Aetna Products for Individuals and Families on the Texas Exchange (2015)
Overview of Aetna plans available on Texas exchange (also called "marketplace")
You can shop for and buy health insurance on your state exchange. Exchanges can help you choose a plan that fits your needs and budget.
Watch our video to learn how marketplaces work
We want to help you understand your Aetna plan choices. Our plan brochure is a good place to start. It has details and features of each plan.
You can also compare plans using a document called the Summary of Benefits and Coverage (SBC). It provides an overview of each medical plan in a standard format, in easy-to-understand language. The SBC documents for Aetna plans available in Texas are listed below.
Once you're enrolled, we'll send you a copy of the SBC for the plan you picked. The SBC will also include the date your plan takes effect.
Picking the plan that’s right for you
It's important to choose a plan that will meet your needs. The information below can help you narrow down your choices:
1. Check our online directories to find out if your doctor and pharmacy are in our network.
2. Search for drug information and learn about covered drugs.
Drug search tool
2015 formulary
3. You may pay more for care (including emergency care) from out-of-network doctors and hospitals.
Read about out-of-network costs
4. You may be eligible for financial help that will make insurance more affordable.
Check the Health Insurance Marketplace for Texas to find out if you qualify
Ready to enroll?
The next open enrollment period begins November 15, 2014, and runs through February 15, 2015. If you have had a life changing event, you may be able to enroll outside of the open enrollment period. If you have questions or need help with enrolling, call the Texas exchange at 1-800-318-2596.
Visit the Health Insurance Marketplace website and select Texas for more information
Don't forget -- you can also buy a plan by shopping with Aetna. However, you won’t be able to apply for financial help.
Summary of Benefits and Coverage (SBC) documents for exchange plans available in Texas
The Summary of Benefits and Coverage (SBC) is designed to help you understand and compare different medical plan options.
The "Standard" category is where most consumers will find their available plans.
However, the Texas exchange may have indicated you are eligible for a Cost-Sharing Reduction (CSR) plan or a Native American (NA) plan. This is based on the information you shared when you applied for insurance. If so, refer to those sections when looking at the plans below.
Here are some quick definitions:
| Abbreviation | What it means |
| Number shown in plan name | Deductible amount for the standard plan (for example, Aetna Classic 5000 has a $5,000 deductible). Based on eligibility, the deductible for a CSR or NA plan may vary from the standard plan deductible. For most plan benefits, you must meet the deductible before you will begin to split the cost of care with your health plan. |
| PD | Includes coverage for pediatric dental (covered to age 19). |
| CSR 73% | With cost-sharing reduction, the percentage of average costs the plan will pay increases to 73%. |
| CSR 87% | With cost-sharing reduction, the percentage of average costs the plan will pay increases to 87%. |
| CSR 94% | With cost-sharing reduction, the percentage of average costs the plan will pay increases to 94%. |
| NA CSR $0 | For this Native American plan, there is no cost-sharing in network for the member; for all benefits, you pay nothing out of pocket for covered expenses. |
| NA CSR LTD | For this Native American plan, you pay nothing for covered expenses or supplies furnished directly to you by the Indian Health Service, an Indian Tribe, Tribal Organization, Urban Indian Organization or through referral under-contract health services. This includes deductibles, coinsurance and copayments. |
About the Metallic Levels
Health insurance plans sold on an exchange are assigned a metallic level (Bronze, Silver, or Gold). The metallic level is based on how much of the total health care cost the plan pays, versus what a member will pay out of pocket.
Bronze plans
For Bronze level plans, the plan will pay about 60 percent of covered health care costs. Bronze plans tend to have lower monthly premiums, but have higher out-of-pocket costs for deductibles, copayments and coinsurance for covered health care services.
