Indiana health plan · 2025

Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 · 96992IN0060004

Aetna Health Inc. (a PA corp.) offers this marketplace health insurance plan (Plan ID 96992IN0060004) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Gold Plan type: HMO CSR: Zero Cost Sharing Plan Variation Issuer: Aetna Health Inc. (a PA corp.)
Telehealth Data pending HSA eligible No Dental Not listed Vision Child

Issuer actuarial value: 100.00%. Expect to pay roughly 0.00% of covered costs out of pocket, based on issuer reporting.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$304 – $1463

Before subsidies

Estimate after subsidies

Deductible

$0

$0 per group

See deductible details

Max out-of-pocket

$0

$0 per group

Review MOOP rules

Office visits

Primary care No Charge
Specialist No Charge
HSA Not eligible

Drug tiers

Generic No Charge
Preferred brand No Charge

View formulary tiers

$431 / mo before subsidies

≈ $5168 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1411 / mo before subsidies

≈ $16929 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1726 / mo before subsidies

≈ $20710 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$1069 / mo before subsidies

≈ $12827 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

No Charge

Durable Medical Equipment

No Charge

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Indiana). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Zero Cost Sharing Plan Variation plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

No Charge

Durable Medical Equipment

No Charge

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 96992IN0060004
Coverage year 2025
State Indiana
Issuer Aetna Health Inc. (a PA corp.)
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 96992IN0060004-02
Available variants

Standard Off Exchange Plan · 96992IN0060004-00

Standard On Exchange Plan · 96992IN0060004-01

Open to Indians below 300% FPL · 96992IN0060004-02

Open to Indians above 300% FPL · 96992IN0060004-03

Last plan update Thu, 26 Sep 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Indiana 10727
PCPs in Indiana 985
Telehealth support Data pending
Nationwide providers 12391
10,727 doctors statewide 985 PCPs 52 OB/GYN
Providers Indiana All US states
All 10727 12391
PCP 985 1029
Allergy 3 4
OB/GYN 52 69
Dentists 1034 1181

Drug coverage overview

3,368 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-GENERIC-NON-PREFERRED-BRAND 2,427
ZERO-COST-SHARE-PREVENTIVE-DRUGS 438
NON-PREFERRED-BRAND-SPECIALTY-DRUGS 274
PREFERRED-BRAND 229
Prior authorization Drugs
Required 618
Not Required 2,750
Step therapy Drugs
Required 195
Not Required 3,173
Quantity limits Drugs
Has Limit 1,003
No Limit 2,365

Customer highlights

What stands out for members

  • Issuer: Aetna Health Inc. (a PA corp.) · Plan ID 96992IN0060004 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 96992IN0060004-02 (Open to Indians below 300% FPL) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

No Charge

Diabetes Education

No Charge

Home Health Care Services

No Charge

Laboratory Outpatient and Professional Services

No Charge

Other Practitioner Office Visit (Nurse, Physician Assistant)

No Charge

Preventive Care/Screening/Immunization

No Charge

Primary Care Visit to Treat an Injury or Illness

No Charge

Rehabilitative Occupational and Rehabilitative Physical Therapy

No Charge

Rehabilitative Speech Therapy

No Charge

Specialist Visit

No Charge

Urgent Care Centers or Facilities

No Charge

X-rays and Diagnostic Imaging

No Charge

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

No Charge

Delivery and All Inpatient Services for Maternity Care

No Charge

Dialysis

No Charge

Durable Medical Equipment

No Charge

Emergency Room Services

No Charge

Emergency Transportation/Ambulance

No Charge

Hospice Services

No Charge

Inpatient Hospital Services (e.g., Hospital Stay)

No Charge

Inpatient Physician and Surgical Services

No Charge

Mental/Behavioral Health Inpatient Services

No Charge

Mental/Behavioral Health Outpatient Services

No Charge

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

No Charge

Outpatient Rehabilitation Services

No Charge

Outpatient Surgery Physician/Surgical Services

No Charge

Radiation

No Charge, No Charge

Skilled Nursing Facility

No Charge

Substance Abuse Disorder Inpatient Services

No Charge

Substance Abuse Disorder Outpatient Services

No Charge

Transplant

No Charge

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

Hearing Aids

Coverage details pending

Major Dental Care - Child

Coverage details pending

Prenatal and Postnatal Care

No Charge

Routine Eye Exam for Children

No Charge

Well Baby Visits and Care

No Charge

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

No Charge

Non-Preferred Brand Drugs

No Charge

Preferred Brand Drugs

No Charge

Specialty Drugs

No Charge

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

No Charge

Basic Dental Care - Adult

Coverage details pending

Dental Check-Up for Children

Coverage details pending

Infusion Therapy

No Charge

Major Dental Care - Adult

Coverage details pending

Nutritional Counseling

No Charge

Orthodontia - Adult

Coverage details pending

Orthodontia - Child

Coverage details pending

Prosthetic Devices

No Charge

Routine Dental Services (Adult)

Coverage details pending

Weight Loss Programs

Coverage details pending

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

Acupuncture

Coverage details pending

Allergy Testing

No Charge

Bariatric Surgery

Coverage details pending

Cosmetic Surgery

Coverage details pending

Eye Glasses for Children

No Charge

Gender Affirming Care

Coverage details pending

Habilitation Services

No Charge

Imaging (CT/PET Scans, MRIs)

No Charge

Infertility Treatment

Coverage details pending

Long-Term/Custodial Nursing Home Care

Coverage details pending

Private-Duty Nursing

No Charge

Reconstructive Surgery

No Charge

Routine Eye Exam (Adult)

Coverage details pending

Routine Foot Care

Coverage details pending

Treatment for Temporomandibular Joint Disorders

No Charge

Variant attributes

Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 · Variant 96992IN0060004-02

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Zero Cost Sharing Plan Variation

HIOS Product ID

96992IN006

Metal Level

Gold

Plan ID (Standard Component ID with Variant)

96992IN0060004-02

Plan Marketing Name

Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Plan Variant Marketing Name

Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

100.00%

Issuer ID

96992

Issuer Marketplace Marketing Name

Aetna CVS Health

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

INN001

Out of Country Coverage

No

Out of Service Area Coverage

No

Out of Service Area Coverage Description

Except for Emergencies

Service Area ID

INS001

State Code

IN

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$0

SBC Scenario, Having a Baby, Copayment

$0

SBC Scenario, Having a Baby, Deductible

$0

SBC Scenario, Having Diabetes, Coinsurance

$0

SBC Scenario, Having Diabetes, Copayment

$0

SBC Scenario, Having Diabetes, Deductible

$0

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$0

SBC Scenario, Treatment of a Simple Fracture, Deductible

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

0.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$0 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$0 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$0

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

INF002

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-09-26 03:01:39

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

No

Plan Effective Date

2025-01-01

Plan Type

HMO

QHP/Non QHP

Both

Source Name

HIOS

Plan ID

96992IN0060004

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

$0

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$0 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$0 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$0

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

Yes

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Indiana?

Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 (96992IN0060004) is a Gold HMO from Aetna Health Inc. (a PA corp.) in Indiana for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy.

Is there out-of-country coverage for Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7?

No, out-of-country services are not covered for this plan.

Does Gold 3 Advanced: Aetna network + $0 MinuteClinic + $0 CVS Health Virtual Care 24/7 cover care outside the service area?

No, the issuer indicates out-of-service-area care is not covered except for emergencies. Details: Except for Emergencies

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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