Aetna Innovation Health vs. CareFirst Blue Choice Advantage?

[Anonymous]

So my employer has eliminated the Carefirst PPO, which we've been on for years (and relatively happy with) and is replacing it with Aetna Innovation Health. We also have the option of enrolling in the CareFirst Blue Choice Advantage. I've been trying to figure out the differences that might affect us, and it seems like the main one is that the CareFirst Blue Choice plan has a slightly smaller network of providers, but the same "pay less for in-network/more for out-of-network" setup as the PPO. I've looked up the PCPs and specialists that we see regularly/semi-regularly (pediatrician, gyn, speech therapist, GI doc), and they all seem to be in the Blue Choice network, so it doesn't appear that we'd be having to switch from anyone we currently see.

We had Aetna years ago, and sort of hated them a lot--still have the dental, and pretty much hate them still, so I'd prefer not to deal with them again, but I wondered if anyone had any experiences to share. I've researched and done my reading, but with insurance, I always seem to feel like I'm missing something important! Thanks in advance.

[Anonymous]

Aetna, across the board, is awful (I work in the medical field). Go with your gut on this one.

[Anonymous]

Looking at the plans, the out of pocket maximum was double for Aetna vs. Carefirst and the premium for us was $110 more if we change to Aetna. My doctors were covered under both plans. Can't understand why Aetna is so much more expensive. When speaking to a representative from Aetna, he mentioned the only real difference was that Aetna has a seamless nationwide company where BCBS was different entities across the country and that dental and medical would be under one company.

[Anonymous]

Anonymous wrote:Looking at the plans, the out of pocket maximum was double for Aetna vs. Carefirst and the premium for us was $110 more if we change to Aetna. My doctors were covered under both plans. Can't understand why Aetna is so much more expensive. When speaking to a representative from Aetna, he mentioned the only real difference was that Aetna has a seamless nationwide company where BCBS was different entities across the country and that dental and medical would be under one company.

In checking out the healthcare marketplace, Innovation Health was NOT listed as having a nationwide network. Not sure entirely what this means, if you can get broader Aetna coverage, vs. the Aetna+Inova "Innovation Health" partnership.

I'm trying to decide between the two companies - but I'm hearing the opposite. That Carefirst is truly horrendous, and that Aetna is much better. The price difference isn't much for me, and ditto for the out of pocket max, for the plans I'm considering.

[Anonymous]

Innovation Health is owned 50% by Inova and 50% by Aetna. It uses the Aetna network. We have it at my work and most everyone seems happy with it.

[Anonymous]

I also work in FCPS and have Carefirst PPO. I am just letting it roll over to Aetna. I do not want to have to go to get a referral.

[Anonymous]

Anonymous wrote:I also work in FCPS and have Carefirst PPO. I am just letting it roll over to Aetna. I do not want to have to go to get a referral.

Carefirst no longer requires referrals or picking a PCP - if they did I definitely would go with Aetna.

[Anonymous]

When you really need something that is expensive, Aetna denies first and you have to go through a lengthy appeal process even though the services should be covered. Happened 3 times just last year. They said my son was 19 and would not cover services for him (he was 9 and had been with Aetna since his birth), they did not like a prescription my DH's doctor prescribed even though it was on their preferred provider list, and they didn't want to pay for physical therapy after I had a car accident. Really crappy. I would go with BCBS if given the choice.

[Anonymous]

OP here. Thanks for all this information, you all. I really appreciate it. It's true that the Carefirst Blue Choice doesn't require referrals or a PCP, which as several of you mentioned, is a big help. I didn't know about the Inova/Aetna connection, but noticed that the info on Innovation Health seemed to mention Inova a lot, so that makes sense now.

We had an Aetna HMO right after we got married for a year, and it sucked royally, and the Aetna dental insurance pretty much still does (every dentist we've seen has been incompetent or a shady salesperson), so we're switching to another dental plan through my husband's employer. (It may still suck, but at least it's different; it seems like it's at least worth a shot.)

[Anonymous]

I hve had Aetna PPO for years and have never had problems getting things paid, finding doctors in network, etc. I really have no complaints. Granted, it's the "platinum" versio and costs a lot a money, but we like it.

I think the key is to have a PPO, not an HMO or other more limited plan.

[Anonymous]

Is your "Blue" part of a Blue Cross program. All I can tell you was that our Anthem Blue Cross insurance policy was just canceled (same situation as the 300,000 floridians). All members of the VA bar received notice that the bar-issued plans were being cancelled as of next renewal date.

[Anonymous]

Thank you all for this discussion. I have the same decision to make (ours is a mini Family option). We have had CareFirst PPO for years, and before that Aetna. THis is FCPS. Now they're removing Carefirst PPO, replacing with Aetna Innovation. I would have just stayed with Carefirst PPO, but now am forced into deciding on a new plan, whether to let it roll over to Aetna Innovation, or 'drop back' (?) to Carefirst Advantage.
I'm retired from FCPS, so am unclear of (1) the 'national' aspect of these two and (2) the effect of when I get to Medicare age shortly.
It was my understanding that Carefirst PPO (what we had but is being replaced) was 'national' and would remain when Medicare kicked in. Those are both a plus for me.
I'm not sure if Aetna Innovation is on a 'national' scale (vs just local) and whether it continues when I reach Medicare age.
I'm also not sure of these two aspects of Carefirst Advantage.
Again, thanks alot for this discussion

[Anonymous]

I'm a healthcare professional and I can just tell you that Aetna is horrible. The are managed by a third party called American Speciality Health Network whose entire purpose is to save Aetna money. This means that even though Aetna says you have (x) amount of visits or benefits ASHN will determine the benefits. In my office the benefits are very minimal with a ton of paperwork for both the doctors office and the patient. I was shocked to hear that the FCPS went to this plan. If you end up choosing Aetna make sure your doctor is a provider (which many are not any more because of ASHN) and that you complain to Aetna and your HR rep if ASHN limits your benefits.

[Anonymous]

Thanks for your help and advice. Here's another 'issue' about losing some amount of control/choice with this new health care environment evolving. I'm retired from fcps. In the previous system, before this year, when we reach age 65, we could continue with Carefirst PPO as an option. Now, with the new system, at age 65 the Carefirst apparently is no longer an option, our only choices at age 65 are the new Aetna plan or Kaiser.

[Anonymous]

I have something called Aetna OPen Access..and have been quite happy. No issues at all.