Both Aetna Open Access and Kaiser Permanente HMO provide comprehensive health coverage with different strengths. Aetna offers greater flexibility in specialist access and potentially broader geographic coverage, while Kaiser Permanente is known for its cost-effectiveness and integrated care model. The best choice depends on individual needs, location, and preferences regarding cost versus flexibility.
| Attribute | Aetna Open Access | Kaiser Permanente HMO |
|---|---|---|
| Monthly Premium Cost | Not available | Varies based on location, age, and specific plan. Average cost for an ACA marketplace plan is $501 monthly as of 2025. |
| Deductible Amount | Many Aetna Open Access plans feature no deductible. However, some plans may have a deductible. For instance, one plan has a $0 deductible. Another plan includes a $20 annual deductible per member for dental PPO options. Some plans may have Tiered deductibles. | Many plans have no deductible. Some plans may have deductibles for specific services like hospital care. |
| Copay for Primary Care Visit | Copays vary. Some plans offer a $10 copay, while others have $15, $20, $25 or $35 copay for primary care visits. | Varies, some plans offer $0 copays. Other examples include $15, $20, $25, $30, $35. |
| Copay for Specialist Visit | Copays vary. Some plans have a $20 copay, while others charge $35, $55, or $60. | Varies, such as $20, $35, $40, $45, $50. |
| Out-of-Pocket Maximum | Some plans have an in-network individual out-of-pocket maximum of $2,000 and a family maximum of $6,000. Other plans have a $5,000 individual / $10,000 family out-of-pocket maximum. | Varies by plan, for instance, $1,500 individual / $3,000 family, $3,000 per individual / $6,000 family, $3,500 per individual / $7,000 family, $6,600 individual / $13,200 family, $9,100 individual / $18,200 family. |
| Prescription Drug Coverage (Formulary) | Aetna Open Access plans include prescription drug coverage. Many plans utilize a formulary, which is a list of preferred generic and brand-name drugs. Copays vary based on the drug tier (preferred generic, preferred brand, non-preferred). Some plans offer a $0 copay for certain generic depression and anxiety medications. Some plans have a separate pharmacy deductible. Mail-order pharmacy options are often available. | Includes prescription drug coverage with a tiered formulary. Generic drugs usually have the lowest copays. Costs depend on the drug type and purchase method. |
| Referral Requirements for Specialist Visits | Generally, referrals are not required to see a specialist within the Aetna Open Access HMO network. However, members in California covered under the Aetna Open Access HMO plan might need referrals from their primary care physician (PCP) to see network specialists. | Referrals are typically needed, coordinated by your PCP. Self-referral may be possible for some specialties like OB/GYN and optometry. |
| In-network vs. Out-of-network Coverage | Aetna Open Access plans generally offer coverage for in-network providers. Out-of-network coverage is limited or not available for many services, except for emergency care. Using in-network providers typically results in lower costs. | Generally requires using Kaiser Permanente doctors and facilities, except in emergencies. Out-of-network coverage is typically limited to emergency or urgently needed services. |
| Coverage Area (Geographic) | Coverage areas vary by plan. Some plans are limited to specific states such as Arizona, California, Georgia, and Pennsylvania. Other plans offer nationwide coverage. Some Aetna International plans have different geographic coverage options. | Available in California, Hawaii, Georgia, Colorado (Denver area only), Oregon, and Washington. May require living or working in the Kaiser network's service area. |
| Preventive Care Coverage | Aetna Open Access plans generally cover preventive care services at 100% in-network. This includes routine physical exams, screenings, and immunizations. | Covers preventive care services at no charge, including physical exams, screenings, and immunizations. |
| Emergency Room Copay | Emergency room copays vary by plan. Some plans have a $50 copay, while others charge $75, $125, $200, $250, or $500. The copay is sometimes waived if the patient is admitted to the hospital. | Varies, examples include $100, $125, $150. The copay may be waived if admitted to the hospital. |
| Telehealth Services Availability | Telehealth services are available, sometimes with a copay. CVS Virtual Care and Teladoc are common telehealth options. | Offers telehealth services, including phone and video appointments. |