Aetna Bronze $20 Copay
| Standard plans: |
| Aetna Bronze $20 Copay |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Bronze $20 Copay NA CSR $0 |
| Aetna Bronze $20 Copay NA CSR LTD |
Aetna Bronze
| Standard plans: |
| Aetna Bronze HSA Eligible |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Bronze NA CSR $0 |
| Aetna Bronze NA CSR LTD |
Aetna Memorial Hermann Bronze $20 Copay
| Standard plans: |
| Aetna Memorial Hermann Bronze $20 Copay |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Bronze $20 Copay NA CSR $0 |
| Aetna Memorial Hermann Bronze $20 Copay NA CSR LTD |
Aetna Memorial Hermann Bronze
| Standard plans: |
| Aetna Memorial Hermann Bronze HSA Eligible |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Bronze NA CSR $0 |
| Aetna Memorial Hermann Bronze NA CSR LTD |
Aetna Bronze $20 Copay Austin Community Plan
| Standard plans: |
| Aetna Bronze $20 Copay Austin Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Bronze $20 Copay Austin Community Plan NA CSR $0 |
| Aetna Bronze $20 Copay Austin Community Plan NA CSR LTD |
Aetna Bronze Austin Community Plan
| Standard plans: |
| Aetna Bronze HSA Eligible Austin Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Bronze Austin Community Plan NA CSR $0 |
| Aetna Bronze Austin Community Plan NA CSR LTD |
Aetna Bronze $20 Copay San Antonio Community Plan
| Standard plans: |
| Aetna Bronze $20 Copay San Antonio Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Bronze $20 Copay San Antonio Community Plan NA CSR $0 |
| Aetna Bronze $20 Copay San Antonio Community Plan NA CSR LTD |
Aetna Bronze San Antonio Community Plan
| Standard plans: |
| Aetna Bronze HSA Eligible San Antonio Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Bronze San Antonio Community Plan NA CSR $0 |
| Aetna Bronze San Antonio Community Plan NA CSR LTD |
Silver plans
For Silver level plans, the plan will pay about 70 percent of covered health care costs. Silver level plans tend to have higher monthly premiums compared to Bronze plans, but out-of-pocket costs for health care services are lower compared to Bronze plans.
Aetna Silver $5 Copay 2750
| Standard plans: |
| Aetna Silver $5 Copay 2750 |
| Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $5 Copay 2750 CSR 73 |
| Aetna Silver $5 Copay 2750 CSR 87 |
| Aetna Silver $5 Copay 2750 CSR 94 |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $5 Copay 2750 NA CSR $0 |
| Aetna Silver $5 Copay 2750 NA CSR LTD |
Aetna Silver $10 Copay
| Standard plans: |
| Aetna Silver $10 Copay |
| Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $10 Copay CSR 73 |
| Aetna Silver $10 Copay CSR 87 |
| Aetna Silver $10 Copay CSR 94 |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $10 Copay NA CSR $0 |
| Aetna Silver $10 Copay NA CSR LTD |
Aetna Memorial Hermann Silver $5 Copay 2750
| Standard plans: |
| Aetna Memorial Hermann Silver $5 Copay 2750 |
| Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Silver $5 Copay 2750 CSR 73 |
| Aetna Memorial Hermann Silver $5 Copay 2750 CSR 87 |
| Aetna Memorial Hermann Silver $5 Copay 2750 CSR 94 |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Silver $5 Copay 2750 NA CSR $0 |
| Aetna Memorial Hermann Silver $5 Copay 2750 NA CSR LTD |
Aetna Memorial Hermann Silver $10 Copay
| Standard plans: |
| Aetna Memorial Hermann Silver $10 Copay |
| Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Silver $10 Copay CSR 73 |
| Aetna Memorial Hermann Silver $10 Copay CSR 87 |
| Aetna Memorial Hermann Silver $10 Copay CSR 94 |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Silver $10 Copay NA CSR $0 |
| Aetna Memorial Hermann Silver $10 Copay NA CSR LTD |
Aetna Silver $5 Copay 2750 Austin Community Plan
| Standard plans: |
| Aetna Silver $5 Copay 2750 Austin Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $5 Copay 2750 Austin Community Plan NA CSR $0 |
| Aetna Silver $5 Copay 2750 Austin Community Plan NA CSR LTD |
Aetna Silver $10 Copay Austin Community Plan
| Standard plans: |
| Aetna Silver $10 Copay Austin Community Plan |
| Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $10 Copay Austin Community Plan CSR 73 |
| Aetna Silver $10 Copay Austin Community Plan CSR 87 |
| Aetna Silver $10 Copay Austin Community Plan CSR 94 |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $10 Copay Austin Community Plan NA CSR $0 |
| Aetna Silver $10 Copay Austin Community Plan NA CSR LTD |
Aetna Silver $5 Copay 2750 San Antonio Community Plan
| Standard plans: |
| Aetna Silver $5 Copay 2750 San Antonio Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $5 Copay 2750 San Antonio Community Plan NA CSR $0 |
| Aetna Silver $5 Copay 2750 San Antonio Community Plan NA CSR LTD |
Aetna Silver $10 Copay San Antonio Community Plan
| Standard plans: |
| Aetna Silver $10 Copay San Antonio Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Silver $10 Copay San Antonio Community Plan NA CSR $0 |
| Aetna Silver $10 Copay San Antonio Community Plan NA CSR LTD |
Gold plans
For Gold level plans, the plan will pay about 80 percent of covered health care costs. Gold level plans tend to have lower out-of-pocket costs for deductibles, copayments and coinsurance for health care services, but have higher monthly premiums.
