meeting the deductible. Examples of copays include: Generic drugs: $10 (retail) / $30 (home delivery), Preferred brand drugs: $20 (retail) / $60 (home delivery), Non-preferred drugs: $60 (retail) / $180 (home delivery), Specialty drugs: $250 (retail/home delivery) or $775 copay. Some plans may have different cost-sharing for retail vs. home delivery. |
| In-Network Coverage Area (States/Counties) | Coverage area can vary. Some Aetna Open Access HMO plans offer access to providers nationwide. One plan serves Delaware, New Jersey, New York, and Pennsylvania. Another plan serves Arizona, California, Georgia, and Pennsylvania. The Aetna Open Access Managed Choice network is available in all California counties, except Mendocino, Sierra, Alpine and Inyo counties. | Cigna offers a broad network of providers. The Cigna Open Access Plus (OAP) network is mentioned in several plan descriptions. Some plans may have different networks in specific states. |
| Availability of Telehealth Services | Aetna offers telehealth services, including online therapy. | Cigna offers telehealth services through partners like Teladoc, AmWell, and MDLIVE. These services provide 24/7 access to doctors and therapists via phone or video chat. Telehealth can be used for urgent care, wellness exams, and mental health services. |
| Coverage for Mental Health Services | Aetna plans generally cover mental health services, including therapy, counseling, and psychiatric care. Coverage includes individual, family, and group therapy. Some plans may not require a referral to see a therapist. Therapy costs with Aetna typically range from $0 to $60 per session after meeting deductibles. | Cigna plans generally cover a wide range of mental health services, including therapy (individual, group, family), psychiatric evaluations, and medication management. Coverage may extend to intensive outpatient programs (IOPs), partial hospitalization programs (PHPs), and residential treatment. Some plans offer no-cost mental health visits. Virtual therapy options are often available. |
| Preventive Care Services Coverage | Aetna Open Access plans typically cover preventive care services at 100% in-network. This includes routine checkups, screenings, and immunizations. | Cigna plans typically cover preventive care services as required by the Affordable Care Act (ACA). This includes annual check-ups, immunizations, and certain screenings. Many plans cover preventive care at 100% with no cost-sharing when using in-network providers. |
| Emergency Room Copay | Copays vary. One plan lists a $100 copay for emergency room visits, which is waived if admitted. Another plan has 20% coinsurance after a $150 copay. | Varies by plan. Examples include a $50 or $200 copay per visit. The copay may be waived if admitted to the hospital. Out-of-network services are often paid at the in-network cost-share. |
| Referral Requirements for Specialist Visits | Most Aetna Open Access plans do not require a referral to see a specialist. However, some exceptions exist. For example, California members may need referrals from their primary care physician (PCP) to see network specialists. | Referral requirements depend on the plan type. HMO and Network plans typically require referrals from a primary care provider (PCP) for specialist visits. Open Access, PPO, and Indemnity plans generally do not require referrals. Some plans may require prior authorization for certain services. |