I have a dilemma.
I’ve carried our health insurance through my job for the past 13 years. My husband has never had a job that offered health insurance, so I’ve always carried it through my job. We’ve had Kaiser Permanente the entire time. I love it, I know a lot of people who hate it, but I’ve really only had a few problems with it. My kids have had the same doctor their entire lives…
The new job my husband just took offers health insurance, but they don’t offer Kaiser. They offer Aetna. I don’t know anyone who has Aetna and I’m scared to change. Tony wants me to quit in September to stay home with the kids, and just take the insurance his job offers. However, now that I found out it’s not Kaiser, I don’t know if I want to do that.
So, here’s where you come in. If you have or have had Aetna health care, would you be so kind as to share your experience with it. That would really help me in making my decision on whether to quit (finally, after FOURTEEN YEARS! ) or stay on for the insurance…
I’ve had Aetna/U.S. Healthcare for five years. They’ve been nothing short of fantastic.
We have a $15 co payment for dr. visits and $15 for prescriptions. (It was only $5 dollars for the five years, so I’m not complaining about the raise).
They have covered everything I needed, even extra tests my doctor ordered that were not completely necessary. And they are great with mental health benefits. My Paxil and Wellbutrin are covered, as well as therapy (should I ever choose to go back to that).
Depends on if it’s the Aetna HMO (sucks) or the Aetna PPO (rocks)
Actually, the Aetna HMO isn’t too bad as long as you go to a doctor that’s in their network. And any visits to specialists have to be ordered by your primary care physician before you go, or the HMO won’t cover them.
At least, that was the rule when I had the Aetna HMO. I’ve got the PPO now and couldn’t be happier. They’ve also got great prenatal care programs.
Would you consider having both. My wife and I have two different plans and they are cool with it as long as there is no double-dipping. This was a big help when one plan didn’t cover something that we needed. As for Aetna, I had it years ago, and I don’t remember any problems. Good Luck.
You can maintain your benefits through your job until you stop working. Once you leave your job, you should be able to switch over to your husband’s insurance without any problems. Most employers will allow employees to take insurance in the middle of the benefit year when there’s a change in a life situation – for example, resigning from your job. If you don’t want to leave your doctor in the middle of your pregnancy it may be something to consider. However, Aetna is a major health plan and will more than likely have the same providers their network that you currently use. Your husband should verify this with his benefits department first, but I’m pretty much sure it is the case.
I used to work for Aetna negotiating physician contracts, so I know them inside out. Over all, they are a decent company and the goverment keeps them pretty well regulated. They used to have a lot of problems paying claims when they merged with USHC, but not so much now.
What you might not know is that copays, what is covered, etc. is determined by your husband’s employer, and not the insurance company. For example, some employers won’t pay to cover birth control pills (although I know that’s not relevant right now to you.)
Your best bet is to review the plan and if you have any questions, to grill the HR people in your husband’s company. They will be the plan experts. And if your doctor isn’t in network, tell HR to request that Aetna contract with your doctor. As bringing new docs in was my job, I can tell you that they will do this if you ask.
jen is exceedingly cool and most wise!
I think Kaiser has its own set of doctors, period, and they only work for Kaiser. I could be wrong, but I’m pretty sure that’s the case.
We just had to switch too, from United Healthcare to Kaiser, and I was bummed about it because I LOVED my babies’ doctor. But, we’ve gotten used to it. It hasn’t been so bad, really.
Find out if it’s a PPO, or if it’s an HMO. I’ve had both. The thing that sucks about an HMO, is just that it’s a Health Maintenance Organization, so it’s great for well-visits, but the minute you have a real problem, you have problems with them. With a PPO, you generally have a deductible with it. But after that, you can choose your doctors. I love that about a PPO. Are they having a benefits meeting with the insurance provider where he works? If so, I highly recommend attending it. They usually allow spouses to attend these meetings as well. If they don’t have a meeting planned, you and your husband can meet with the HR director, and discuss what plans are available to you. I’ve had Aetna before, and it’s a world apart from Kaiser. I say go for it! When you go in, however, be sure to discuss whether or not your pregnancy is a non-covered pre-existing condition. That can be different, depending on the insurance company. Usually if it’s an employee benefit as opposed to a private insurance provider, you are covered no matter what, but there can be exceptions.
-H
I wish I could advise you, but since I�m Dutch.. I would pick Aetna, I like that name better.
How strange!
I grew up with Kaiser, and loved it.
When I was ten my Mom took a job with Aetna, so we switched.
We never had any problems with Aetna, and there were major medical issues throughout the years.
They have a lot of PCPs available, just make sure you choose a good one, that you like, and you should be all set.
(As a strange coinincidence I’m looking at the main Aetna building right now, Hi Aetnaites!)
Aetna sux! The copay is $20! That’s all I can say. If you can afford the copay it won’t be a prob at all. We had to choose Aetna so that my kids can have their same doc as that doc knows their medical history since the day they were born, we had no choice but stick with Aetna 🙁
first visit here and I’m offering up my opinion! go figure.
i had aetna for 3 years and while i was pregnant and delivered my son. i can’t even begin to tell you my HATE for that insurance company. i had the HMO/100% coverage plan and i have to tell you that it was an absolute joke.
everything was a battle to get paid. they wouldn’t pay for the majority of my son’s hospital stay (34 days in the NICU) or part of my hospital stay.
perhaps they are better now some 3 years later – but you couldn’t pay me to use them ever again.
just my horrible biased opinion against aetna.
jsg
I would do a lot of research before you make your decision. one of the best resources is consumer reports online. find someone with a subscription and look up the pros and cons on there.
I had Aetna PPO for 10 years. LOVED. IT.
I had Aetna PPO for 3 years before my husband got laid off last April. I had no complaints. They’ve pretty much covered anything with no questions asked, on the spot. If I had any questions, they were always there to walk me through each and every charge, etc.
i have had aetna for quite a while now and have never had problems with them. this year the co-pay went up from $10 to $15 but as someone said above, that is my company setting that. All 3 of my sons were born under Aetna and on the first I only paid for the long distance call to my parents from the delivery room, the other 2 were $200 hospital co-pay. I paid $10 to get myself a vasectomy. We have never had problems with Aetna though the rules have changed some in 2004 as far as deductibles and stuff. I think all that is based on my companies agreements with Aetna though and not Aetna directly.
I guess I have a slightly jaded opinion. I love Aetna. Our co-pay is only $5 for doctor’s visits. My bloodwork was free. Prescription meds are $1 for generics, $5 for name brand. Then again, that’s just our plan…be sure to check things out first, because it seems to differ among companies.
I think, in general, you get better care from any provider with the PPO plan, not the HMO.
Good luck!