Aetna Gold $5 Copay
| Standard plans: |
| Aetna Gold $5 Copay |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Gold $5 Copay NA CSR $0 |
| Aetna Gold $5 Copay NA CSR LTD |
Aetna Memorial Hermann Gold $5 Copay
| Standard plans: |
| Aetna Memorial Hermann Gold $5 Copay |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Memorial Hermann Gold $5 Copay NA CSR $0 |
| Aetna Memorial Hermann Gold $5 Copay NA CSR LTD |
Aetna Gold $5 Copay Austin Community Plan
| Standard plans: |
| Aetna Gold $5 Copay Austin Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Gold $5 Copay Austin Community Plan NA CSR $0 |
| Aetna Gold $5 Copay Austin Community Plan NA CSR LTD |
Aetna Gold $5 Copay San Antonio Community Plan
| Standard plans: |
| Aetna Gold $5 Copay San Antonio Community Plan |
| Native American (NA) Cost Sharing Reduction (CSR) plans: |
| Aetna Gold $5 Copay San Antonio Community Plan NA CSR $0 |
| Aetna Gold $5 Copay San Antonio Community Plan NA CSR LTD |
Premium Payment FAQs
What forms of payment does Aetna accept?
We accept:
- Electronic funds transfer (payment made to us directly from your bank)
- Credit cards (American Express®, Visa® and MasterCard®)
- Debit cards (Visa or MasterCard)
- Check or money orders
Please Note: Under Aetna health insurance policies in some states, we do not generally accept premium payments from third parties, unless they are related to you or required by law. Examples of third parties we do not accept payment from include (but are not limited to) hospitals and health care providers.
How can I make my monthly payment?
We offer several options to make your monthly premium payment. You can:
- Log in to your Aetna Navigator® secure member website and pay online.
- Use EasyPay. We will automatically withdraw your payment from your checking account on the due date.
- Call our Member Services department to make your payment through our automated call system.
- Send your payment by mail. Make sure to include key information from your billing invoice.
When is my premium due each month?
Premium payments are due the first of the month.
Health benefits and health insurance plans are offered and/or underwritten by Aetna Health Inc., Aetna Health Insurance Company and/or Aetna Life Insurance Company (Aetna). Each insurer has sole financial responsibility for its own products.
This material is for information only. Health benefits and health insurance contain exclusions and limitations. Not all health services are covered. See plan documents for a complete description of benefits, limitations, exclusions and conditions of coverage. Plan features and availability may vary by location. Providers are independent contractors and are not agents of Aetna. Provider participation may change without notice. Aetna does not provide care or guarantee access to health services. If you are in a plan that requires the selection of a primary care physician and your primary care physician is part of an integrated delivery system or physician group, your primary care physician will generally refer you to specialists and hospitals that are affiliated with the delivery system or physician group. Investment services are independently offered by HealthEquity, Inc.. Information is believed to be accurate as of the production date; however, it is subject to change.
Investment services are independently offered by the HSA Administrator.
We're here to support you
On the phone:
Once you've enrolled, you can reach us by calling the number on your Aetna ID card.
Or, call 1-855-586-6960 8 a.m.-8 p.m. local time, seven days a week.
Do you have a certified speech or hearing disability?
Call 711 and we'll help you.
Do you need help in another language?
Our Member Service representatives can connect you to a special line. You can talk to someone in your own language, receive oral interpretation and request written translations of documents into another language.
- Para obtener asistencia en Español, por favor llame al 1-855-586-6960
We offer these services at no cost to you.
Online:
If you’re not a member or if you prefer not to log in, e-mail us. We’ll need your personal and contact information so we can get back to you. We respond to messages from 8 a.m.-6 p.m. (ET), Monday-Friday.
Once you've enrolled
You’ve purchased an Aetna plan through your state’s public exchange/marketplace. Welcome to the Aetna family! Below are a few tips to get started.
Still have questions? Learn more about your health insurance exchange plan.
Getting started
Activate your coverage
You'll receive a "What Comes Next" letter from us, along with your first month's premium invoice. Pick the payment method that works for you. (see “Premium payment FAQs” above).
Get a quick overview
Now that you're officially enrolled, you'll get information to help you understand your plan and the many features it offers you, including:
- A "quick start" guide that walks you through three easy steps to begin getting the most from your plan.
- Your ID card with the phone number to your Member Services team, in case you have any questions.
Get connected
Register for our online and mobile self-serve resources. They give you access to the information you need, when you need it. Quick, convenient, and hassle-free!
Personal information
When you are enrolled with us and need to change any personal information, contact the marketplace. This includes changing your address or phone number.
